Investigator Sr - #122171 (Any Anthem location or telecommute) Preferr

Recruiter
Anthem, Inc
Location
Wallingford
Salary
Competitive
Posted
Oct 07, 2016
Closes
Oct 19, 2016
Role
Security
Industry
Education
Employer Type
Direct Employer
Employment Type
Permanent
Hours
Full Time
/ Your Talent. Our Vision. / At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care .

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

Responsible for investigating, collecting, researching and analyzing billing data in order to detect fraudulent, abusive or wasteful activities/practices. Primary duties may include, but are not limited to: Using appropriate system tools, analyzes data to detect fraudulent, abusive or wasteful payments to providers and subscribers. Prepares statistical/financial analyses and reports to document findings and maintains up-to-date case files for management review. Prepare final report and notification of findings letter suitable for dissemination to provider and counsel. Presents providers offers for settlement to supervisor and legal for approval. Communicates orally and in writing with all customers, internal and external, regarding findings. Assists in the development of policy and/or procedures to prevent loss of company assets. Prepares and delivers training to internal and external entities. Develops and maintains a high degree of rapport and cooperation with the Federal, State and local law enforcement and regulatory agencies which can assist in investigative efforts. Represents the Company in court proceedings regarding research findings. Provides technical support and guidance to lower-leveled associates. Assists with special projects, systems implementations and updates. Requires BA/BS, 3-5 years experience in healthcare, white collar crime investigation or related area; or any combination of education and experience, which would provide an equivalent background. Professional certification of CFE, AHFI or other job related designation preferred.
EOE.M/F/Disability/Veteran


Requires BA/BS, 3-5 years experience in healthcare, white collar crime investigation or related area; or any combination of education and experience, which would provide an equivalent background. Professional certification of CFE, AHFI or other job related designation preferred.



Strong Analytical skills required. BA preferred.



Work experience investigating, collecting, researching and analyzing billing data in order to detect fraudulent, abusive or wasteful activities/practices in a law enforcement or medical environment highly preferred.





*/This position may be located in any Anthem location and telecommute is available. However, preferred location is within the State of Texas/*







/ Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran. /


**Job** *Fraud*

**Title:** *Investigator Sr - #122171 (Any Anthem location or telecommute) Preferred: TX location*

**Location:** *CT-Wallingford*

**Requisition ID:** *122171* 22a4ea24792a402daea6e0df91818ccc

Company Description:

We recently changed our name from WellPoint to Anthem, Inc., the name people know us by best. As our companies continue to take a more active role in helping people access the right health care and programs, going by a name that people know and trust is important.

Anthem, Inc. is one of the nation's leading health benefits insurer and a Fortune Top 50 company. At Anthem, Inc., we are working to transform health care with trusted and caring solutions and meaningfully advance affordability and better health outcomes for our health plan members. Nearly 69 million people are served by our affiliated companies including more than 37 million enrolled in our family of health plans.

  • One in nine Americans receives coverage for their medical care through Anthem's affiliated plans.
  • We offer a broad range of medical and specialty products.

Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to help drive the future of health care.

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our co