Investigator II

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. This position is accountable for analytical and investigative activities related to claims, enrollment, accounting and other operations to detect, receive and review suspected fraud and to complete cases with all information and analysis for resolution.

Requirements

• Detects fraudulent activities by subscribers, providers, groups, employees and other parties.
• Decides the most efficient and effective method of investigation appropriate for each individual case.
• 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.
• Represents the Company in conducting complex and potentially multi-million dollar settlement negotiations with attorneys and/or other responsible parties (representing providers, enrolled groups and individual subscribers).
• Serves as Company's representative in testifying in legal proceedings as required in fraud cases.
• Up to date and Knowledgeable about all applicable fraud statutes; Local, state and federal to ensure duties and assignments are carried out within the requirement of applicable law and local office expectations.

Benefits

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous Paid Time Off
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement