Company: Premera Blue Cross
Posted on: May 3, 2021
Join Our Team: Do Meaningful Work and Improve People's Lives
Our purpose, to improve customers' lives by making healthcare
work better, is far from ordinary. And so are our employees.
Working at Premera means you have the opportunity to drive real
change by transforming healthcare.
To better serve our customers, we're creating a culture that
promotes employee growth, collaborative innovation, and inspired
leadership. We are committed to creating an environment where
employees can do their best work and where best-in-class talent
comes, stays, and thrives!
As a member of Premera's Special Investigations Unit (SIU), the
Investigator II will be responsible for investigating allegations
of external fraud, waste and abuse (FWA). The Investigator will
initiate, analyze, develop, and successfully complete and resolve
fraud investigations of medium to high level complexity. This role
will perform multiple high-quality investigations concurrently and
work in a collaborative environment with other SIU personnel to
perform analysis and obtain analytical information of significance
to support case investigations. The Investigator will coordinate
efforts to recover erroneous payments made due to misrepresentative
billing, fraud or another criminal act.
What you'll do:
- Analyze healthcare claim data and vet referrals to detect
fraudulent activity and independently determine the most effective
and efficient method of investigation for each individual
- Perform investigative field work to include on-site office
visits, record collection, and surveillance.
- Interview suspects and witnesses.
- Prepare cases, testify and give depositions to law enforcement
and regulatory agencies for potential criminal prosecution.
- Participate in settlement negotiations with attorneys and other
- Perform root cause analysis of identified issues and prepare
post-investigative reports directed towards the prevention of
- Make recommendations for creating SIU policies, procedures,
workflows and process improvements.
- Develop and maintain collaborative and liaison relationships
with Blue Cross Blue Shield Association (BCBSA), Blue Cross Blue
Shield (BCBS) Plans, HHS OIG, other carriers' anti-fraud
professionals, law enforcement and regulatory agencies.
What you'll bring:
- Bachelor's degree or four (4) years of work experience in field
- Three (3) years of experience in fraud investigation, special
investigation unit, or a related field of which includes;
- Two (2) years of active experience in auditing and
investigating in the healthcare industry.
Preferred incumbents will have
- Registered Nurse (RN), Certified Professional Coder (CPC),
Certified Fraud Examiner (CFE), or Accredited Health Care Fraud
What we offer
- Medical, vision and dental coverage
- Life and disability insurance
- Retirement programs (401K employer match and pension plan)
- Wellness incentives, onsite services, a discount program and
- Tuition assistance for undergraduate and graduate degrees
- Generous Paid Time Off to reenergize
- Free parking
Equal employment opportunity/affirmative action:
Premera is an equal opportunity/affirmative action employer.
Premera seeks to attract and retain the most qualified individuals
without regard to race, color, religion, sex, national origin, age,
disability, marital status, veteran status, gender or gender
identity, sexual orientation, genetic information or any other
protected characteristic under applicable law.
If you need an accommodation to apply online for positions at
Premera, please contact Premera Human Resources via email at
email@example.com or via phone at 425-918-4785.
Keywords: Premera Blue Cross, Anchorage , Investigator, Other , anchorage, Alaska
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