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. Perform other duties as assigned. Comply with all policies and standards. Qualifications Education: Bachelor's Degree in Business, Criminal Justice, Healthcare, or related field, or equivalent experience. Experience: 1+ years of medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation. Pay Range $56,200.00 - $101,000.00 per year. Benefits Competitive pay Health insurance 401(k) and stock purchase plans Tuition reimbursement Paid time off plus holidays Flexible approach to work with remote, hybrid, field, or office schedules Additional incentives based on position and performance EEO Statement 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 any other characteristic protected under applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act. #J-18808-Ljbffr
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