Investigator II

BlueCross BlueShield of Tennessee • Nashville, TN

4d • Remote

About The Position

BCBST is hiring an Investigator II. Are you an experienced investigator with a strong eye for detail and a passion for protecting the integrity of healthcare? At BlueCross BlueShield of Tennessee, our Special Investigations Unit plays a critical role in identifying and addressing potentially fraudulent activity to safeguard our members and resources. In this role, you will lead end-to-end fraud investigations—analyzing evidence, identifying patterns, conducting interviews, and developing clear, defensible case documentation—while presenting findings to leadership, supporting legal proceedings, and ensuring each case is evaluated for risk and impact. This opportunity is ideal for professionals with experience in white-collar crime or healthcare fraud investigations, particularly those who hold or are pursuing certifications such as CFE, AHFI, ALHC, or CIFI, and are driven to reduce financial loss, strengthen compliance, and enhance fraud prevention strategies across the organization. Success in this role means delivering well-supported conclusions, identifying trends that strengthen internal controls, and serving as a trusted advisor by providing insights that enable confident decision-making. Ready to take the next step? Note: This is a remote role with occasional travel across Tennessee, including provider site visits and periodic time in our Chattanooga office. You’ll join a collaborative team where your work has a direct impact on our business and the members we serve. Sponsorship is not available for this role. We foster a culture of innovation, including responsible use of AI-enabled tools to enhance how we serve our members.

Requirements

• Bachelor's Degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience in a corporate environment
• 8 years - Experience in the investigation of healthcare fraud investigations or similar white collar criminal investigations required
• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
• Proficient in Microsoft Office (Outlook, Word, Excel and Powerpoint)
• Must be a team player, be organized and have the ability to handle multiple projects
• Excellent oral and written communication skills
• Strong interpersonal and organizational skills
• Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis will be automatically enrolled into the BCBST Driver Safety Program.
• The employee will also be required to adhere to the guidelines set forth through the program.
• This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR).
• The definition for "routine basis" is defined as daily, weekly or at regularly schedule times.

Nice To Haves

• Industry designation involving Healthcare Fraud Investigation, such as the Certified Fraud Examiner (CFE), Accredited Health Care Fraud Investigator (AHFI), Associate, Life and Health Claims (ALHC), Certified Insurance Fraud Investigator (CIFI)

Responsibilities

• Preparing legal and investigation documentation; presenting findings and making recommendations to management.
• Participating in legal proceedings when necessary.
• Analyzing all evidence, looking for possible fraud, and conducting ongoing investigations.
• Conducting interviews with parties involved and obtaining the information needed to determine the validity of claims.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree