Company Statement
Connecticare is a leading health plan in the state of Connecticut and a subsidiary of EmblemHealth, a health and wellness company that provides insurance plans, primary and specialty care, and wellness solutions. WellSpark is a digital wellness company and national subsidiary of EmblemHealth that offers a full suite of products and solutions to reward people for healthy behaviors.
Sr. Investigator
Summary of Position:
Conducts complex, in-depth investigations of reported fraud involving the full range of healthcare products. Provides guidance to the Fraud Investigators conducting anti-fraud training sessions and public speaking engagements.
Responsibilities:
- Investigates complex cases of reported fraud involving the Company’s full range of healthcare products. Develops leads from various sources to review for suspect activity. Reviews claim files and develop action plans for the investigation.
- Conducts highly comprehensive interviews/interrogations with providers. Performs various related duties as assigned, including but is not limited to conduct medical records assessments, and CPT coding issues.
- Establishes and maintains liaisons with law enforcement, regulatory agencies, and with industry peers. Refers cases to law enforcement agencies as needed.
- Conducts fraud awareness training sessions and public speaking engagements. Provides guidance to the Fraud Investigators. Answers and responds to SIU Fraud Hotline on rotating basis.
- Regular attendance is an essential function of the job. Performs other duties as assigned or required.
Qualifications:
- Bachelor’s degree in Criminal Justice
- 5 years of professional investigation experience with a law enforcement agency required
- Strong knowledge of CPT and ICD9-CM coding, medical terminology, and treatment options required
Security Disclosure
If you are offered a job from one of the EmblemHealth family of companies that includes ConnectiCare, AdvantageCare Physicians, and WellSpark, the offer confirmation email will come from “HRTalentAcquisition” with the subject line: “Offer of Employment for (job title)” – Please respond online”.
We never ask you to join a Google Hangout, request you to purchase your own equipment or pay to apply. We do not send email from a third-party email service such as Yahoo or Gmail.
Pay Disclosure
A good faith estimate of the compensation range for individuals hired to work for the EmblemHealth Family of Companies is provided. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, internal peer equity, and market and business considerations. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. It is not typical for an individual to be hired at or near the top of the range, as compensation decisions depend on each case’s facts and circumstances. Union roles covered by a collective bargaining agreement will compensate in accordance with the union contract.
EEOC Statement
We are committed to leveraging the diverse backgrounds, perspectives, and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy or related condition, marital status, national origin, disability, protected veteran status or any other characteristic protected by law.