Special Investigation Unit Investigator at Centene Corporation: 100% Remote (FL)

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SIU Investigator

locations Remote-FL

time type Full time

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.

Please note: candidates who reside in Florida are highly preferred.

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 Business, Criminal Justice, Healthcare, or related field, or equivalent experience required
  • 1+ years Medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation required

Pay Range: $56,200.00 - $101,000.00 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.

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