Special Investigator

Blue Cross

Louisiana, USA
Not specified (assumed in-office based on location preference).
Conduct internal and external investigations
Ensure payment integrity
Deter, detect, prevent, and recover losses
Blue Cross is seeking a Special Investigator to conduct investigations related to fraud, waste, and abuse within various healthcare programs in Louisiana. The ideal candidate should have a background in audit, accounting, or criminal justice, along with experience in analytical roles related to fraud investigations

Job Summary

  • Responsible for conducting and leading internal and external investigations for designated lines of business to ensure payment integrity within the respective programs.
  • Provides management with insights and recommendations to deter, detect, prevent and recover losses due to fraud, waste, and abuse.
  • We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities.

Matching Summary

Match Score: 75

Blue Cross is seeking a Special Investigator to conduct investigations related to fraud, waste, and abuse within various healthcare programs in Louisiana. The ideal candidate should have a background in audit, accounting, or criminal justice, along with experience in analytical roles related to fraud investigations.

Skills & Requirements

Must-have

  • Conduct internal and external investigations
  • Ensure payment integrity
  • Deter, detect, prevent, and recover losses
  • Gather and analyze data
  • Collect and preserve evidence
  • Prepare cases for referral
  • Testify in legal proceedings

Nice-to-have

  • Serve local communities
  • Develop skills and grow professionally
  • Promote good health and well-being

Key Requirements

  • Bachelor's degree or 4 years related experience
  • 3 years experience in fraud investigations, audits, medical procedures or coding
  • Excellent communication, negotiation, and interrogation skills
  • Ability to travel 20% to 40%
  • Proficient computer skills including Microsoft programs
  • Approved certification or medical license

Work Rights

Not specified

Tailored Resume

Cover Letter