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Special Investigation Unit Investigator

Company: Centene Coproration
Location: Chesterfield
Posted on: September 20, 2019

Job Description:

Description: 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

Keywords: Centene Coproration, Saint Peters , Special Investigation Unit Investigator, Other , Chesterfield, Missouri

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