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Are you a seasoned **Investigator** with a keen eye for detail and a drive to protect the integrity of healthcare? At BlueCross BlueShield of Tennessee, our Special Investigation Unit plays a critical role in safeguarding our members and resources by identifying and analyzing potentially fraudulent insurance claims\.

If you bring over eight years of experience in white\-collar crime or healthcare fraud investigations as well as certifications such as CFE, AHFI, ALHC, or CIFI, you'll lead complex investigations, conduct interviews, and deliver findings that influence high\-stakes decisions\. Your expertise will support legal proceedings and uphold the trust our members place in us\. We're looking for proactive, organized professionals with strong communication skills and proficiency in Microsoft Office\.

Our Investigator role presents an opportunity to join a collaborative team where your work has real impact—on our business, our members, and the future of healthcare in Tennessee\.

This is a remote position that requires frequent monthly travel to provider offices throughout the Middle Tennessee area for investigative purposes, as well as quarterly travel to the company headquarters in Chattanooga, TN for meetings\.

Job Responsibilities

+ Preparing legal and investigation documentation; presenting findings and making recommendations to management\.

+ Participating in legal proceedings when necessary\.

+ Analyzing all evidence, looking for possible fraud, and conducting ongoing investigations\.

+ Conducting interviews with parties involved and obtaining the information needed to determine the validity of claims\.

Job Qualifications

_Education_

+ Bachelor's Degree or equivalent work experience required\. Equivalent experience is defined as 4 years of professional work experience in a corporate environment

_Experience_

+ 8 years \- Experience in the investigation of healthcare fraud investigations or similar white collar criminal investigations required

_Skills\\Certifications_

+ Industry designation involving Healthcare Fraud Investigation, such as the Certified Fraud Examiner \(CFE\), Accredited Health Care Fraud Investigator \(AHFI\), Associate, Life and Health Claims \(ALHC\), Certified Insurance Fraud Investigator \(CIFI\)

+ Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability\.

+ Proficient in Microsoft Office \(Outlook, Word, Excel and Powerpoint\)

+ Must be a team player, be organized and have the ability to handle multiple projects

+ Excellent oral and written communication skills

+ Strong interpersonal and organizational skills

Employees who are required to operate either a personal or rental vehicle for company business on a routine basis\* will be automatically enrolled into the BCBST Driver Safety Program\. The employee will also be required to adhere to the guidelines set forth through the program\. This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST\-Owned Vehicle” Policy \(for employees driving personal or rental vehicles only\); and maintaining an acceptable motor vehicle record \(MVR\)\. \*The definition for "routine basis" is defined as daily, weekly or at regularly schedule times\.

Number of Openings Available

1

Worker Type:

Employee

Company:

BCBST BlueCross BlueShield of Tennessee, Inc\.

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin,citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law\.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices \(https://www\.bcbst\.com/docs/equal\-employment\-opportunity\.pdf\)

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity\. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via\-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered\. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means\.

As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health since 1945\. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow\.

At BCBST, we empower our employees to thrive both independently and collaboratively, creating a collective impact on the lives of our members\. We seek talented individuals who excel in a team environment, share responsibility, and embrace accountability\.

We're also seeking candidates who are proficient in the Microsoft Office suite, including Microsoft Teams, organized, and capable of managing multiple assignments or projects simultaneously\. Additional, strong interpersonal abilities along with strong oral and written communication skills are important across all roles at BCBST\.

BCBST is a remote\-first organization with many employees working primarily from their homes\. Each position within the company is classified as either fully remote, partially remote, or office based\.

BCBST hires employees for remote positions from across the U\.S\. with the exception of the following states: California, Massachusetts, New Hampshire, New Jersey, and New York\. Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense\.If the position requires the individual to reside in Chattanooga, TN, they may be eligible for relocation assistance\.