Special Investigations FEP Program Lead

The Special Investigations FEP Program Lead is responsible for overseeing FEP related activities to ensure consistency with FEHB Carrier Letter and BCBSA FEP Anti-Fraud policies and procedures. The program lead will be the primary contact for program integrity audits conducted by BCBSA and OPM-OIG, as well as internal audits. The program lead will lead healthcare fraud investigations that impact the FEP and manage and maintain records on all claim savings and recoveries.

Requirements

• Responsible for creating and presenting quarterly reports to Special Investigations Senior Management (VP & Director) regarding the SIU FEP operations.
• Manages and facilitates SIU program audits and yearly certifications of the FEP program by the Blue Cross Blue Shield Association and the Office of Personnel Management, Office of Inspector General.
• Leads internal and external investigations (approximately 375 to 400 cases) which consists of collecting, collating, analyzing and interpreting data in a timely, accurate fashion, securing necessary documentation to resolve open cases;
• Provides oversight and direction to our Investigators conducting healthcare fraud investigations, which impact the FEP.

Benefits

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