Anthem Investigator III / SR - #122474 (Any Anthem location - not telecommute) in Denison, Texas
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.
Responsible for the identification, investigation and development of complex cases against perpetrators of fraud in order to recover corporate and client funds paid on fraudulent claims, utilizing FBI and other law enforcement resources, and state of the art investigation techniques. Primary duties may include, but are not limited to: Responsible for enterprise-wide specific investigations that may impact more than one company health plan. Must be able to effectively establish rapport and on-going work relationship with FBI and District Attorney office. Will interface internally with Senior level management and legal department. Must have experience in complex, high dollar white collar and/or healthcare investigations required.
Requires BA/BS degree, 3-5 years related experience; or any combination of education and experience, which would provide an equivalent background. Prior experience working with FBI, HHS-OIG or Department of Justice, or prosecution experience preferred. Fraud certification from HIAA or NHCAA, JD or paralegal certification preferred. Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.
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. Professional certification of CFE, AHFI, Paralegal or other job related designation preferred.
Prior experience working with law enforcement on criminal health care investigations or civil health care cases preferred. Medical Coding experience is helpful. Proficiency in Excel and experience using Microsoft Word
Please note, we currently have one opening for this position and level will be determined by candidates' skills, experience and education.
This position may be located in any Anthem location; this is not a telecommute position and incumbent would be expected to commute daily to an Anthem location. This position does not offer relocation assistance.
Title: Investigator III / SR - #122474 (Any Anthem location - not telecommute)
Requisition ID: 122474