Hybrid Program Integrity and Fraud Analyst

BCBSM, Inc.; Eagan (MN); Hybrid; USD 69,000 - 114,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

Life insurance

401k

Paid Time Off (PTO)

Volunteer Paid Time Off (VPTO)

Job summary

Blue Cross and Blue Shield of Minnesota is seeking a healthcare investigations professional to analyze referrals, conduct investigations into fraud, waste, and abuse, and prepare case referrals. You will interview patients, providers, and witnesses, and review medical records for accuracy and compliance.

The role is hybrid, with two days onsite, and offers a comprehensive benefits package, including medical, dental, life, 401k, PTO, VPTO, and more.

Qualifications

• 3+ years of healthcare operations auditing/investigations experience.
• Ability to travel during the workday and overnight travel.

Responsibilities

• Analyze and triage referrals to determine research/investigation needs.
• Investigate moderate to complex potential fraud, waste or abuse; document findings and referrals.
• Interview patients, providers, and witnesses; review medical records for appropriateness.

Skills

Healthcare experience

Investigation skills

Data analysis

Travel willingness

Education

Bachelor’s degree

Job description

Blue Cross and Blue Shield of Minnesota is seeking a healthcare investigations professional to analyze referrals, conduct investigations into fraud, waste, and abuse, and prepare case referrals. You will interview patients, providers, and witnesses, and review medical records for accuracy and compliance.

The role is hybrid, with two days onsite, and offers a comprehensive benefits package, including medical, dental, life, 401k, PTO, VPTO, and more.