Evernorth Health Services · 6 hours ago

Healthcare Fraud Investigator - EVERNORTH

United States

Full-time

Remote

Mid Level

$65K/yr - $108K/yr

3+ years exp

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Responsibilities

Analyze information gathered by investigation/audit and report findings and prepare written summary/recommendations.

Prepare evidence package for referral to third parties including contract holders, state insurance fraud bureaus and law enforcement agencies.

Lead on-site inspections and patient/provider interviews as necessary.

Respond to subpoenas and requests for information from law enforcement agencies and State Departments of Insurance. May represent company as a witness in judicial proceedings when appropriate.

Perform special projects requiring expertise in fraud detection, investigation, claim auditing and other areas related to Special Investigations.

Prepare reports to expedite tracking and reporting of investigations.

Qualification

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Health insurance investigationFraud detectionClaim auditingCriminal Justice degreeExcelAccessWordAHFI certificationCFE certification