Analyst, Corporate Fraud

Summary

Position Purpose:

Responsible for conducting research to detect and investigate suspected instances of fraudulent or abusive activities against the corporation.

Description

Logistics:

This position is HYBRID (2 days in office/3 days remote, subject to change) at our 51 Clemson Road, Columbia, SC location. This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings.

What You’ll Do

• Identifies fraudulent activities by means of research in various systems.
• Performs further research and investigate on fraudulent findings to develop cases.
• Maintains fraud hotline and conducts preliminary research to develop investigations.
• Assists investigators in developing cases. Communicates with management as to findings.
• Represents company as witness at regulatory hearing or court proceedings as needed.
• Research and obtain information corresponding to documentation received with BlueCard SIU Provider Settlement checks.
• Create and obtain solicited Refund Control Number's (RCN’s) to reflect information and payment amount.
• Send SIU Provider Settlement check(s) to appropriate area to be deposited and monies be applied to RCN(s). Distribute documentation to appropriate LOB areas for manual postings.
• Assists in documentation of findings for reporting purposes. Reports findings and makes recommendations for correction of weaknesses or poor controls.
• Monitors and tracks restitution payments, recoupments, and savings activities for monthly, quarterly, and yearly reporting.
  
  

To Qualify For This Position, You'll Need The Following

• Required Education: Bachelor's
• Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience.
• Required Work Experience: 3 years experience in investigations, law enforcement or health insurance.
• Required Skills and Abilities:
• Strong customer service skills.
• Ability to effectively communicate both verbally and in writing to all levels throughout the organization.
• Excellent analytical, critical thinking, and problem solving capabilities.
• Ability to review, analyze and develop information and make appropriate decisions.
• Ability to work independently and prioritize workload.
• Knowledge of insurance commission regulations.
• Required Software and Tools: Microsoft Office skills
  

We Prefer That You Have The Following

• ITS/BlueCard experience
• Experience with DB2 and commercial claims system
• Investigative curiosity, Fraud mindset
  
  

Our Comprehensive Benefits Package Includes The Following

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more
  
  

What We Can Do For You

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with those candidates who are the most qualified, with prioritization given to those candidates who demonstrate the required qualifications.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email [email protected] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.

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