SIU Investigator

Related keywords: remote job in californiaremote job californiaremote job in healthcare

Overview

Centene Corporation is seeking an SIU Investigator who is dedicated to investigating allegations of potential healthcare fraud and abuse. This position plays a crucial role in ensuring the integrity of health services and protecting the interests of over 28 million members across the organization. The job requires attention to detail and a commitment to overcoming fraud challenges in the healthcare system.

Job Responsibilities

In this role, you will:

• Investigate allegations of healthcare fraud and abuse activities that threaten the company's missions and values.

• Assist in planning, organizing, and executing investigations or audits that identify and evaluate potential healthcare fraud and abuse issues.

• Conduct thorough investigations of claims, documenting activities meticulously to ensure that issues are referred to the appropriate parties in a timely manner.

• Perform data mining and analysis to detect aberrancies and identify potential fraud or waste within claims.

• Develop innovative queries and reports aimed at uncovering fraudulent activities in claims processing.

• Provide consistent updates on case progress and coordinate with various Health Plans regarding recommendations and further actions.

• Assist with complex allegations and prepare detailed reports on your investigative findings for referral to Federal and State agencies, ensuring all activities comply with established policies and standards.

• Engage in various special projects and audits as needed, supporting the broader objectives of Centene Corporation.

Required Skills

To be considered for this position, candidates must possess:

• A Bachelor's Degree in Business, Criminal Justice, Healthcare, or a related field, or an equivalent combination of education and experience.

• A minimum of 1 year of experience in medical claim investigation, audit, analysis, or fraud investigation. Prior familiarity with healthcare systems and claims processing will be advantageous.

• Strong analytical skills and the ability to interpret complex data to identify suspicious patterns.

  

• Effective communication skills both verbal and written to articulate findings clearly and conduct interviews when necessary.

• Proficiency in using various investigation tools and software to support fraud detection efforts.

Salary and Benefits

The salary for the SIU Investigator position ranges from $56,200.00 to $101,000.00 per year, depending on factors such as experience, skills, education, and individual circumstances.

Centene also provides an extensive benefits package which includes:

• Competitive pay

• Health insurance coverage

• 401K and stock purchase plans

• Tuition reimbursement for continuous learning

• Paid time off alongside standard holidays

• Flexible work options including remote, hybrid, field, and office schedules.

These benefits ensure that employees can achieve a balance between work and personal goals.

Other Considerations

It’s important to note that this position is primarily remote but mandates residency in Louisiana. This requirement can limit the pool of potential candidates but is critical for compliance with regional regulations.

As an equal opportunity employer, Centene Corporation champions diversity and inclusion in the workplace. They ensure that all qualified applicants receive fair consideration for employment irrespective of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristics that may require protection under relevant laws. Qualified candidates with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.

Overall, this is an excellent opportunity for those interested in a career in fraud investigation within the healthcare industry. Individuals looking for a dynamic work environment, where they can make a significant impact on healthcare integrity and service delivery, will find Centene Corporation a suitable employer.

This job offer was originally published on himalayas.app