Job Overview Anticipated End Date: 2026-06-26Position Title: Investigator IIHybrid 1: This role requires associates to be in-office 1‑2 days per week, fostering collaboration and connectivity while providing flexibility to support productivity and work‑life balance. Alternate locations may be considered if candidates reside within a commuting distance from an office. Per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting locations will not be considered for employment, unless accommodation is granted as required by law.Hours: Monday – Friday 8:00AM – 5:00PM ESTResponsibilities Identify, investigate, and develop cases against perpetrators of healthcare fraud to recover corporate and client funds paid on fraudulent claims.Conduct claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims.Identify and develop enterprise‑wide investigations that may impact more than one company health plan, line of business and/or state.Establish rapport and ongoing working relationships with law enforcement.Interface internally with senior‑level management and legal department throughout the investigative process.Assist in the training of internal and external entities.Assist in the development of policy and/or procedures to prevent loss of company assets.Qualifications BA/BS degree and a minimum of three years related experience; or any combination of education and experience that provides an equivalent background.Preferred Skills and Experience Fraud certification from CFE, AHFI, AAPC or coding certificates preferred.Knowledge of plan policies and procedures in all facets of benefit programs management, with heavy emphasis on negotiation.Health insurance or law enforcement experience preferred.Hybrid Work Requirements Location: Columbus, OH. In‑person or virtual work is permitted; however, associates are required to work onsite at least one day per week. Alternate locations may be considered if within a reasonable commuting distance.Compensation and Benefits Salary Range: $71,200 to $106,800.Comprehensive benefits package, including medical, dental, vision, short and long‑term disability.401(k) with company match, equity stock purchase plan, and life insurance.Paid holidays, paid time off, and incentive bonus programs.Wellness programs and financial education resources.Equal Employment Opportunity Statement Elevance Health is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable federal, state, or local laws.#J-18808-Ljbffr
