Job Information
Independence Blue Cross, LLC Financial Investigator II or III - 240521 in Philadelphia, Pennsylvania
Financial Investigator II or III - 240521
DESCRIPTION/RESPONSIBILITIES: JOB DESCRIPTION for Financial Investigator II or III (Level of the role is contingent on experience)
Responsible for the detection, analysis and in-depth investigation of allegations of fraud, waste and abuse against the Independence Health Group. Conducts research, data analysis and interviews to develop information necessary for the referral of suspicious activities to licensing boards and/or law enforcement agencies. Prepares and maintains files and memorandums to document the progression of assigned cases. Analyzes data and gathers information from surveillances, leads and other investigative techniques to further cases to conclusions.
MAJOR ACCOUNTABILITIES: 1. Performs in-depth investigative activities relating to alleged fraudulent claims. When requested by management and/or subpoenaed by law enforcement gathers documentation to support investigative efforts.
Compiles and investigates information gathered from various internal and external sources to determine financial exposure to fraud activities.
Builds and maintains case files for presentation to management and presents recommendations for further action.
Searches claims and provider systems to identify claims trends and tracks activities that may be potential fraud issues. Prepares trend reports to management.
Provides assistance to senior investigative staff and management on complex cases and collaborates counsel on special projects.
May testify on behalf of Independence as required.
Conducts interviews of subjects and third parties.
Performs other duties as assigned.
QUALIFICATIONS EXPERIENCE: Job Title With BS Without BS Financial Investigator II 1 to 3 years of experience At least 5 years of experience Financial Investigator III 3 to 5 years of experience At least 8 years of experience
- Undergraduate degree in criminal justice or related field preferred.
- Minimum of 5 years' experience with financial, criminal or law enforcement investigations.
- In lieu of degree, must have 8-10 years' experience in specialized law enforcement.
- Must understand technical and financial aspects of the health insurance industry.
- Strong writing, communication and computer skills required.
- Experience with claims and provider systems a plus.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
Independence has implemented a "Hybrid" model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the "Hybrid" model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania
Equal Opportunity Employer-minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity