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Special Investigation Unit Investigator

Chesterfield, Missouri Apply Now Job ID 1126170 Category Compliance Organization Centene Corporation Schedule Full-time
Description:
Position Purpose: Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse.

  • Conduct investigations of potential waste, abuse, and fraud
  • Document activity on each case and refer issues to the appropriate party
  • Perform data mining and analysis to detect aberrancies and outliers in claims
  • Develop new queries and reports to detect potential waste, abuse, and fraud
  • Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions
  • Assist with complex allegations of healthcare fraud
  • Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies
  • Complete various special projects and audits
  • Qualifications:

    Education/Experience: Bachelor’s Degree in Business, Criminal Justice, Healthcare, related field or equivalent experience. 1+ years of medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation experience. Knowledge of Microsoft Applications, medical coding and terminology preferred.

    Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
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