Financial Investigator III
Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together, we will achieve our mission to enhance the health and well-being of the people and communities we serve.
We are seeking a Financial Investigator III to detect, analyze, and conduct in-depth investigations of allegations of fraud and abuse against Independence Health Group. Conducts research, data analysis, and interviews to develop information necessary for the referral of suspicious activities to licensing boards and/or law enforcement agencies. Prepares and maintains files and memorandums to document the progression of assigned cases. Analyzes data and gathers information from surveillances, leads, and other investigative techniques to further cases to conclusions.
Responsibilities:
1. Performs in-depth investigative activities relating to alleged fraudulent claims. When requested by management and/or subpoenaed by law enforcement, gathers documentation to support investigative efforts.
2. Compiles and investigates information gathered from various internal and external sources to determine financial exposure to potential fraud activities.
3. Builds and maintains case files for presentation to management and presents recommendations for further action.
4. Searches claims and provider systems to identify claims trends and tracks activities that may be potential fraud issues. Prepares trend reports for management.
5. Provides assistance to senior investigative staff and management on complex cases and collaborates with counsel on special projects.
6. May testify on behalf of Independence as required.
7. Conducts interviews of subjects and third parties.
Qualifications:
1. Undergraduate degree in criminal justice or related field preferred.
2. Minimum of 5 years’ experience with financial, criminal, or law enforcement investigations.
3. In lieu of a degree, must have 8-10 years’ experience in specialized law enforcement.
4. Must understand technical and financial aspects of the health insurance industry.
5. Strong writing, communication, and computer skills required.
Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device that is compatible with the free Microsoft Authenticator app.
Vaccination Update
This job requires that you demonstrate you have been fully vaccinated for COVID-19 prior to the start of employment, to the extent permitted by law.
About Our Company
AmeriHealth Casualty has been successfully returning employees to work since 1994, providing quality medical treatment and care and reducing costs for our customers. With our affiliates, we serve more than 1,800 businesses in the area and have offices in Philadelphia, Camp Hill, and Pittsburgh, PA, and Mount Laurel, NJ.
In 1994, CompServices, Inc. began offering workers’ compensation third-party administration services for manufacturers, municipalities, health care facilities, social services, transportation risk, universities, and retail firms. In 1996, AmeriHealth Casualty Insurance Company was established as an extension of our workers’ compensation claims services — its mission to provide workers’ compensation insurance combined with high quality claims service and cost containment.
AmeriHealth Casualty Insurance Company and CompServices write premiums and administer self-insured programs for over 1,800 customers.
Equal Employment Opportunity
AmeriHealth Casualty is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an AmeriHealth Casualty employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of AmeriHealth Casualty and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by AmeriHealth Casualty or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.