Senior Fraud Investigations Analyst

Blue Cross and Blue Shield of North Carolina; Virginia (MN); Remote; USD 62,000 - 112,000; Full time

Job summary

A leading health care company seeks a Senior Fraud Investigations Analyst to conduct thorough fraud investigations. The role involves documentation, communication of deficiencies, and compliance with regulations. Offers a chance for career development and work-life balance, alongside competitive health benefits and employee support programs.

Benefits

Work-life balance

Medical, dental, and vision coverage

401k match with annual contribution

Career development programs

Parental leave and support

Tuition reimbursement for continued education

Qualifications

• 5+ years of experience in related field.
• In lieu of degree, 7+ years of experience in related field.

Responsibilities

• Conduct investigations in accordance with investigative action plan.
• Maintain timely and factual documentation in designated case tracking.
• Prepare and conduct presentations for health care fraud education.

Skills

Depositions

Evidence Collection

Forensic Accounting

Fraud Investigations

Investigation Techniques

Investigative Analysis

Job Interviews

Regulatory Analysis

Risk Assessments

Testifying in Court

Education

Bachelor's degree

Advanced degree (where required)

Job description

Senior Fraud Investigations Analyst page is loaded

Senior Fraud Investigations Analyst

Apply locations Remote - North Carolina Full Time Remote - Virginia Full Time Remote - South Carolina time type Full time posted on Posted 2 Days Ago job requisition id RQ0017657

Job Description

The Special Investigations Unit (SIU) Investigator is responsible to conduct timely and thorough health care fraud investigations on behalf of the Company. Investigations are confidential and are conducted in accordance with SIU Policies and Procedures, contractual obligation and in accordance with applicable state and federal regulation.

What You'll Do

• Conducts investigations in accordance with investigative action plan and documents all findings in standard with SIU Policies and Procedures

• Identifies errors and control deficiencies. Understands and communicates the downstream impact of process weaknesses and gaps on the business/organization.

• In the course of investigation, may be required to provide deposition and/or testimony May also be required to conduct interviews of victims, subjects and/or other related persons

• In accordance with SIU Policies and Procedures, maintains timely and factual documentation in designated case tracking, from inception to case closure

• Prepares and conducts presentations and/or provides content for health care fraud and abuse education and awareness

What You'll Bring

• Bachelor's degree or advanced degree (where required)
• 5+ years of experience in related field
• In lieu of degree, 7+ years of experience in related field

What You'll Get

• The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community

• Work-life balance, flexibility, and the autonomy to do great work

• Medical, dental, and vision coverage along with numerous health and wellness programs

• Parental leave and support plus adoption and surrogacy assistance

• Career development programs and tuition reimbursement for continued education

• 401k match including an annual company contribution

• Learn more

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$62,100.00 - $111,800.00

Skills

Depositions, Evidence Collection, Forensic Accounting, Fraud Investigations, Investigation Techniques, Investigative Analysis, Job Interviews, Regulatory Analysis, Risk Assessments, Testifying in Court

About Us

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.

Blue Cross NC is a fully taxed, not-for-profitcompany headquarteredin Durham, North Carolina. We servemore than 4.3 million members, and we employ more than 5,000 people across the countrywho are passionate about making health care better for all.

Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at [e-mail] .

For most roles, you can choose where to work - fully remote in one of the states listed below, in the office, or a hybrid of the two:

Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming