Investigator Sr. - #122287 (Any Anthem location or telecommute)

Anthem, Inc
Oct 09, 2016
Oct 19, 2016
Employer Type
Direct Employer
Employment Type
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.

*The Investigator Sr.*will be 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.
* Ensures investigations are managed and documented in an audit ready and compliant manner.
* 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. Previous law enforcement experience preferred. RN, CPA, or JD certification preferred. Experience with FBI or District Attorney's Office preferred.

Experience in handling health care fraud investigations preferred.

Medicaid/Medicare experience is preferred.

*Please note, we currently have one opening for this position. This position may be located in any Anthem location or telecommute available.*

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/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 please visit us at EOE. M/F/Disability/Veteran./

**Job** *Fraud*

**Title:** *Investigator Sr. - #122287 (Any Anthem location or telecommute)*

**Location:** *CT-Wallingford*

**Requisition ID:** *122287* 157a1fe69af74b7ca37aec5918bc6eb3

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