Top 569 Health Net Jobs

SIU Investigator
Centene —California
- $56,200 - $101,000 a year
- Full-time
- Remote
- Mid-level
- Analysis skills
- Fair chance
- Paid holidays
- Health insurance
SIU Investigator
Centene —New York, NY
- $56,200 - $101,000 a year
- Full-time
- Remote
- 5 years
- Fair chance
- Senior level
- Paid holidays
- Health insurance
SIU Investigator
Centene —Indiana
- $56,200 - $101,000 a year
- Full-time
- Remote
- Mid-level
- Fair chance
- Associate's degree
- Paid holidays
- Health insurance
Senior Compliance Investigator
Centene —New York, NY
- $70,100 - $126,200 a year
- Full-time
- Remote
- Writing skills
- High school diploma or GED
- Fair chance
- Paid holidays
- Health insurance
Utilization Review Clinician - Behavioral Health
Centene —Oklahoma
- $27.02 - $48.55 an hour
- Full-time
- Remote
- LMFT
- Nursing
- Addiction Medicine
- Paid holidays
- Health insurance
8d
Corporate Ethics & Compliance Investigator
Centene —New York, NY
- $107,700 - $199,300 a year
- Full-time
- Remote
- 7 years
- Management
- HIPAA
- Paid holidays
- Health insurance
Plan President & CEO - Health Net of California
Centene —Woodland Hills, CA
- $390,000 - $740,000 a year
- Full-time
- 5 years
- Master's degree
- Bachelor's degree
- Paid holidays
- Health insurance
6d
Senior Care Manager (RN)
Meridian Michigan —Michigan
- $75,300 - $135,400 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
8d
Care Manager (RN)
Centene Corporation —Michigan
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
7d
Inpatient Utilization Review Clinician, Behavioral Health
Centene —Louisiana
- $27.02 - $48.55 an hour
- Full-time
- Remote
- LMFT
- Nursing
- Addiction Medicine
- Paid holidays
- Health insurance
8d
Senior Compliance Corrections Specialist
Centene —Missouri
- $70,100 - $126,200 a year
- Full-time
- Remote
- 5 years
- Bachelor's degree
- Data entry
- Paid holidays
- Health insurance
Psychologist Reviewer
Centene —Louisiana
- $87,700 - $157,800 a year
- Full-time
- Remote
- Addiction Medicine
- Mid-level
- Outpatient experience
- Paid holidays
- Health insurance
7d
Supervisor, Utilization Management (RN)
Centene —Missouri
- $75,300 - $135,400 a year
- Full-time
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
Manager, Sales Investigations
Centene —New York, NY
- $87,700 - $157,800 a year
- Full-time
- Remote
- High school diploma or GED
- Fair chance
- 1 year
- Paid holidays
- Health insurance
Clinical Review Clinician - Appeals
Centene —Florida
- $27.02 - $48.55 an hour
- Full-time
- Remote
- LMFT
- Nursing
- LVN
- Paid holidays
- Health insurance
20h
Senior Manager, Enterprise Compliance Corrections
Centene —Missouri
- $87,700 - $157,800 a year
- Full-time
- Remote
- Master's degree
- Bachelor's degree
- Recruiting
- Paid holidays
- Health insurance
Senior Communications Specialist
Centene —Missouri
- $56,200 - $101,000 a year
- Full-time
- Remote
- Marketing
- Mid-level
- 3 years
- Paid holidays
- Health insurance
Supervisor, Appeals
Centene —Georgia
- $75,300 - $135,400 a year
- Full-time
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
1d
Actuary
Centene —California
- $107,700 - $199,300 a year
- Full-time
- Remote
- Microsoft Excel
- 5 years
- SQL
- Paid holidays
- Health insurance
Senior Manager, Payment Integrity - Vended Audit Programs
Centene —California
- $107,700 - $199,300 a year
- Full-time
- Remote
- 6 years
- Finance
- Bachelor's degree
- Paid holidays
- Health insurance

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SIU Investigator

Centene -
California

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Job Details

Full-time
$56,200 - $101,000 a year

Benefits

Paid holidays
Health insurance
401(k)
Tuition reimbursement
Paid time off

Qualifications

Healthcare financial misconduct investigations
Data mining
Health data analysis
Bachelor's degree in business
Mid-level
Suspicious activity investigations
Data summary reports
Criminal Justice
Audit Reporting
Investigative data analysis
Analysis skills
Insurance investigation report preparation
Outlier detection
Healthcare billing investigations
Case referral
1 year
Insurance claims auditing
Query management
Business
Healthcare claims compliance audits
Bachelor's degree in criminal justice

Full Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

*Please note: Candidates must reside within the state of California*

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
Performs other duties as assigned
Complies with all policies and standards

Education/Experience: Bachelor's Degree in Business, Criminal Justice, Healthcare, related field or equivalent experience required. 1+ years of medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation experience required.

Pay Range: $56,200.00 - $101,000.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Apply Now

Refine Your Search

Health Net jobs

SIU Investigator

SIU Investigator

SIU Investigator

Senior Compliance Investigator

Utilization Review Clinician - Behavioral Health

Corporate Ethics & Compliance Investigator

Plan President & CEO - Health Net of California

Senior Care Manager (RN)

Care Manager (RN)

Inpatient Utilization Review Clinician, Behavioral Health

Senior Compliance Corrections Specialist

Psychologist Reviewer

Supervisor, Utilization Management (RN)

Manager, Sales Investigations

Clinical Review Clinician - Appeals

Senior Manager, Enterprise Compliance Corrections

Senior Communications Specialist

Supervisor, Appeals

Actuary

Senior Manager, Payment Integrity - Vended Audit Programs

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