CareFirst Careers

Manager, Special Investigations (Hybrid)

Resp & Qualifications

Responsible for planning, organizing, and controlling the activities of cross-functional employees engaged in the detection and elimination of fraudulent behavior.  Also responsible to reduce and/or recuperate losses to CareFirst by the detection, investigation and resolution of all levels, (low to complex), of fraud, waste and abuse schemes, resulting in the savings and recovery of funds.


  • Prepares comprehensive investigative reports and analyses pertinent to evidence obtained in investigations.

  • Coordinates information and action with law enforcement agencies at the local, state, and federal level.

  • Manage SIU plan and budget to achieve performance goals.  Consistently ensures compliance with all applicable professional practices, laws, and regulations.

This position manages people.


Education Level: Bachelor's Degree in Business Administration, Management, Nursing or Criminal Justice OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Licenses/Certifications Preferred:
Certified Expert Coder-AHIMA or AAPC


  • 5 years experience in fraud and abuse investigations, health care fraud, etc.
  • 1 year supervisory experience or demonstrated progressive leadership experience.

Knowledge, Skills and Abilities (KSAs)

  • Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.



Department: Special Investigations Unit

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply:

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.


The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship



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