Investigator II – Behavioral Health

Join Elevance Health as an Investigator II - Behavioral Health in Tampa, Hillsborough County, where you'll play a critical role in protecting plan integrity and ensuring appropriate use of behavioral health services. This full-time position requires 1-2 days per week on-site in Tampa, with flexibility for managing the remainder of your work schedule to support both collaboration and work-life balance.

About the Role

As an Investigator II specializing in behavioral health claims, you'll investigate potential fraud, waste, and abuse within behavioral health service delivery. You'll examine claims data, review medical records, conduct interviews with providers and members, and document your findings in full compliance with company policies and healthcare regulations. Your work directly impacts plan member safety and organizational financial health.

What You'll Do

• Conduct thorough investigations into behavioral health claims flagged for potential irregularities or compliance concerns
• Review clinical documentation and claims records to identify patterns of abuse or misuse
• Interview healthcare providers, members, and other relevant parties to gather investigation information
• Compile detailed investigation reports with findings, analysis, and supporting documentation
• Collaborate with compliance, claims, and legal teams to resolve investigations and ensure appropriate action
• Maintain strict confidentiality of sensitive member and provider information
• Stay current with healthcare regulations, compliance standards, and company investigation protocols

What We're Looking For

• High school diploma or GED required; Bachelor's degree preferred
• 2+ years of professional experience in investigations, insurance fraud, compliance, or related healthcare field
• Strong written and verbal communication skills with the ability to document findings clearly and concisely
• Proficiency with computer systems and proven ability to analyze data from multiple sources
• Understanding of healthcare regulations, compliance requirements, and behavioral health services
• Ability to handle confidential information with integrity and maintain professional discretion
• Strong attention to detail, organizational skills, and sound problem-solving judgment

About Elevance Health

Elevance Health is a leading health insurance company dedicated to improving lives and advancing health outcomes. We serve millions of members across multiple states and partner with healthcare providers to deliver quality, affordable, and accessible healthcare solutions. Our Tampa operations are part of this mission to drive meaningful change in healthcare.

How to Apply

To apply, complete your application directly on this page, or you'll be redirected to the employer's application platform to finish submitting there.