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. The Staff Vice President (VP) of the Special Investigations Unit (SIU) is responsible for leading, planning, organizing, and controlling the activities of cross-functional employees engaged in the detection and elimination of fraudulent behavior. This role requires associates to be in-office at least three days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. Alternate locations may be considered. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

Team Scope : 19 direct reports / 600+ total FTEs

Position Responsibilities :

• Works with key internal areas and external regulators to address fraudulent activity.
• Prepares internal and external analyses and reports of investigative findings, trends, outcomes, and savings.
• Establishes process for establishing cases and assignment of cases to investigators.
• Establishes processes for handling referrals of suspected fraud and abuse from internal / external sources and tracking referrals to disposition.
• Leads and directs multiple functions and / or teams across the national SIU.
• Functions within the SIU include investigations, case intake and assignment, and data analysis.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Position Requirements :

Preferred Skills, Capabilities and Experiences :

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. 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. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state, and local laws. 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.