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

Overview

Anticipated End Date : 2025-11-23

Position Title : Staff Vice President (VP), Special Investigations Unit (SIU)

Job Description : 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.

Location : May be located in any Elevance Health PulsePoint office, preferably in Indianapolis, IN; Atlanta, GA; Mason, OH; Richmond, VA; Norfolk, VA; or Woodland Hills, CA. This role requires associates to be in-office at least 3 days per week. Alternate locations may be considered. Per policy on hybrid / virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered unless an accommodation is granted as required by law.

Position

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

Summary

Responsible for leading, planning, organizing, and controlling the activities of cross-functional employees engaged in the detection and elimination of fraudulent behavior.

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

Requires a BA / BS in business administration, health care administration, criminal justice, nursing, contract administration, or related field and a minimum of 10 years investigation, prosecution, or healthcare experience; or any combination of education and experience that would provide an equivalent background.

Preferred Skills, Capabilities and Experiences

For candidates working in person or virtually in the locations listed, the salary range for this specific position is $160,880 to $289,584.

Locations : California; Cleveland, OH; Colorado; Illinois; Maryland; Massachusetts; Minnesota; Nevada; New Jersey; New York

Compensation and Benefits

In addition to salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution. The salary offered is based on a number of factors including geography, experience, education, and skill. Equal pay for equal work is provided in accordance with laws. The ranges and specifics may be modified based on location, experience, and market conditions.

Job Level

Staff / Regional VP

Workshift

Not specified

Job Family

FRD >

Investigation

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Unsolicited resumes are the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company looking for leaders who are passionate about making an impact on our members and the communities we serve.

How We Work

We foster a culture designed to advance our strategy and support personal and professional growth. Our values and behaviors drive our culture and enable our business outcomes.

We offer a range of market-competitive total rewards, including merit increases, paid holidays, PTO, incentive programs, medical, dental, vision, disability benefits, 401(k) match, stock purchase plan, life insurance, wellness programs, and financial education resources.

Elevance Health operates a Hybrid Workforce Strategy. Associates are required to work at an Elevance Health location at least once per week unless specified otherwise by the hiring manager. Time onsite expectations will be discussed during the hiring process.

The health of our associates and communities is a priority. Some patient / member-facing roles require vaccination against COVID-19 and Influenza. If not vaccinated, offers may be rescinded unless an acceptable explanation is provided in accordance with law. Elevance Health will 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 protected by applicable laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport at elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all applicable laws.

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