Staff Vice President (VP), Special Investigations Unit (SIU)

Staff Vice President (VP), Special Investigations Unit (SIU)

Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. Responsible for leading, planning, organizing, and controlling the activities of cross-functional employees engaged in the detection and elimination of fraudulent behavior. Team scope includes 19 direct reports and 600+ total FTEs. Position responsibilities include working with key internal areas and external regulators to address fraudulent activity, preparing internal and external analyses and reports of investigative findings, trends, outcomes, and savings, establishing processes for handling referrals of suspected fraud and abuse from internal / external sources and tracking referrals to disposition, and leading and directing multiple functions and / or teams across the national SIU.

Position requires a BA / BS in business administration, health care administration, criminal justice, nursing, contract administration, or related field and minimum of 10 years investigation, prosecution, or healthcare experience; or any combination of education and experience, which would provide an equivalent background. Preferred skills, capabilities and experiences include current R.N. degree, FBI, HHA-OIG or Department of Justice experience, Law degree or Prosecution experience, fraud certification from HIAA or NHCAA, RN or JD certification, experience in complex, high dollar white collar and / or healthcare investigations, experience with the FBI or District Attorneys office, and knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation.

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 range for this specific position is $160,880 to $289,584. The salary offered 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.

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs, medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient / member-facing roles to become vaccinated against COVID-19 and Influenza. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.