Anthem Blue Cross and Blue Shield is a proud member of the WellPoint family of companies. At Anthem, we are dedicated to improving the lives of the people we serve and the health of our communities. Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.
This position is to be on site with no opportunity to work remotely.
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.
JD or RN preferred
FBI or other law enforcement background preferred
Professional certification of CFE, AHFI or other job related designation preferred.
WellPoint is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2012 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at www.wellpoint.com/careers . EOE
Once an offer is accepted, all external applicants are subject to a background investigation
and if appropriate, drug testing. Offers of employment shall be contingent upon
passing both the background investigation and drug testing (if required).
*Current WellPoint associates: All referrals must be submitted through the formal
associate referral process on WorkNet. Official guidelines for the associate referral
program can be found in My HR.
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