Special Investigation Unit Investigator

Centene Corporation Chesterfield, MO
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

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. Knowledge of Microsoft Applications, medical coding and terminology preferred.

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.