Clinical Fraud Investigator II

Carelon Global Solutions India
Norfolk, GA
Category Consulting
Job Description
The Clinical Fraud Investigator II is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. Conducts data mining activities, performs comprehensive analysis and clinical evaluation of collected data, and recommends possible interventions for loss control and risk avoidance.

Requirements

  • Associate Degree in Nursing
  • Certified Professional Coder (AAPC or AHIMA)
  • Minimum of 4 years related experience
  • Minimum of 1 year experience in a Clinical Fraud and Abuse Investigation area

Benefits

  • Merit increases
  • Paid holidays
  • Paid Time Off
  • Incentive bonus programs
  • Medical, dental, vision, short and long term disability benefits
  • 401(k) + match
  • Stock purchase plan
  • Life insurance
  • Wellness programs and financial education resources
]]>