Senior Special Investigation Unit Investigator

Centene

Job Details

Location: Charlotte, Mecklenburg County, North Carolina, USA Posted: Nov 08, 2019

Job Description

Position Purpose: Investigate allegations of healthcare fraud and abuse activity. Assist in planning, organizing, and executing special claims investigations or audits that identify, evaluate and measure potential healthcare fraud.

Assist in monitoring business processes and systems to assure integrity and compliance in billing and claims payment

Investigate possible waste , abuse and fraud leads and document activity on each lead and refer issues to the appropriate party

Develop internal reports to identify potential waste, abuse and fraud

Perform data mining and analysis to detect aberrancies and outliers in claims

Serve as point of contact for corporate and field inquiries regarding waste, abuse and fraud

Review post-payment cases with appropriate parties to obtain refund

Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions

Prepare summary and detailed reports on investigative findings for referral to Federal and State agencies

Arrange, conduct, and attend meetings with providers, business partners, and representatives from regulatory agencies and law enforcement regarding investigations

About Centene

Centene is a multi-line health care enterprise offering Medicaid managed care and specialty services.

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