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Investigator I

Company: Anthem, Inc
Location: Lexington
Posted on: May 16, 2022

Job Description:

Description SHIFT: Day JobSCHEDULE: Full-time Location - Remote Be part of an extraordinary team. We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving high-performance culture that empowers you to make an impact? Responsible for investigating assigned cases, collecting, researching and analyzing claim data in order to detect fraudulent, abusive or wasteful activities/practices. Essential Duties and Responsibilities 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 + BA/BS and minimum of 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 may be accepted. Preferred Qualifications: + Familiarity with Medical Terminology + Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation. + Health insurance, law enforcement experience. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance. REQNUMBER: PS70653-Kentucky

Keywords: Anthem, Inc, Lexington , Investigator I, Other , Lexington, Kentucky

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