Okay, I found several Clinical Fraud Investigator roles in Tampa, FL, that match your criteria. These positions require at least 4 years of experience, prefer candidates with a Certified Professional Coder certification, and offer full-time employment along with benefits including 401(k) and disability insurance. You can explore these positions now.

Sure. Here's the analysis:

Job Analysis:

The Clinical Fraud Investigator II role at Elevance Health is fundamentally about safeguarding the integrity of healthcare operations by identifying and mitigating risks associated with fraud and abuse. This position combines analytical prowess with a nuanced understanding of clinical processes and compliance standards, as the investigator must conduct data mining, perform clinical evaluations, and engage in comprehensive investigations of potential fraud cases. The responsibilities highlight not just the technical analysis of claims and medical records but also emphasize collaboration with various internal teams, such as the Special Investigation Unit, which requires strong interpersonal skills and the ability to communicate findings effectively. Success in this role hinges on the investigator's ability to synthesize data insights, inform loss control strategies, and assist in the training of new associates, all while navigating the complexities and regulations of the healthcare industry. This role also involves judgment and decision-making, particularly when determining whether to pursue certain investigations or recommend specific interventions based on findings.

Company Analysis:

Elevance Health stands out as a formidable player in the healthcare industry, stepping from traditional health benefits into becoming a holistic health partner committed to improving community health. This transformation indicates a progressive culture that prioritizes innovation and community engagement, reflecting its bold purpose. With nearly 100,000 associates serving a substantial member base, the company's scale fosters a collaborative environment; thus, the Clinical Fraud Investigator II will likely enjoy a blend of autonomy and support. Given its Fortune 25 status, the organization embraces a professional growth mindset that aligns well with individuals looking to make impactful contributions. Team dynamics may require adaptability considering the hybrid work environment, which facilitates a balance between structured collaboration and individual productivity. Elevance Health’s strategic focus on redefining health models will undoubtedly influence the investigator's efforts, as their work directly contributes to the integrity and trust of the services offered to its members.

Absolutely. Here are some mock interview questions that could come up:

• Tell me about a time when you had to investigate a complex case of healthcare fraud. What steps did you take, and what was the result?
• Describe a situation where you identified a significant compliance issue. How did you address it?
• Can you give an example of how you have collaborated with cross-functional teams in a previous role?
• Explain how you approach data analysis, and what tools you find most useful in identifying suspicious patterns in claims.
• Walk me through your process for evaluating a medical record for compliance. What specific indicators do you look for?
• If faced with incomplete data during an investigation, how would you proceed to ensure a thorough analysis?
• Imagine you discover a pattern of billing irregularities within a provider’s claims. What steps would you take to investigate further?
• In your opinion, how important is it to have a strong understanding of healthcare regulations in this role?
• Why are you interested in working at Elevance Health specifically, considering its mission to improve community health?
• How do you see your values aligning with Elevance Health's purpose of transforming health and enhancing lives?
• What skills or experiences do you bring that uniquely position you for success in this role?
• What aspect of the hybrid work model appeals to you most, and how do you see it impacting your productivity?
• What questions do you have about Elevance Health's approach to handling fraud and abuse in the healthcare system?