BlueCross BlueShield of South Carolina Hiring for Investigator I at Columbia, SC Full Time

Responsible for developing feasible, logical procedures to assess and identify potential Medicare fraud by using investigative and analytical techniques in an effort to protect the Medicare trust fund.

Description

Summary

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, 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 nation’s 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 that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

What You’ll Do

• Conducts site visits of Durable Medical Equipment (DME) suppliers in an accurate/timely manner.
• Establishes and maintains liaison with federal law enforcement agencies and other health care agencies regarding issues relating to Medicare supplier standards.
• Actively contributes to unit meetings, complaint development and resolution, intelligence referrals, fraud alerts and program vulnerabilities.
• Attends and/or participates in training programs and conferences.

To Qualify For This Position, You’ll Need

• Bachelor’s Degree OR Associate’s and 2 years job related work experience OR 4 years job related work experience
• 4 years customer services, education/training, medical affairs, provider network, or underwriting.
• Strong customer service orientation skills.
• Ability to effectively communicate verbally/in writing to all levels throughout organization.
• Excellent analytical or critical thinking, problem solving skills.
• Ability to persuade, negotiate, or influence others.
• Ability to review, analyze, and develop information and make appropriate decisions.
• Ability to develop working knowledge of medical terminology.
• Ability to work independently, prioritize workload, organize daily itinerary and travel.
• Experience with Microsoft office.

What We Prefer You To Have

• Bachelor’s degree-Criminal Justice/Criminology, Healthcare Administration, or Public Health
• Certified Fraud Examiner(CFE) or Accredited Healthcare Fraud Investigator(AHFI).

What We Can Do For You

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• Subsidized health plans, dental and vision coverage
• 401K retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Wellness program and healthy lifestyle premium discount
• Tuition assistance
• Service recognition
• Employee Assistance
• Discounts to movies, theaters, zoos, theme parks and more

What To Expect Next

After submitting your application, our recruiting team members will review your resume to ensure your meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. If the qualifications required proof of semester hours, please attach your transcript to your application.

Management will be conducting interviews with the most qualified candidates, with prioritization give to those candidates who demonstrate the preferred qualifications.

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

Some states have required notifications. Here’s more information.

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 minorities, females, disabled individuals and 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 physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.