Manager Investigations

Overview

Location: Atlanta GA, Richmond VA, Costa Mesa CA, Indianapolis IN

Hours: Standard Working hours

Travel: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Position Overview:

Responsible for directing all activities of the Fraud Investigations Unit responsible for overseeing assigned Medicaid markets.

• Supervises and coordinates the investigations of alleged Medicaid fraud
• Coordinates the analysis of provider utilization patterns and trends and of provider billing and financial data and supervises the case inventory to include monitoring of aging and priority
• Oversees the integration of various computer systems in the Unit, to include monitoring of aging and priority
• Coordinates the review of documentation to ensure validity and applicability of data, the preparation of written summaries of the investigations, and the development of cases to be referred to the Office of the Inspector General (OIG)
• Continually communicates with Medicaid state agencies CMS, OIG, and Department of Justice regarding current fraud trends, current case issues, and current analyses and training opportunities
• Keeps abreast of changes in Medicaid benefits, policies and regulations and in CMS performance standards and assists management in the interpretation of Medicaid policies and procedures
• Hires, trains, coaches, counsels, and evaluates performance of direct reports

Required Qualifications:

• Requires a BA/BS in business or nursing and minimum of 5 years in investigations; or any combination of education and experience, which would provide an equivalent background.
• The Government requires that personnel working on Medicaid Fraud investigations are U.S. Citizens.

Preferred Qualifications:

• Previous management experience is a must
• CFE, AHFI, CPC Certifications preferred
• Experience with Virginia and Arkansas Medicaid preferred

For candidates working in person or virtually in the below location(s), the salary
* range for this specific position is $93,200 to $160,770

Locations:
California

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations.
  
  No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring…