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 leading and directing multiple functions and / or teams across the national SIU. 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 include current R.N. degree, FBI, HHA-OIG or Department of Justice experience, Law degree or Prosecution experience, fraud certification, and experience in complex, high dollar white collar and / or healthcare investigations. 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. 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, 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.