Investigator II

BlueCross BlueShield of TennesseeKnoxville, TN, US

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Investigator

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 impacton 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.

Job 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.

Job Qualifications

Education

Bachelor's Degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience in a corporate environment

Experience

8 years - Experience in the investigation of healthcare fraud investigations or similar white collar criminal investigations required

Skills / Certifications

Industry designation involving Healthcare Fraud Investigation, such as the Certified Fraud Examiner (CFE), Accredited Health Care Fraud Investigator (AHFI), Associate, Life and Health Claims (ALHC), Certified Insurance Fraud Investigator (CIFI)

Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.

Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)

Must be a team player, be organized and have the ability to handle multiple projects

Excellent oral and written communication skills

Strong interpersonal and organizational skills

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).

The definition for "routine basis" is defined as daily, weekly or at regularly schedule times.

Number of Openings Available 1

Worker Type : Employee

Company : BCBST BlueCross BlueShield of Tennessee, Inc.

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.

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.

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Investigator • Knoxville, TN, US