Job Description The Special Investigations Unit (SIU) Investigator is responsible for conducting timely and thorough health care fraud investigations on behalf of the Company. Investigations are confidential and conducted in accordance with SIU Policies and Procedures, contractual obligations, and applicable state and federal regulations. What You'll Do Conduct investigations following investigative action plans and document all findings in accordance 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. Provide deposition and/or testimony as required. Conduct interviews of victims, subjects, and other related persons. Maintain timely and factual documentation in designated case tracking from case inception to closure, following SIU Policies and Procedures. Prepare and deliver presentations or content for healthcare fraud and abuse education and awareness. What You'll Bring Bachelor's degree or higher (where required). 5+ years of experience in a related field. In lieu of a degree, 7+ years of experience in a related field. Bonus Points Deep Medicare and/or Medicare Advantage regulatory experience. Extensive investigative experience in Medicare / Medicare Advantage. What You'll Get The opportunity to work at the forefront of healthcare delivery with a dedicated community-focused team. Work-life balance, flexibility, and autonomy. Medical, dental, and vision coverage, along with health and wellness programs. Parental leave, adoption, and surrogacy support. Career development programs and tuition reimbursement. 401(k) match with annual company contribution. Additional benefits include PTO, health benefits, and wellness programs. Salary Range: $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 Blue Cross and Blue Shield of North Carolina
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