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.

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

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, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law).

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

Primary duties may include, but are not limited to:

Works with key internal areas and external regulators to address fraudulent activity. Prepares internal and external analyses and repots 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 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

Current R.N. degree, FBI, HHA-OIG or Department of Justice experience, Law degree or Prosecution experience preferred. Fraud certification from HIAA or NHCAA, RN or JD certification preferred. Experience in complex, high dollar white collar and/or healthcare investigations strongly preferred. Experience with the FBI or District Attorneys office preferred. Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.

For candidates working in person or virtually in the below location(s), the salaryrange for this specific position is $160,880 to $289,584.

Locations:


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


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.

The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law



Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be 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 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.


How We Work


At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.


We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), 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. 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.


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.