Top 577 Health Net Jobs

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 —Ohio
- $56,200 - $101,000 a year
- Full-time
- Remote
- Mid-level
- Fair chance
- Associate's degree
- Paid holidays
- Health insurance
Remote Medical Director, Appeals
Centene —Washington, DC
- $236,500 - $449,300 a year
- Weekends as needed
- Remote
- Medicine
- Fair chance
- Senior level
- Paid holidays
- Health insurance
Associate Actuary
Centene —New York, NY
- $87,700 - $157,800 a year
- Full-time
- Remote
- Research
- Mid-level
- Analysis skills
- 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
11d
SIU Investigator
Centene —California
- $56,200 - $101,000 a year
- Full-time
- Remote
- Mid-level
- Analysis skills
- Fair chance
- Paid holidays
- Health insurance
Actuary
Centene —New York, NY
- $107,700 - $199,300 a year
- Full-time
- Remote
- Microsoft Excel
- 5 years
- SQL
- Paid holidays
- Health insurance
Chief Medical Officer
Fidelis Care —New York, NY
- $276,400 - $525,800 a year
- Full-time
- Remote
- Medicine
- 7 years
- BC/BE
- Paid holidays
- Health insurance
Senior Actuarial Analyst
Centene —New York, NY
- $70,100 - $126,200 a year
- Full-time
- Remote
- Mid-level
- SQL
- Math
- Paid holidays
- Health insurance
12d
Manager, Sales Investigations
Centene —Georgia
- $87,700 - $157,800 a year
- Full-time
- Remote
- High school diploma or GED
- Fair chance
- 1 year
- Paid holidays
- Health insurance
Senior Director, Clinical Data Science
Centene —New York, NY
- $185,700 - $352,500 a year
- Full-time
- Remote
- Computer Science
- Master's degree
- SQL
- Paid holidays
- Health insurance
Senior Care Manager (RN)
Meridian Michigan —Macomb, MI
- $75,300 - $135,400 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
13d
Manager, Actuarial Services
Centene —Washington, DC
- $134,600 - $249,000 a year
- Full-time
- Remote
- 5 years
- Research
- SQL
- Paid holidays
- Health insurance
11d
Corporate Ethics & Compliance Investigator
Centene —Pennsylvania
- $107,700 - $199,300 a year
- Full-time
- Remote
- 7 years
- Management
- HIPAA
- Paid holidays
- Health insurance
Supervisory Medical Director, National Physical Health Appeals Outpatient UM
Centene —New York, NY
- $236,500 - $449,300 a year
- Full-time
- Remote
- Medicine
- 5 years
- Fair chance
- Paid holidays
- Health insurance
Vice President, Clinical Technology UM Portfolio Management
Centene —Missouri
- $188,900 - $359,800 a year
- Full-time
- Remote
- 8 years
- Bachelor's degree
- Product management
- Paid holidays
- Health insurance
Associate Actuary, Strategic Analytics
Centene —New York, NY
- $87,700 - $157,800 a year
- Full-time
- Remote
- Mid-level
- SQL
- Math
- Paid holidays
- Health insurance
RN Supervisor, Appeals, Managed Care, UM
Centene —Washington, DC
- $75,300 - $135,400 a year
- Full-time
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
7d
Psychologist Reviewer
Centene —California
- $87,700 - $157,800 a year
- Full-time
- Remote
- Addiction Medicine
- Mid-level
- Outpatient experience
- Paid holidays
- Health insurance
13d
Remote Behavioral Medical Director, Central Region
Centene —Texas
- $236,500 - $449,300 a year
- Weekends as needed
- Remote
- Medicine
- Psychiatry
- Neurology
- Paid holidays
- Health insurance
7d

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SIU Investigator

Centene -
New York, NY

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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
5 years
Bachelor's degree in business
Forensic audits
Suspicious activity investigations
Data summary reports
Criminal Justice
Investigative data analysis
Insurance investigation report preparation
Outlier detection
Healthcare billing investigations
Case referral
Insurance claims auditing
Senior level
Business
Healthcare claims compliance audits
Bachelor's degree in criminal justice
Law enforcement

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: this is a remote role with high preference on candidates residing within New York.

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 Business, Criminal Justice, Healthcare, or related field, or equivalent experience required. 1+ years Medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation required. Minimum of five (5) years in healthcare field working in fraud, waste and abuse investigations and audits, (or) five years of insurance claims investigation experience or professional investigation experience with law enforcement agencies, (or) seven years of professional investigation experience involving economic or insurance related matters.

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

Remote Medical Director, Appeals

Associate Actuary

Plan President & CEO - Health Net of California

SIU Investigator

Actuary

Chief Medical Officer

Senior Actuarial Analyst

Manager, Sales Investigations

Senior Director, Clinical Data Science

Senior Care Manager (RN)

Manager, Actuarial Services

Corporate Ethics & Compliance Investigator

Supervisory Medical Director, National Physical Health Appeals Outpatient UM

Vice President, Clinical Technology UM Portfolio Management

Associate Actuary, Strategic Analytics

RN Supervisor, Appeals, Managed Care, UM

Psychologist Reviewer

Remote Behavioral Medical Director, Central Region

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