Program Integrity Analyst/Investigator Associate

Blue Cross Blue Shield of Minnesota • Eagan, MN • 1h ago

About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You Will Have In this position, you will be responsible for the prospective and retrospective investigation of suspect claims and assisting in initial development of fraud, waste, abuse and over-payment recovery cases. This includes learning to gather, analyze and interpret data and information to provide meaningful results in developing leads, collaboration with internal resources as well as complying with state and federal requirements for fraud, waste and abuse detection and prevention. Your Responsibilities Analyze referrals/leads and determine what @type of research/investigation is needed under close supervision. Assess intent and potential for fraudulent activities and/or over-payment recovery opportunities under close supervision. Contributes to preparations for facilitating settlement negotiations with providers, attorneys and other responsible parties with direct supervision. Assist with investigating cases through personal interview, analysis of claims, medical records and other available data. Document case activity and fund allocation and conduct follow-up-actions in a timely manner following documented departmental guidelines. Provide appropriate notifications to accounts as well as state and federal entities with moderate supervision. Assist in completing well documented and substantiated cases to law enforcement agencies which may include the Federal Bureau of Investigations (FBI), the Office of the Attorney General (OIG) and local police departments. Required Skills and Experience 4 or more years experience in health insurance operations, or related field. All relevant experience including work, education, transferable skills, and military experience will be considered. 2 years of fraud, waste and abuse investigation/loss prevention experience or 3 years medical/pharmacy claims audit research and analytics or a related experience. Strong written and oral communication, analytical, problem resolution and negotiation skills. Demonstrated ability to present positive, professional behavior. Strong quantitative, problem-solving, and computer skills. Proficient use of Microsoft Office: Excel and Word. This role requires the ability to travel during the workday and potential overnight travel. Required to have and maintain a valid driver's license and auto insurance or access to reliable transportation. High school diploma (or equivalency) and legal authorization to work in the U.S. Preferred Skills and Experience Bachelors degree in Health Administration, Health Care Informatics, Business Administration or related fields of study Knowledge of health care nomenclature and coding, programs, services, claims and fraud, waste and abuse schemes. Compensation and Benefits: Pay Range: $60,000.00 - $67,500.00 - $83,100.00 Annual Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job. We offer a comprehensive benefits package which may include: Medical, dental, and vision insurance Life insurance 401k Paid Time Off (PTO) Volunteer Paid Time Off (VPTO) And more To discover more about what we have to offer, please review our benefits page. Role Designation Hybrid Anchored in Connection Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week - most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote. Equal Employment Opportunity Statement At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic. Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com. Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association. Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.

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