Blue Cross NC
Senior Fraud Investigations Analyst - Medicare/Medicare Advantage Investigations
What's your preference?
Job Description
- Req#: RQ0017657
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
- 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
- Deep Medicare and/or Medicare Advantage regulatory experience
- Extensive Medicare/Medicare Advantage investigative experience
- 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
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
What You'll Bring
Bonus Points
What You'll Get
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 CourtAbout the company
Shop for health insurance plans for North Carolina. Blue Cross NC offers individual and family, Medicare, vision, and dental insurance plan options.
Notice
Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Talentify provides reasonable accommodations to qualified applicants with disabilities, including disabled veterans. Request assistance at accessibility@talentify.io or 407-000-0000.
Federal law requires every new hire to complete Form I-9 and present proof of identity and U.S. work eligibility.
An Automated Employment Decision Tool (AEDT) will score your job-related skills and responses. Bias-audit & data-use details: www.talentify.io/bias-audit-report. NYC applicants may request an alternative process or accommodation at aedt@talentify.io or 407-000-0000.