Vacancy caducado!
Additional Locations:Full Time Remote - Alabama, Full Time Remote - Alabama, Full Time Remote - Arizona, Full Time Remote - Arkansas, Full Time Remote - Colorado, Full Time Remote - Florida, Full Time Remote - Georgia, Full Time Remote - Idaho, Full Time Remote - Indiana, Full Time Remote - Iowa, Full Time Remote - Kansas, Full Time Remote - Kentucky, Full Time Remote - Louisiana, Full Time Remote - Maryland, Full Time Remote - Michigan, Full Time Remote - Mississippi, Full Time Remote - Missouri, Full Time Remote - Ohio, Full Time Remote - Oklahoma, Full Time Remote - Pennsylvania, Full Time Remote - South Carolina, Full Time Remote - South Dakota, Full Time Remote - Tennessee, Full Time Remote - Texas, Full Time Remote - Utah {+ 2 more}Job DescriptionThe Sr. Fraud, Waste and Abuse Investigations Analyst on the Special Investigations Unit (SIU) will 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.
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
Hiring Requirements
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.
Preferred Skills/Qualifications
Law Enforcement Investigative Experience
Healthcare Fraud, Waste, and Abuse Investigative Experience
AHFI/CFE certification
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-profit North Carolina company with major operations centers in Durham and Winston-Salem. We employ more than 5,000 people who are passionate about health care, and we serve more than 4.3 million members.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.E-VerifyOur company uses E-Verify to confirm the employment eligibility of all newly hired employees. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview (https://www.e-verify.gov/employees/e-verify-overview) for English or Visión General de E-Verify (https://www.e-verify.gov/es/empleados/vision-general-de-e-verify) for Español.Third Party Staffing AgenciesBlue Cross NC does not accept unsolicited resumes from any source other than directly from candidates. For the protection of all parties involved in the recruiting process, resumes will only be accepted from recruiters/agencies if a signed agreement is in place at the inception of the recruiting effort and authorized for a specific position. Unsolicited resumes sent to Blue Cross NC from recruiters/agencies do not constitute any type of relationship between the recruiter/agency and Blue Cross NC and do not obligate Blue Cross NC to pay fees if we hire from those resumes.
Vacancy caducado!