Program Integrity AnalystInvestigator Associate
Share
Job Location:
Yearly Salary:
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
About Blue Cross and Blue Shield of Minnesota
At Blue Cross and Blue Shield of Minnesota we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate you are joining a culture that is built on values of succeeding together finding a better way and doing the right thing. If you are ready to make a difference join us.
The Impact You Will Have
In this position you will be responsible for the prospective and retrospective investigation of suspect claims and assisting in initial development of fraud waste abuse and over-payment recovery cases. This includes learning to gather analyze and interpret data and information to provide meaningful results in developing leads collaboration with internal resources as well as complying with state and federal requirements for fraud waste and abuse detection and prevention.
Your Responsibilities
- Analyze referrals/leads and determine what type of research/investigation is needed under close supervision.
- Assess intent and potential for fraudulent activities and/or over-payment recovery opportunities under close supervision.
- Contributes to preparations for facilitating settlement negotiations with providers attorneys and other responsible parties with direct supervision.
- Assist with investigating cases through personal interview analysis of claims medical records and other available data.
- Document case activity and fund allocation and conduct follow-up-actions in a timely manner following documented departmental guidelines.
- Provide appropriate notifications to accounts as well as state and federal entities with moderate supervision.
- Assist in completing well documented and substantiated cases to law enforcement agencies which may include the Federal Bureau of Investigations (FBI) the Office of the Attorney General (OIG) and local police departments.
Required Skills and Experience
- 4 or more years experience in health insurance operations or related field. All relevant experience including work education transferable skills and military experience will be considered.
- 2 years of fraud waste and abuse investigation/loss prevention experience or 3 years medical/pharmacy claims audit research and analytics or a related experience.
- Strong written and oral communication analytical problem resolution and negotiation skills.
- Demonstrated ability to present positive professional behavior.
- Strong quantitative problem-solving and computer skills.
- Proficient use of Microsoft Office: Excel and Word.
- This role requires the ability to travel during the workday and potential overnight travel.
- Required to have and maintain a valid drivers license and auto insurance or access to reliable transportation.
- High school diploma (or equivalency) and legal authorization to work in the U.S.
Preferred Skills and Experience
- Bachelors degree in Health Administration Health Care Informatics Business Administration or related fields of study
- Knowledge of health care nomenclature and coding programs services claims and fraud waste and abuse schemes.
Role Designation
HybridAnchored in Connection
Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships creativity and alignment. The rest of the week you are empowered to work remote.
Compensation and Benefits
$60000.00 - $67500.00 - $83100.00 AnnualPay is based on several factors which vary based on position including skills ability and knowledge the selected individual is bringing to the specific job.
We offer a comprehensive benefits package which may include:
Medical dental and vision insurance
Life insurance
401k
Paid Time Off (PTO)
Volunteer Paid Time Off (VPTO)
And more
To discover more about what we have to offer please review our benefits page.
Equal Employment Opportunity Statement
At Blue Cross and Blue Shield of Minnesota we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to and will not be discriminated against based on any legally protected characteristic.
Individuals with a disability who need a reasonable accommodation in order to apply please contact us at:
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
Required Experience:
IC
Key Skills
- Project / Program Management
- Program Management
- Data Collection
- Military Experience
- Microsoft Powerpoint
- Earned Value Management
- Sharepoint
- Microsoft Project
- Budgeting
- DoD Experience
- Financial Management
- Contracts
