Top 561 Health Net Jobs

SIU Investigator
Centene —Indiana
- $56,200 - $101,000 a year
- Full-time
- Remote
- Mid-level
- Fair chance
- Associate's degree
- Paid holidays
- Health insurance
Utilization Review Clinician - Behavioral Health
Centene —Oregon
- $27.02 - $48.55 an hour
- Weekends as needed
- Remote
- LMFT
- Nursing
- Addiction Medicine
- Paid holidays
- Health insurance
4d
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 —California
- $56,200 - $101,000 a year
- Full-time
- Remote
- Mid-level
- Analysis skills
- Fair chance
- 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
8d
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
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
9d
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
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
RN Supervisor, Appeals, Managed Care, UM
Centene —Pennsylvania
- $75,300 - $135,400 a year
- Full-time
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
3d
Utilization Review Clinician - ABA
Centene —Delaware
- $27.02 - $48.55 an hour
- Full-time
- Remote
- LMFT
- Nursing
- RN License
- Paid holidays
- Health insurance
1d
Quality Trainer I
Centene —Florida
- $56,200 - $101,000 a year
- Full-time
- Remote
- Research
- Mid-level
- Bachelor's degree
- Paid holidays
- Health insurance
7d
Care Manager (RN)
Centene Corporation —Michigan
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
9d
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
10d
Psychologist Reviewer
Centene —Kentucky
- $87,700 - $157,800 a year
- Full-time
- Remote
- Addiction Medicine
- Mid-level
- Outpatient experience
- Paid holidays
- Health insurance
9d
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
Supervisor, Utilization Management (RN)
Centene —Missouri
- $75,300 - $135,400 a year
- Full-time
- Nursing
- RN License
- Mid-level
- 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
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
Director, Vendor Management
Sunshine State Health Plan —Florida
- $148,000 - $274,200 a year
- Full-time
- Remote
- 7 years
- Microsoft Office
- Bachelor's degree
- Paid holidays
- Health insurance
4d

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SIU Investigator

Centene -
Indiana

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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
Health data analysis
Suspicious activity investigations
Investigative data analysis
Healthcare billing investigations
Insurance claims auditing
Healthcare claims compliance audits
Healthcare coding investigations

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 preference on candidates residing within Ohio.

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, or an Associate's degree with an additional 2 years working on health care fraud, waste, and abuse investigations and audits in lieu of a Bachelors is required.
A minimum of 2 years in a health care field working on fraud, waste, and abuse investigations and audits required.
The ability to understand and analyze health care claims and coding 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

Utilization Review Clinician - Behavioral Health

SIU Investigator

SIU Investigator

Plan President & CEO - Health Net of California

Senior Compliance Investigator

Senior Care Manager (RN)

Corporate Ethics & Compliance Investigator

Senior Compliance Corrections Specialist

RN Supervisor, Appeals, Managed Care, UM

Utilization Review Clinician - ABA

Quality Trainer I

Care Manager (RN)

Inpatient Utilization Review Clinician, Behavioral Health

Psychologist Reviewer

Manager, Sales Investigations

Supervisor, Utilization Management (RN)

Senior Communications Specialist

Senior Manager, Enterprise Compliance Corrections

Director, Vendor Management

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