Legal Staff Paralegal in Winston Salem, NC

In-House

Winston Salem, NC

Legal Staff Paralegal in Winston Salem, NC

Legal Staff

Min 5 yrs required

No

Job Title: Investigator Senior
Job Type: Full Time
Salary: Competitive salary based on experience and qualifications
Experience: Minimum of 5 years in healthcare insurance and investigation

Investigator Senior is a full-time position within Carelon Payment Integrity, a member of the **MEMBERS ONLY**SIGN UP NOW***. family of companies. The role involves identifying, investigating, and developing complex cases of healthcare fraud in order to recover funds paid on fraudulent claims. The ideal candidate must have a strong background in health insurance, including knowledge of policies, claims handling, and provider network contracting.

Key Responsibilities:

- Conduct claim reviews for appropriate coding, data mining, entity review, and law enforcement referral
- Utilize proprietary data and claim systems to review facility, professional, and pharmacy claims
- Independently identify and develop enterprise-wide healthcare investigations and initiatives
- Interface with senior level management and legal department throughout investigative process
- Assist in training internal and external entities
- Develop policies and procedures to prevent loss of company assets
- Represent the company in court proceedings regarding research findings
- Maintain strong relationships with law enforcement and regulatory agencies

Minimum Requirements:

- BA/BS degree and minimum of 5 years experience in healthcare insurance and investigation, or equivalent combination of education and experience

Preferred Qualifications:

- Professional certification such as CFE, AHFI, CPC, Paralegal, RN, or JD
- Knowledge of plan policies and procedures in benefit program management
- Negotiation skills

Company Overview:

**MEMBERS ONLY**SIGN UP NOW***. is a Fortune 25 company dedicated to improving lives and communities through simplified healthcare. We are looking for passionate individuals at all levels of our organization to join us in making a positive impact on our members and the communities we serve. Our culture is rooted in our values and behaviors, which drive our strategy and lead to personal and professional growth for our associates.

Benefits:

- Market-competitive total rewards package including merit increases, paid holidays, and paid time off
- Incentive bonus programs (unless covered by a collective bargaining agreement)
- Medical, dental, and vision insurance
- Short and long term disability benefits
- 401(k) with company match
- Stock purchase plan
- Life insurance
- Wellness programs and financial education resources

Workforce Strategy:

**MEMBERS ONLY**SIGN UP NOW***. operates in a hybrid workforce strategy, with both remote and office work. Candidates must live within 50 miles or a 1-hour commute of one of our locations. The health and safety of our associates and communities is a top priority, and we require all new candidates in certain patient/member-facing roles to be vaccinated against COVID-19 and Influenza.

EEO Statement:

**MEMBERS ONLY**SIGN UP NOW***. is an Equal Employment Opportunity employer and considers all qualified applicants for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status protected by applicable federal, state, or local laws. Accommodations for the job application process can be requested by contacting . Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.