Resp & Qualifications
PURPOSE: To reduce and/or recuperate losses to CareFirst BlueCross BlueShield 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.
Required: A 4-year relevant college degree or 4 or more years of work experience in insurance, investigative, health care, nursing or law enforcement and a Certified Professional Coding (CPC) or equivalent credential.
Preferred: Credential in a health care or investigations related area such as Certified Fraud Examiner (CFE), Accredited Health Fraud Investigator (AHFI), RN/LPN, or Certified Professional Coder (CPC). Knowledge of ICD 10 and CPT® Codes, medical terminology, extensive training in claims and subscriber customer service methods, and previous experience in the health care industry. Knowledge of corporate and divisional policies and procedures, claims processing, underwriting, medical policies, enrollment and billing and/or other related systems and procedures to determine the integrity of claims’ payments and business operations within CareFirst or previous experience in the health care industry.
Department: Post Payment 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: www.carefirst.com/careers
Please apply before: 10/12/2019
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.
Physical Demands: The physical demands described here are representative of those that must be met by an associate to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.
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 of up to 25 pounds are occasionally lifted. Travel may be required between CareFirst sites and to other business-required destinations.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship