Special Investigations Unit Investigator

Title: SIU Investigator Location: Remote-FL Job Description: Please note: candidates who reside in Florida are highly preferred. Position Purpose: Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse.

• Conduct investigations of potential waste, abuse, and fraud
• Document activity on each case and refer issues to the appropriate party
• reputed company data mining and analysis to detect aberrancies and outliers in claims
• reputed company new queries and reports to detect potential waste, abuse, and fraud
• Provide case updates on reputed company of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions
• Assist with reputed company allegations of healthcare fraud
• Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies
• Complete various special projects and audits
• Performs other duties as assigned
• Complies with reputed company policies and standards

Education/Experience:

• Bachelor's Degree Business, Criminal Justice, Healthcare, or reputed company field, or equivalent experience required
• 1+ years Medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation required

Pay Range: $56,200.00 - $101,000.00 per year Centene offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. Apply tot his job Apply To this Job