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Investigator I

Company: Anthem, Inc
Location: Reston
Posted on: May 3, 2021

Job Description:

Description SHIFT: Day Job SCHEDULE: Full-time Investigator I This position can sit remotely. Responsible for investigating assigned cases, collecting, researching and analyzing claim data in order to detect fraudulent, abusive or wasteful activities/practices. Primary duties may include, but are not limited to: + Using appropriate system tools and databases for analysis of data and review of professional and facility claims to detect fraudulent, abusive or wasteful healthcare insurance payments to providers and subscribers. + Preparation of statistical/financial analyses and reports to document findings and maintain up-to-date electronic case files for management review. + Preparation of final case reports and notification of findings letters to providers. + Receive offers of settlement for review and discussion with management. + Communication skills, both oral and written required for contact with all customers, internal and external, regarding findings. Qualifications + Requires BA/BS, 2+ years related experience preferably in healthcare insurance departments such as Grievance and Appeals, Contracting or Claim Operations, law enforcement; or any combination of education and experience, which would provide an equivalent background. + Proficient in Microsoft Excel. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at . An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions. REQNUMBER: PS48814-Virginia

Keywords: Anthem, Inc, Reston , Investigator I, Other , Reston, Virginia

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