Fraud Investigator II (SIU)

Horizon Blue Cross Blue Shield of New Jersey; United States; Remote; USD 63,000 - 84,000; Full time

Benefits offered by this job

Health benefits

Retirement plans

Generous PTO

Incentive plans

Wellness programs

Volunteer time off

Tuition reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey seeks an Investigator II to conduct analytical and investigative activities related to fraud across claims, enrollment and operations. You will review cases, gather evidence and follow FEHB Carrier Letter guidelines to resolve inquiries.

The role involves field investigations, coordinating with law enforcement, and presenting findings in complex settlements. Travel within the service area is required.

Qualifications

• High School Diploma or GED required.
• Minimum 2 years claims, customer service or relevant law enforcement experience.
• ITS/Blue Card knowledge preferred.

Responsibilities

• Prepare and document fraud cases with evidence for potential prosecution.
• Provide evidence and testify in cases pursued by law enforcement.
• Lead field investigations and coordinate with law enforcement and claims stakeholders.
• Represent Horizon in complex, potentially multi‑million dollar settlements with attorneys.
• Testify in legal proceedings as required for fraud cases.
• Travel as needed to support investigative activity within the service area.

Skills

Verbal communication

Written communication

MS Excel

MS Access

Organizational skills

Confrontation handling

Education

High School Diploma/GED

ITS/Blue Card knowledge

Tools

MS Office

Excel

Access

Job description

Horizon Blue Cross Blue Shield of New Jersey seeks an Investigator II to conduct analytical and investigative activities related to fraud across claims, enrollment and operations. You will review cases, gather evidence and follow FEHB Carrier Letter guidelines to resolve inquiries.

The role involves field investigations, coordinating with law enforcement, and presenting findings in complex settlements. Travel within the service area is required.