Special Investigations Unit (SIU) Manager of Investigations

Blue Cross and Blue Shield of North Carolina • Durham, CA

5d • $107,901 - $172,642 • Hybrid

About The Position

Blue Cross NC is hiring a Special Investigations Unit (SIU) Manager of Investigations to lead a multi-state team dedicated to identifying, preventing, and addressing health care fraud, waste, and abuse. In this role, you will oversee case inventory, guide investigative action plans, and provide tactical and strategic direction to support timely, thorough investigations from start to finish. The SIU’s mission is to protect and improve the health and well-being of Blue Cross NC employees, members, providers, business partners, and the communities we serve.

Requirements

• Minimum of a Bachelor's degree preferred
• In lieu of degree, 10+ years of experience in related field.
• Accredited Health Care Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE)
• 8+ years of experience conducting/leading healthcare fraud investigations

Nice To Haves

• Experience leveraging data-driven insights to prioritize investigations, quantify financial impact, and support strategic SIU decision-making.
• Data analytics, fraud detection modeling, and interpretation of complex healthcare claims data to identify emerging fraud, waste, and abuse trends.
• Certified Professional Compliance Officer (CPCO)
• Certified Professional Coder (CPC) and other Specialty Certifications
• Statistics and Extrapolation

Responsibilities

• Assign and manage case inventory, support investigative action plans, and drive timely, thorough investigations from intake through resolution.
• Review cases to ensure documentation meets quality standards, confirm referrals to internal and external stakeholders are completed in accordance with policy, and advise on final case disposition, including engagement with internal and external counsel.
• Provide investigative guidance and subject matter expertise to team members, support professional growth opportunities, and help drive team performance in alignment with organizational strategies and goals.
• Serve as a liaison with industry peers and key internal and external partners to support tactical and strategic initiatives related to fraud, waste, and abuse prevention.
• Provide dynamic leadership for SIU team members and participate in internal committees, cross-functional presentations, and initiatives related to SIU responsibilities.
• Develop, monitor, and update approaches and strategies that strengthen anti-fraud, waste, and abuse programs.
• Ensure SIU activities comply with applicable internal and external legal, contractual, regulatory, and policy requirements, including the Company Code of Conduct, Compliance Program, SIU Fraud Plan, and state and federal guidelines.
• Leverage and support the development of AI-enabled solutions to improve process efficiency.

Benefits

• Medical, dental, and vision coverage along with numerous health and wellness programs.
• Parental leave and support plus adoption and surrogacy assistance.
• Career development programs and tuition reimbursement for continued education.
• 401k match including an annual company contribution.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager