Job Description The Special Investigations Unit (SIU) Investigator is responsible for conducting timely and thorough healthcare fraud investigations on behalf of the Company. Investigations are confidential and conducted in accordance with SIU Policies and Procedures, contractual obligations, and applicable state and federal regulations. What You'll Do Conduct investigations according to investigative action plans and document all findings in accordance with SIU Policies and Procedures. Identify errors and control deficiencies, understanding and communicating the downstream impact of process weaknesses on the organization. Provide deposition and/or testimony as required. Conduct interviews of victims, subjects, and other relevant persons. Maintain timely and factual documentation in designated case tracking systems from inception to case closure. Prepare and deliver presentations or content related to healthcare fraud and abuse education and awareness. What You'll Bring Bachelor's degree or higher (if required). 5+ years of experience in a related field. Alternatively, 7+ years of experience in a related field in lieu of a degree. Bonus Points Deep regulatory experience with Medicare and/or Medicare Advantage. Extensive investigative experience in Medicare/Medicare Advantage. What You'll Get The opportunity to work at the forefront of healthcare delivery with a dedicated community-focused team. Work-life balance, flexibility, and autonomy. Comprehensive health benefits including medical, dental, and vision coverage, along with wellness programs. Parental leave, adoption, and surrogacy support. Career development opportunities and tuition reimbursement. 401(k) match including an annual company contribution. Learn more about our benefits. Salary Range Blue Cross NC offers a fair and equitable compensation package, typically near the middle of the market range. Salary factors include experience, skills, licensure, certifications, and organizational needs. Our total rewards include an annual incentive bonus, 401(k) with employer match, PTO, and health benefits. *Based on corporate goals and individual performance. $62,100.00 - $111,800.00 Skills Depositions, Evidence Collection, Forensic Accounting, Fraud Investigations, Investigation Techniques, Investigative Analysis, Job Interviews, Regulatory Analysis, Risk Assessments, Testifying in Court #J-18808-Ljbffr Davita Inc.
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