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Blue Shield of California
El Dorado Hills, CA | Full Time
$90k-114k (estimate)
2 Weeks Ago
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Path-Arc
El Dorado Hills, CA | Full Time
$41k-52k (estimate)
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Riverside Payments
El Dorado Hills, CA | Full Time
$110k-148k (estimate)
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MyKelly
El Dorado Hills, CA | Full Time
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VersaLink LLC
El Dorado Hills, CA | Part Time
$48k-59k (estimate)
1 Month Ago
Special investigator
Blue Shield of California El Dorado Hills, CA
$90k-114k (estimate)
Full Time | Insurance 2 Weeks Ago
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Blue Shield of California is Hiring a Special investigator Near El Dorado Hills, CA

Your Role

The Special Investigations Unit team is responsible for preventing, detecting, investigating, and resolving health care fraud, waste, and abuse.

The Special Investigations Investigator, Consultant will report to the SIU Manager. In this role you will represent a high level of professionalism both internally and externally.

Conduct investigations in accordance with company policies and procedures and in compliance with all applicable laws and regulations.

Your Work

In this role, you will :

  • Initiate, analyze, develop, and successfully complete complex fraud investigations with limited to no supervisory assistance.
  • Develop and maintain relationships with personnel from other business units and departments within Blue Shield of CA
  • Be responsible for coordinating and overseeing efforts to recover erroneous payments made because of a claims processing error, misrepresentative billing, fraud, abuse or any other criminal act with no assistance
  • Document all stages of each investigation using Company and department procedures, templates and form. Prepare detailed post-audit investigative reports.

Limited to no supervisory assistance needed

  • Handle highly confidential and sensitive information while ensuring compliance with privacy policies
  • Work independently in a secure remote environment with minimal supervision as well as function within team and corporate structure
  • Prioritize and practice excellent time management and organizational skills.
  • Work flexible work schedules to accommodate investigations
  • Identify problems, develop solutions, and implement a chosen course of action
  • Last updated : 2024-05-11

Job Summary

JOB TYPE

Full Time

INDUSTRY

Insurance

SALARY

$90k-114k (estimate)

POST DATE

05/13/2024

EXPIRATION DATE

06/21/2024

WEBSITE

tempral.com

HEADQUARTERS

San Francisco, CA

SIZE

<25

INDUSTRY

Insurance

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The following is the career advancement route for Special investigator positions, which can be used as a reference in future career path planning. As a Special investigator, it can be promoted into senior positions as a Campus Police Officer that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Special investigator. You can explore the career advancement for a Special investigator below and select your interested title to get hiring information.