04 Jun
Investigator I-Commercial (PS365275)
New York, Brooklyn 00000 Brooklyn USA

Vacancy expired!

Description SHIFT: Day JobSCHEDULE: Full-timeInvestigator I (Commercial)This position can sit onsite in any Anthem office or remote. Responsible for investigating assigned cases, collecting, researching and analyzing claim data in order to detect fraudulent, abusive or wasteful activities/practices. Primary duties may include, but are not limited to:

Using appropriate system tools and databases for analysis of data and review of professional and facility claims to detect fraudulent, abusive or wasteful healthcare insurance payments to providers and subscribers.

Preparation of statistical/financial analyses and reports to document findings and maintain up-to-date electronic case files for management review.

Preparation of final case reports and notification of findings letters to providers.

Receive offers of settlement for review and discussion with management.

Communication skills, both oral and written required for contact with all customers, internal and external, regarding findings.

Qualifications Qualifications

Requires BA/BS, 2+ years related experience preferably in healthcare insurance departments such as Grievance and Appeals, Contracting or Claim Operations, law enforcement; or any combination of education and experience, which would provide an equivalent background

Investigations experience is an asset

Proficient in Microsoft Excel is required

Data mining experience

Commercial experience is an asset

AnEqualOpportunityEmployer/Disability/VeteranREQNUMBER: PS36275

Vacancy expired!


Related jobs

Report job