Investigator II

Job not on LinkedIn

🔥 14 hours ago

🦌 Connecticut, New Jersey, +2 more states – Remote

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $63k - $84.4k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Horizon Connect @ Wall BCBSNJ

WebsiteLinkedInAll Job Openings

2 - 10 employees

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ is a LinkedIn presence or local program/office associated with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Based on the name and context, it appears to be connected to Horizon BCBSNJ’s health insurance operations and local outreach or member/provider engagement in the Wall, NJ area. Publicly available information provided is limited and mostly LinkedIn site chrome rather than a company profile, so this description is conservative and based on the affiliation indicated by the name.

📋 Description

• Conduct analytical and investigative activities related to claims, enrollment, accounting and other operations to detect, receive and review suspected fraud • Prepare and document fraud cases, assembling evidence for potential prosecution or civil litigation • Provide evidence and/or testify in cases where law enforcement agencies pursue prosecution • Handle field investigation work and coordinate efforts with law enforcement state agencies and claims stakeholders • Represent the Company in complex settlement negotiations with attorneys and other responsible parties • Testify in legal proceedings as required in fraud cases • Follow procedures and guidelines outlined in the latest Federal Employee Health Benefits (FEHB) Carrier Letter • Investigate cases impacting the FEP line of business, including FEP eligibility investigations • Update and track the FEP SIU Tracking System with case activity, subpoenas, financial information, audits, referrals, settlements and convictions • Interface with the BCBSA FEP SIU Consultant • Manage fraud hotline calls impacting the FEP program

🎯 Requirements

• High School Diploma/GED required • Minimum 2 yrs claims, customer service or relevant law enforcement experience required • ITS/Blue Card knowledge preferred • Basic knowledge of health insurance operations (i.e. claims, enrollment, underwriting, etc.) • Basic knowledge of SIU health insurance operations • Excellent verbal and written communication skills • Ability to effectively handle confrontational situations • Demonstrated ability in MS Office applications, in particular Excel and Access • Strong organizational skills • Travel as needed to support investigative activity within Company's service area • Employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

🏖️ Benefits

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