Senior Claims Fraud Investigator

Horizon Blue Cross Blue Shield of New Jersey; Hartford (CT); On-site; USD 63,000 - 84,000; Full time

Benefits offered by this job

Comprehensive health benefits (Medical

Retirement Plans

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey seeks an investigator to manage analytical and investigative activities related to fraud across claims, enrollment, and accounting. The role includes documenting cases, coordinating with law enforcement, and testifying as required.

The position requires a high school diploma, at least 2 years in claims or related law enforcement, and knowledge of health insurance operations. Travel to support investigations is expected.

Qualifications

• Analytical and investigative work in claims, enrollment, and accounting to detect fraud.
• Strong communication and documentation skills.
• Experience in health insurance operations and SIU processes is preferred.

Responsibilities

• Lead analytical and investigative activities related to claims, enrollment, and other operations to detect and resolve suspected fraud.
• Prepare and document fraud cases with evidence for possible prosecution or civil litigation.
• Conduct field investigations and coordinate with law enforcement and stakeholders.

Skills

Investigation

Fraud detection

Communication

Education

High School Diploma/GED

Tools

Excel

Access

Job description

Horizon Blue Cross Blue Shield of New Jersey seeks an investigator to manage analytical and investigative activities related to fraud across claims, enrollment, and accounting. The role includes documenting cases, coordinating with law enforcement, and testifying as required.

The position requires a high school diploma, at least 2 years in claims or related law enforcement, and knowledge of health insurance operations. Travel to support investigations is expected.