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Posted: Thursday, February 1, 2018 11:36 AM

*Anthem* is one of the nation's leading health benefits companies and a Fortune Top 50 company. At Anthem, we are working together to transform health care with trusted and caring solutions.
Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people s lives, and to take your career further than you can imagine.
*Investigator I or II *
*Location Preferred: Tennessee *
The Investigator I or II is 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.
* Claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional
* Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company health plan, line of business and/or state.
* Must be able to effectively establish rapport and on-going working relationship with law enforcement.
* May interface internally with Senior level management and legal department throughout investigative process.
* May assist in training of internal and external entities.
* Assists in the development of policy and/or procedures to prevent loss of company assets.
*_Investigator I_*
* 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.
*_Investigator II_*
* Requires BA/BS degree, 3 years related experience; or any combination of education and experience, which would provide an equivalent background.
* Fraud certification from CFE, AHFI, AAPC or coding certificates preferred.
* Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.
*/ Anthem is ranked as one of America s Most Admired Companies among health insurers by Fortune magazine, and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at/**/**/. EOE.M/F/Disability/Veteran.__/*
**Job** *Fraud*
Equal Employment Opportunity Statement
Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.
**Title:** *Investigator I or II (#139848)*
**Location:** *virginia-Chesapeake*
**Requisition ID:** *139848*
Associated topics: crime scene, detective, fingerprint, inspector, investigate, investigation, investigative, investigator


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