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 healthcare. 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

In this position, you will be responsible for performing technical and analytical work under limited supervision in support of implementing business solutions through research, database maintenance, reporting, audit and analysis of data to determine viability of Fraud, Waste, and Abuse (FWA) tips. This position is directly responsible for researching and triaging all incoming tips and referrals to SIU investigators or other appropriate business areas for resolution.

Your Responsibilities

• Performs reporting and data analysis for the department.  Provides recommendations for improvements, and how to best achieve the desired business outcome.
• Monitor channels for incoming FWA tips regardless of channel (phone, email, mail or fax). This includes taking phone calls received through the internal SIU hotline phone number.
• Timely and accurately document/track all FWA tips received following departmental guidelines to ensure regulatory and business reporting is complete and accurate.
• Performs initial analysis and review of complaints through research and data analysis to accurately triage internal and external hotline tips to an SIU investigator or other business areas for resolution as appropriate with minimum supervision.
• Assists in the development of recommendations to solve routine or standard problems and issues related to business operations.
• Independently monitor, triage and assign incoming pre-pay claims and inquiry work as well as all SIU correspondence to appropriate investigator or other business area if misdirected to SIU.
• Process FWA settlement/recovery checks which includes identifying lines of business for which funds are recovered and preparing requests to operations and/or accounting to allocate funds to impacted accounts.
• Conducts research and evidence gathering for FWA investigations which can include data analysis, background research, internet searches and written requests for documentation. Prepares internal requests for document review to support FWA investigations.
• Gathers information from across divisions and from various levels of management to support completion of requests for information as well as internal, regulatory, and contractually required FWA reporting.
• Actively participates in assigned workgroups, committees, and project implementations.
• May prepare presentations to report findings to a supervisor or project leader.

Required Skills and Experience

• 3+ years' related experience or Bachelor’s degree. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Ability to communicate with impact and skilled at delivering focused and compelling presentations.
• Proficient in Microsoft Word and Excel.
• Ability to make decisions based on analysis and business needs.
• Ability to bring a different perspective to situations and challenge the status quo.
• Must possess a strong work ethic and be flexible.
• Excellent organization and time management skills.
• Excellent verbal and written communication skills.
• Strong customer service and computer proficiency.
• Strong interpersonal communication skills.
• Must have knowledge of claims processing systems and coding and billing proficiency.
• Ability to use fraud data mining tools.
• Ability to work independently with excellent attention to detail.
• High school diploma (or equivalency) and legal authorization to work in the U.S.

Preferred Skills and Experience

• Bachelor's degree.
• Knowledge of health insurance claims processing or customer service.
• Knowledge of health care nomenclature, claim coding and fraud, waste and abuse schemes.

Compensation and Benefits:

Pay Range: $60,000.00 - $69,100.00 - $85,000.00 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.

Role Designation

Hybrid

Anchored in Connection

Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week – most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote.

Equal Employment Opportunity Statement

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.

Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.

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