Why should you join the BlueCross BlueShield of South Carolina family of companies Other companies come and go but weve been part of the national landscape for more than seven decades with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina and much more. We are one of the nations leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy consider joining our team!

Position Purpose:

The Investigator II is responsible for conducting timely thorough and accurate investigations of suspected fraud and abuse cases involving providers contractors and suppliers by using investigative and analytical techniques.

Location:

This position is full time and will work Monday Friday 40 hours per week in a typical office environment. The work hours can be 8-hour shifts between 7: 30 AM 5:00 PM. This role is onsite at 2401 Faraway Drive in Columbia SC.

What Youll Do:

• You will coordinate and support site visit process to include oversight of off-site personnel and support management and senior fraud analyst to coordinate action/workloads and ensures all timeliness standards and regulatory standards are met.
• Youll coordinate case development for geographic or function related teams and evaluate quality of investigations and provides guidance recommends courses of action for improvement.
• The Investigator II provides team lead support in the development of analytical data to identify fraud trends throughout country.
• You will interact with various outside agencies including but not limited to contractors attorneys federal and state government agencies on compliance related issues and investigations.
• Youll support the corporate quality management system (QMS) program by developing work instructions etc.

To Qualify for This Position Youll Need:

• Required Education: A Bachelors Degree.
• Required Experience: Six (6) years claims processing customer service healthcare program management medical affairs or research and analysis.
• Required Skills and Abilities: Strong customer service orientation skills. The ability to effectively communicate verbally/in writing to all levels throughout organization. Excellent analytical or critical thinking problem solving skills. The ability to persuade negotiate or influence others. The ability to review analyze and develop information and make appropriate decisions. The ability to develop working knowledge of medical terminology. The ability to work independently prioritize workload organize daily itinerary and travel.
• Required Software and tools: Proficiency in word processing spreadsheet database presentation software. Knowledge of Microsoft Office applications.
• Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI).

We Prefer That You Have The Following:

• Experience with SC Medicaid product or with SCDHHS.

Our comprehensive benefits package includes The Following:

• 401(k) retirement savings plan with company match.
• Health Insurance.
• Free vision coverage.
• Voluntarydental vision and lifeinsurance.
• Paid annual leave the longer you work here the more you earn.
• Nine paid holidays.
• On-site cafeterias and fitness centers in major locations.
• Wellness programs and a healthy lifestyle premium discount.
• Tuition assistance.
• Service recognition.

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills advance their careers and contribute their unique abilities to the growth of our company.

What to Expect Next:

After submitting your application our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age race color national origin sex religion veteran status disability weight sexual orientation gender identity genetic information or any other legally protected status. Additionally as a federal contractor the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities pregnant individuals individuals with pregnancy-related conditions and individuals needing accommodations for sincerely held religious beliefs provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment please email or call ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Heres moreinformation.

Some states have required notifications. Heres more information.