Program Integrity AnalystInvestigator Associate

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

Preferred Skills and Experience

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.

Compensation and Benefits

$60000.00 - $67500.00 - $83100.00 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.

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 :

Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.

Required Experience :

IC

Key Skills

Project / Program Management,Program Management,Data Collection,Military Experience,Microsoft Powerpoint,Earned Value Management,Sharepoint,Microsoft Project,Budgeting,DoD Experience,Financial Management,Contracts

Employment Type : Full-Time

Experience : years

Vacancy : 1

Yearly Salary Salary : 60000 - 83100