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beBee Handyman St. Louis, OK, United States FreelanceGreetings and schedule entries, as it is only for 4 hours and works more than 8 in St. Louis, OK. · And for custody, I need to prove that the mother has a schedule, which is not true.What type of case needs to be investigated? · Work schedules, · Will the investigation be used in ...
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beBee Handyman Clayton, MO, United States Freelance"I am suffering from neighborhood harassment with constant insults and surveillance from multiple neighbors, which has affected my physical and moral integrity. I have been dealing with this issue for almost two years.What type of case needs to be investigated? · Neighborhood har ...
Investigator II - St Louis, United States - Elevance Health
Description
Investigator IILocation
:
This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.
The
INVESTIGATOR II
is responsible for the identification, investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on fraudulent claims.
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 and pharmacy claims.
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.
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.
Minimum Requirements:
Requires a BA/BS and minimum of 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.
Health insurance, law enforcement experience preferred.
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