Investigator II

BlueCross BlueShield of South Carolina•Columbia, SC

2d•Onsite

About The Position

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've 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 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, 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.

Requirements

A Bachelor’s Degree.
Six (6) years claims processing, customer service, healthcare program management, medical affairs or research and analysis.
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.
Proficiency in word processing, spreadsheet, database, presentation software.
Knowledge of Microsoft Office applications.
Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI).

Nice To Haves

Experience with SC Medicaid product or with SCDHHS.

Responsibilities

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.
Coordinate case development for geographic or function related teams and evaluate quality of investigations and provides guidance, recommends courses of action for improvement.
Provide team lead support in the development of analytical data to identify fraud trends throughout country.
Interact with various outside agencies including but not limited to contractors, attorneys, federal and state government agencies on compliance related issues and investigations.
Support the corporate quality management system (QMS) program by developing work instructions, etc.