Bcbsa
Senior Manager, SIU Fraud Investigation
US DC 9th St NW · Senior
Sponsorship not specified$131k-$177kDetected 15 days ago
Data AnalysisProject ManagementLead GenerationExcelPerformance ManagementLeadershipCommunicationPublic SpeakingMicrosoft Office
About the role
- This position plans and directs activities related to program strategy, coordination, investigation, and reporting of fraud, waste, and abuse.
- include but are not limited to: - Supervises the detection, investigation, reporting and mitigation of fraud, waste and abuse across all lines of business.
- Oversees the development and the implementation of an enterprise anti-fraud program including intake, triage, investigation, recovery, and referral processes, informed by advanced data analytics.
Responsibilities
- Leads and manages a team with the aim of driving effective performance management, fostering professional growth, and creating a positive and inclusive work environment.
- Performs other duties as assigned
- The role is responsible for developing, executing, and overseeing a comprehensive anti-fraud program driven by advanced data analytics and focused on identifying, investigating and mitigating fraud, waste and abuse across all lines of business.
- This position ensures timely, thorough, and well-documented investigations; and drives continuous improvement through monitoring of trends, root-cause analysis, and corrective action.
- The role also establishes standards, procedures, and oversight mechanisms to support consistent case management, reporting, and outcome measurements across the enterprise.
- Oversees user adoption, training, and effective use of analytic models, dashboards, and workflows to improve lead generation, investigation efficiency, and mitigation outcomes.
- Serves as a primary liaison to build and sustain relationships with internal stakeholders and external partners to support the detection, investigation, reporting and mitigation of fraud, waste, and abuse.
- Coordinates timely information-sharing, referrals, and cooperative engagement strategies with vendors, industry associations, regulators and oversight entities, law enforcement, and government partners.
- Maintains productive relationships that support investigations and analytics capabilities, including setting expectations and escalating issues as needed.
Requirements
- Required - BS in a related field or the equivalent of work experience
- Demonstrated ability to develop and maintain relationships, while instilling a sense of professional confidence and trust is required.
Nice to have
- Certified Insurance Fraud Investigator (CIFI) - IASIU
- Physical Demands/Working Environment
- Preferred: Certified Insurance Fraud Investigator (CIFI) - IASIU
Skills
- Knowledge of the Blue Cross and Blue Shield system.
- Ability to conduct presentations to various groups, in both an informational and a training format.
- Ability to take action so that objectives and directives are executed timely and effectively.
- Excellent organizational, project management, and leadership skills with ability to think strategically.
- Ability to adapt to changing situations by taking on ad hoc duties.
- Technical proficiency with various software applications to include Microsoft Windows, WORD, EXCEL, PowerPoint, and Outlook.
- Knowledge, Skills, and Abilities:
Compensation
- The posted salary range is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.
Benefits
- 10+ Years staff and project management experience in insurance health care anti-fraud functions
This listing is sourced directly from Bcbsa's careers page and normalized into a canonical job model.