Investigative Support Specialist

Independence Blue Cross; Philadelphia (Philadelphia County); Hybrid; USD 42.000 - 64.000; Vollzeit

Zusammenfassung

Independence Blue Cross in Philadelphia is seeking an Investigative Support Specialist to provide administrative and operational support to the Corporate and Financial Investigations Department. You will coordinate intake, maintain case records, track allegations, and support recovery efforts while ensuring compliance with regulatory requirements.

The role requires attention to detail, strong organizational skills, and discretion handling confidential information.

Qualifikationen

• High school diploma or equivalent required.
• 2+ years in administrative support, healthcare operations, compliance, fraud prevention, investigations support, records management, or related field.
• Strong organizational and time-management skills; ability to manage multiple priorities.

Aufgaben

• Receive and process allegations of Fraud, Waste, and Abuse from multiple channels.
• Acknowledge receipt and request additional information when needed.
• Create, maintain, and update case records for tracking and reporting.
• Review and organize case materials for investigative review.
• Assign cases to team members per procedures.
• Maintain electronic and physical investigative files per policies.
• Coordinate record retention activities and compliance with standards.
• Process refunds and restitution payments; maintain recovery records.
• Support preparation of departmental reports and regulatory documentation.
• Collaborate with internal and external stakeholders while maintaining confidentiality.

Kenntnisse

Organizational skills

Time management

Attention to detail

Written communication

Verbal communication

Teamwork

Independence

Ausbildung

High school diploma or equivalent

Tools

Microsoft Office

Jobbeschreibung

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together, we will achieve our mission to enhance the health and well-being of the people and communities we serve.

Independence's Corporate and Financial Investigations Department (CFID) is responsible for protecting organizational assets and supporting compliance efforts through the identification, prevention, investigation, and reporting of potential Fraud, Waste, and Abuse (FWA) activities. The department works closely with business partners, regulatory agencies, and internal stakeholders to ensure the integrity of healthcare operations and financial transactions.

The Investigative Support Specialist provides administrative and operational support to the investigative team by coordinating intake activities, maintaining case records, tracking allegations, and supporting investigative and recovery efforts. This role assists with records management, complaint intake, case documentation, payment processing, and reporting activities while ensuring compliance with departmental, regulatory, and organizational requirements.

Responsibilities

• Receive and process allegations of Fraud, Waste, and Abuse received through various channels, including mail, email, telephone, and internal referrals.
• Acknowledge receipt of allegations and communicate with complainants when additional information or documentation is required.
• Create, maintain, and update case records to ensure accurate tracking, documentation, and reporting of investigative activities.
• Review and organize case-related materials and supporting documentation for investigative review.
• Assign cases and referrals to appropriate team members based on established procedures.
• Maintain electronic and physical investigative files in accordance with organizational policies and regulatory requirements.
• Coordinate departmental record retention activities, including the retention, retrieval, archival, and disposition of records.
• Serve as the department's Record Retention Coordinator and maintain compliance with established records management standards.
• Receive, document, track, and process refund and restitution payments associated with audits, investigations, and recovery efforts.
• Maintain accurate financial recovery records and supporting documentation.
• Assist with monitoring repayments, recoveries, and related reporting activities.
• Support the preparation of departmental reports, metrics, and regulatory documentation.
• Collaborate with internal and external stakeholders while maintaining confidentiality and professionalism.
• Perform other duties and special projects as assigned.

Qualifications

Required

• High school diploma or equivalent.
• Two (2) or more years of experience in administrative support, healthcare operations, compliance, fraud prevention, investigations support, records management, financial operations, or a related field.
• Strong organizational and time-management skills with the ability to manage multiple priorities simultaneously.
• Demonstrated attention to detail and accuracy in recordkeeping and documentation.
• Experience maintaining confidential and sensitive information.
• Proficiency with Microsoft Office applications, including Outlook, Word, Excel, and Teams.
• Strong written and verbal communication skills.
• Ability to analyze information, follow established procedures, and resolve routine issues independently.
• Ability to work effectively both independently and as part of a team.

Preferred

• Experience supporting fraud, waste, and abuse, compliance, audit, investigative, legal, healthcare, insurance, or regulatory functions.
• Experience with case management systems, records management systems, or document retention processes.
• Knowledge of healthcare insurance operations, claims processing, healthcare compliance, or fraud prevention programs.
• Experience tracking financial recoveries, processing payments, reconciling records, or managing financial documentation.

Independence has implemented a Hybrid model which consists of associates working in the office three days a week (Tuesday, Wednesday, and Thursday) and remotely two days a week (Monday and Friday). This role is designated as a role that fits into the Hybrid model. While associates may work remotely on designated remote days, the work must be performed within the Tri-State Area of Delaware, New Jersey, or Pennsylvania. Occasional travel may be available for training, meetings, or professional development opportunities.

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

Must have an Android or iOS device that is compatible with the free Microsoft Authenticator app.

Inclusion and Belonging

At IBX, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

About Our Company

Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.

At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com . We’re revolutionizing health care, and our focus is on you!

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.