Investigator II

Overview

Join to apply for the Investigator II role at BlueCross BlueShield of Tennessee

Are you a seasoned Investigator with a keen eye for detail and a drive to protect the integrity of healthcare? At BlueCross BlueShield of Tennessee, our Special Investigation Unit plays a critical role in safeguarding our members and resources by identifying and analyzing potentially fraudulent insurance claims.

If you bring over eight years of experience in white-collar crime or healthcare fraud investigations as well as certifications such as CFE, AHFI, ALHC, or CIFI, you'll lead complex investigations, conduct interviews, and deliver findings that influence high-stakes decisions. Your expertise will support legal proceedings and uphold the trust our members place in us. We're looking for proactive, organized professionals with strong communication skills and proficiency in Microsoft Office.

Our Investigator role presents an opportunity to join a collaborative team where your work has real impact—on our business, our members, and the future of healthcare in Tennessee.

This is a remote position that requires frequent monthly travel to provider offices throughout the Middle Tennessee area for investigative purposes, as well as quarterly travel to the company headquarters in Chattanooga, TN for meetings.

Responsibilities

• Preparing legal and investigation documentation; presenting findings and making recommendations to management.
• Participating in legal proceedings when necessary.
• Analyzing all evidence, looking for possible fraud, and conducting ongoing investigations.
• Conducting interviews with parties involved and obtaining the information needed to determine the validity of claims.

Qualifications

Education

Experience

Skills / Certifications

Employees who are required to operate either a personal or rental vehicle for company business on a routine basis will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver's license, auto insurance compliance with minimum liability requirements; as defined in the "Use of Non BCBST-Owned Vehicle" Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR).

Number of Openings

Worker Type

Employee

Company

BCBST BlueCross BlueShield of Tennessee, Inc.

Applying for this job indicates your acknowledgement and understanding of the following statements : BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies / Notices may be found by reviewing the following page : BCBST's EEO Policies / Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR / Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Seniority level

Mid-Senior level

Employment type

Full-time

Job function

Other, Information Technology, and Management

Industries

Insurance

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