Investigator Senior supports the Payment Integrity line of business. This position works a hybrid model (remote and office) with alternate locations considered. The ideal candidate must live within 50 miles of MO, NC, and TX PulsePoint locations. Carelon Payment Integrity, part of Elevance Health, focuses on recovering, eliminating, and preventing unnecessary medical-expense spending. The Investigator Senior independently identifies, investigates, and develops complex cases against healthcare fraud perpetrators to recover corporate and client funds paid on fraudulent claims. Requires health insurance experience with understanding of policies, claims handling, and provider network contracting. Responsibilities include claim reviews for coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for facility, professional, and pharmacy claims. The role involves developing enterprise-wide healthcare investigations impacting multiple health plans, lines of business, or states, interfacing with senior management and legal departments, assisting in training, developing policies to prevent asset loss, representing the company in court, and maintaining cooperation with law enforcement and regulatory agencies. Minimum requirements include a BA/BS and at least 5 years of related experience in healthcare insurance, investigation, or law enforcement, or equivalent education and experience. Preferred qualifications include professional certifications such as CFE, AHFI, CPC, Paralegal, RN, JD, or related designations, and knowledge of plan policies and benefit program management with emphasis on negotiation.
By applying, you consent to your information being transmitted by Jooble to the Employer, as data controller, through the Employer’s data processor SonicJobs.
See Sonicjobs Privacy Policy at and Terms & Conditions at and SonicJobs Privacy Policy at and Terms of Use at
...Job Description: The Role We are seeking a Quantitative Crypto Analyst to join the Fidelity Digital Asset Management business and report directly to the Head of Investments. This team of multi-disciplinary research analysts will be focused on developing frameworks...
...Looking for an experienced SEO professional to join our growing team! What You'll Be Doing: * Managing and updating citations* Supporting new client SEO onboarding* Executing backlink outreach* Handling day-to-day SEO tasks* Admin work, reporting, and research...
...patients. Apply now! Education: Bachelor of Science Degree in physical therapy from an APTA approved program. Experience: One... ...: Possession of a current license to practice as a physical therapist in the State of Connecticut. General Summary of Duties:...
Overview: LINUX ADMINISTRATOR (RED HAT) (RDTE) Bowhead seeks a Linux Administrator (Red Hat) to join our team in Dahlgren, VA. The Linux Administrator (Red Hat) is responsible for system administration and customer support of servers and workstations in a Research...
...Voca Healthcare is seeking a travel nurse RN Endoscopy for a travel nursing job in Boise, Idaho. Job Description & Requirements ~ Specialty: Endoscopy ~ Discipline: RN ~ Start Date: 05/04/2025~ Duration: 13 weeks ~40 hours per week ~ Shift: 10 hours,...