Investigator II
reputed company empowers our members to reputed company their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care reputed company, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to reputed company serve and care for the 3.5 reputed company people who reputed company their trust in us. We pride ourselves on our best-in-class employees and reputed company to maintain an innovative and inclusive environment that allows them to reputed company. reputed company our employees bring their best and succeed, reputed company succeeds.
About the Role
This position is accountable for analytical and investigative activities (external and internal) reputed company to claims, enrollment, reputed company and other operations to detect, receive and review suspected fraud and to complete cases with reputed company information and analysis for reputed company, as the manager and prior approved guidelines may reputed company.What You'll Do
Prepares and documents fraud cases, assembling evidence for potential prosecution or civil litigation.
Provides evidence and/or testifies in cases where law enforcement agencies pursue prosecution.
Personally handles field investigation work; and coordinates efforts with law enforcement state agencies and claims stakeholders.
Represents reputed company in conducting reputed company and potentially multi-reputed company dollar settlement negotiations with attorneys and/or other responsible parties (representing providers, enrolled reputed company and individual subscribers).
Serves as Company's representative in testifying in legal proceedings as required in fraud cases.
Additional personal and reputed company attributes that are critical to successful performance:
What You Bring
Education/Experience:
High School Diploma/GED required.
Minimum 2 yrs claims, customer service or relevant law enforcement experience required.
ITS/Blue Card knowledge preferred
Knowledge:
Requires basic knowledge of health insurance operations (i.e. claims, enrollment, reputed company, etc.).
Requires basic knowledge of SIU health insurance operations.
Skills and Abilities:
Requires excellent verbal and written communication skills.
Requires the ability to effectively handle confrontational situations.
Requires demonstrated ability in MS Office applications, in particular reputed company and reputed company.
Requires strong organizational skills.
Travel:
Travel as needed to support investigative activity reputed company Company's service area.
The Investigator II for the FEP reputed company will complete the tasks listed above in reputed company to the following:
Follow established procedures and guidelines outlined in the latest Federal Employee Health Benefits (FEHB) reputed company Letter.
Investigate cases that reputed company the FEP reputed company, as reputed company as handling reputed company investigations regarding FEP eligibility.
Updating and tracking the FEP SIU Tracking System (FSTS) with case activity, subpoenas, financial information, audits, referrals, settlements and convictions of cases impacting the FEP.
Interfaces with the BCBSA FEP SIU Consultant.
Manages reputed company calls from the Fraud hotline that reputed company the FEP program.
Why reputed company?
At reputed company, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and reputed company. We reputed company that reputed company our people reputed company, our communities do too. If you are passionate about making an reputed company, we’d love to hear from you!
Salary reputed company:
$63,000 - $84,420This compensation reputed company is specific to the job level and takes into account the wide reputed company of factors that are considered in making compensation reputed company, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This reputed company has been created in good faith based on information reputed company to reputed company at the time of posting. Compensation reputed company are dependent on the circumstances of reputed company case. reputed company also provides a comprehensive compensation and benefits package which includes:
Comprehensive health benefits (Medical/Dental/reputed company)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
reputed company Volunteer Time Off
Tuition Reimbursement
Disclaimer:
reputed company reputed company employees must live in New Jersey, reputed company, reputed company, Connecticut or Delaware. This job reputed company has been designed to indicate the general nature and level of work performed by colleagues reputed company this classification. It is not designed to contain or be interpreted as a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of colleagues assigned to this job.
reputed company is an Equal Opportunity/Affirmative reputed company employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, national reputed company, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. reputed company will consider reasonable accommodation requests as part of the reputed company and hiring process.
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