Blue Cross and Blue Shield of North Carolina
Senior Fraud Investigations Analyst - Medicare/Medicare Advantage Investigations
Blue Cross and Blue Shield of North Carolina, New York, New York, United States
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
Conduct investigations in accordance with investigative action plan and documents all findings in standard with SIU Policies and Procedures
Identify errors and control deficiencies. Understand and communicate 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, maintain timely and factual documentation in designated case tracking, from inception to case closure.
Prepare and conduct presentations and/or provide 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
Bonus Points
Deep Medicare and/or Medicare Advantage regulatory experience
Extensive Medicare/Medicare Advantage investigative experience
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
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What You'll Do
Conduct investigations in accordance with investigative action plan and documents all findings in standard with SIU Policies and Procedures
Identify errors and control deficiencies. Understand and communicate 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, maintain timely and factual documentation in designated case tracking, from inception to case closure.
Prepare and conduct presentations and/or provide 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
Bonus Points
Deep Medicare and/or Medicare Advantage regulatory experience
Extensive Medicare/Medicare Advantage investigative experience
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
#J-18808-Ljbffr