A Career of Your Calling

About Blue Cross and Blue Shield of Minnesota

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming health care. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

The Impact You Will Have

You will be responsible for overseeing and executing the enterprise-wide fraud risk management and awareness program to address internal and external fraud risks. You will lead the cross-functional fraud initiatives through collaboration with the Operations, Enterprise Risk Management, Compliance, Internal Audit, Special Investigations Unit, Information Technology, and Finance teams, as well as other partners within the organization to implement changes to further prevent and detect fraud.

Your Responsibilities

Governance

• Facilitates the creation of fraud policies and communicate policies across the organization and establish a process to monitor adherence to fraud policies. Develops a fraud prevention and detection framework to ensure a consistent approach to fraud across the enterprise through effective process discipline, execution, insight, and oversight.
• Enhances organizational fraud awareness through development of training programs to ensure associates are aware of potential fraud risks, mitigation strategies and how to report fraud.

Fraud Risk Assessment

• Oversees and conducts routine Enterprise Fraud Risk Assessments (EFRA).
• Understands and quantifies potential fraud risks associated with new or proposed processes or procedural changes, new products, or programs.
• Meets and discusses results of the EFRA with various leaders throughout the organization including the Executive Leadership Team (ELT).
• Coordinates with Information Technology on cybersecurity efforts including social engineering tests to identify high risk areas.

Fraud Control Activities

• Leverages EFRA results, fraud expertise and partnerships with internal stakeholders and leadership to identify process control opportunities to mitigate fraud risk.
• Analyzes data to determine areas with high fraud loss levels, or opportunities for loss, and develops solutions to mitigate fraudulent activity.

Fraud Risk Monitoring

• Develops comprehensive reporting and analysis to monitor fraud trends and drive improvements.
• Develops and tracks measurable benchmarks and reporting to evaluate effectiveness of fraud mitigation strategies.

Fraud Investigation and Corrective Action

• Oversees and conducts fraud investigations across a broad scope of functional areas within the organization.
• Proactively investigates and researches fraud and risk management trends in the industry.
• Conduct investigations and perform ad-hoc analysis.

Required Skills and Experiences

• 8+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Excellent organizational skills, excellent analytical skills, strong problem resolution skills, strong project management skills, and ability to adapt to a changing environment and work independently.
• Demonstrated ability to analyze and interpret data and develop strategic recommendations.
• Excellent communication, interpersonal skills, demonstrated collaboration and consultation skills.
• Ability to influence leadership through clear presentation and communication of complex data analysis.
• Certified Fraud Examiner (CFE) in good standing through the Association of Certified Fraud Examiners or ability to obtain certification within one year of hire.

Preferred Skills and Experience

• Bachelor’s degree.
• Experience leading projects and/or programs.
• Advanced knowledge of the health care and insurance industry.
• Thorough understanding and knowledge of BCBSMN operations, products and systems.
• Proficient in the use of data analytics tools and superior Excel, Word and PowerPoint skills.

Compensation and Benefits:

Pay Range: $100,000.00 - $135,000.00 - $170,000.00 Annual

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

• Medical, dental, and vision insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more

To discover more about what we have to offer, please review our benefits page.

Equal Employment Opportunity Statement

Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.

Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.

All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.