Program Integrity Analyst/investigator Clinical - Behavioral Health

Blue Cross Blue Shield of Minnesota

Base: $68,900.00 - $91,300.00 - $113,700.00 annual...
Hybrid (2 days onsite, 3 days remote)
Registered nurse or licensed behavioral health clinician
3+ years clinical experience
4 years fraud investigation experience
Blue Cross Blue Shield of Minnesota is seeking a Program Integrity Analyst/Investigator in Clinical Behavioral Health, responsible for investigating fraud, waste, and abuse in healthcare claims. The ideal candidate will have clinical experience, strong analytical skills, and a relevant professional license

Job Summary

  • The role involves investigating suspect claims and developing fraud, waste, abuse, and over-payment recovery cases.
  • Candidates must conduct interviews, review medical records, and represent the company in legal proceedings such as depositions and trials.
  • The position offers a comprehensive benefits package including medical, dental, vision, life insurance, and 401k.

Matching Summary

Match Score: 85

Blue Cross Blue Shield of Minnesota is seeking a Program Integrity Analyst/Investigator in Clinical Behavioral Health, responsible for investigating fraud, waste, and abuse in healthcare claims. The ideal candidate will have clinical experience, strong analytical skills, and a relevant professional license.

Salary

Base: $68,900.00 - $91,300.00 - $113,700.00 annually; Bonus/Equity: Not specified; Benefits: Medical, dental, vision, life insurance, 401k, PTO

Skills & Requirements

Must-have

  • Registered nurse or licensed behavioral health clinician
  • 3+ years clinical experience
  • 4 years fraud investigation experience
  • Data analysis tools like Healthcare Fraud Shield
  • HIPAA compliance knowledge

Nice-to-have

  • Excellent negotiation skills
  • Ability to work independently
  • Strong organizational skills
  • Travel availability for investigations
  • AHFI accreditation preferred

Key Requirements

  • Current MN license (RN, LICSW, LPCC, etc.)
  • 4 years of fraud/waste/abuse investigation experience
  • Legal authorization to work in the U.S.
  • Valid driver's license and auto insurance
  • AHFI accreditation within five years of hire

Work Rights

Legal authorization to work in the U.S.

Tailored Resume

Cover Letter