SIU Investigator Job at Centene, Sylmar, CA

VUF0YllVajcwMEpMV0VQNEtYR0g1VDJaMnc9PQ==
  • Centene
  • Sylmar, CA

Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

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
  • Perform data mining and analysis to detect aberrancies and outliers in claims
  • Develop new queries and reports to detect potential waste, abuse, and fraud
  • Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions
  • Assist with complex 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 all policies and standards

Education/Experience: Bachelor’s Degree in Business, Criminal Justice, Healthcare, related field or equivalent experience. 1+ years of medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation experience.

Pay Range: $55,100.00 - $99,000.00 per year

Centene offers a comprehensive benefits package including: competitive pay, 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-related 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. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.


Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Job Tags

Full time, Part time, Work at office, Remote work, Flexible hours,

Similar Jobs

Federal Express Corporation

Seasonal Package Handler - Part Time (Warehouse like) Job at Federal Express Corporation

 ...why pay for a gym membership when you can get paid while working out? Warehouse duties include loading, unloading, and sorting of packages of various sizes. Part time Federal Express Corporation (FEC) employees work one shift a day; full time Federal Express Corporation... 

Britt Medical Search LLC Defunct

Orthopedics - Hand Surgery Physician Job at Britt Medical Search LLC Defunct

 ...Seeking a full-time Board-Certified Orthopedic Surgeon with interests in Hand & Upper Extremities to join our well-established department in the Chicago area. Our expert team of orthopedic surgeons offers a comprehensive orthopedic program specializing in the prevention... 

UFP Industries

Receiving Forklift Driver Job at UFP Industries

 ...Forklift Operator I Forklift Operator I is responsible for the movement of material from inventory to production and back to inventory...  ...diploma or GED preferred but not required No minimum experience is required however, forklift driving experience is preferred... 

Vector Marketing

Sales Representative - Part Time - Work from Home Job at Vector Marketing

 ...of our sales reps start with very little work or sales experience. We get new reps up to...  ...sell Cutco products that are used in the home focusing on the kitchen and some...  ...What makes a good candidate: This entry level position is a good fit for people who are... 

Wellstar Health Systems, Inc.

Certified Surgical Tech- Operating Room(OR) - Fulltime Day Job at Wellstar Health Systems, Inc.

 ...industry, and in people's lives. Work Shift Day (United States of America) Job Summary: Fulltime Certified Surgical Tech Inpatient OR experience strongly preferred Certified Surg Tech required- Ortho a plus must be willing to take call as...