Centene Corporation · 12 hours ago
Senior SIU Investigator
United States
Full-time
Remote
Mid, Senior Level
$70K/yr - $126K/yr
3+ years expCentene Corporation is transforming the health of our communities, and they are seeking a Senior SIU Investigator to investigate allegations of healthcare fraud and abuse activity. The role involves planning, organizing, and executing special claims investigations, as well as monitoring business processes to ensure integrity and compliance in billing and claims payment.
Hospital & Health Care
Responsibilities
Assist in monitoring business processes and systems to assure integrity and compliance in billing and claims payment
Investigate possible waste , abuse and fraud leads and document activity on each lead and refer issues to the appropriate party
Develop internal reports to identify potential waste, abuse and fraud
Perform data mining and analysis to detect aberrancies and outliers in claims
Serve as point of contact for corporate and field inquiries regarding waste, abuse and fraud
Review post-payment cases with appropriate parties to obtain refund
Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions
Prepare summary and detailed reports on investigative findings for referral to Federal and State agencies
Arrange, conduct, and attend meetings with providers, business partners, and representatives from regulatory agencies and law enforcement regarding investigations
Qualification
Required
Bachelor's Degree in Business, Criminal Justice, Healthcare, related field or equivalent experience
3+ years of medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation experience
Knowledge of Microsoft Applications
Knowledge of medical coding
Knowledge of claims processing
Knowledge of data mining
Preferred
Certified Professional Coder
Benefits
Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Company
Centene Corporation
Centene Corporation is a leading healthcare enterprise committed to helping people live healthier lives.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Beth Johnson
President and CEO, Coordinated Care
Clyde White
President & CEO (New Hampshire Healthy Families)
Recent News
Business Journals
2024-05-06
FierceHealthcare
2024-04-28
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