All about us
You likely know us as an insurance company, but that’s just a portion of what we do. Hundreds of thousands of North Dakotans trust us to provide them with personalized service and unmatched access to care. It’s a mission we take seriously.
We also work with entities throughout the state to challenge the cost and complexity of health care in North Dakota. This uncompromising goal requires caring, innovative people who are ready and willing to help create a new level of health and well-being in North Dakota and beyond.
Work environment
This opportunity is open to a remote, hybrid or in-office working arrangement out of the Fargo, ND office. We empower our employees to find a work style that is best for them. Learn more at Life at Blue | BCBSND.
Pay information
- Pay Level: 021
- FLSA Category: Non-Exempt – Hourly
- Individual pay will be based on skills, experience, qualifications, location, internal equity, and other relevant factors.
- Opportunities for continued salary growth through a performance-based merit program.
A day in the life
The Investigator is responsible for investigating moderately complex allegations of fraud, waste and abuse perpetrated by healthcare providers, facilities, members and/or groups and provides support in investigations of higher complexity. This position identifies areas of concerns using software, tips, interviews, and other means.
Your responsibilities will include
- Uses software analysis and other resources to conduct moderately complex investigations.
- Gathers and analyzes data from relevant resources, documenting all steps of investigations.
- Assesses the company’s potential exposure level to help determine case prioritization.
- Identifies aberrant patterns and/or suspected fraud, waste, or abuse practices.
- Maintains accurate records, documentation, and evidence for each case.
- Develops detailed formal case reports and corrective action plans as appropriate for each investigation.
- Manages a full case load by performing multiple low to mid-level investigations concurrently.
- Submits claims for adjustment in accordance with established processes and policies.
- Collaborates with management and/or internal staff to determine appropriate case resolution when guidance is needed.
- Assists in identifying internal process improvement to prevent future fraud, waste, or abuse occurrences.
- Builds and maintains up-to-date knowledge of trends and techniques in detecting fraud, waste, and abuse.
- Performs work under general supervision. Handles moderately complex issues and problems and refers more complex issues to higher-level staff.
What you need to succeed
- A Bachelor's degree in Healthcare, Business, Finance, Criminal Justice or related field
- 3 years of experience in audits, data analysis, healthcare or healthcare claims, investigations, law or related experience.
- Prior experience in the healthcare industry, a plus
- Be a problem solver with the ability to research, analyze and define methods, practices, and procedures to resolve issues.
- Brings a creative mindset and a go-get-em’ attitude to find ways to improve upon processes and projects.
- A strong ability to prioritize and organize work with varying timelines for projects and daily work.
- A keen attention for detail
- Be an effective communicator with a collaborative mindset.
- Skilled in research and analytical thinking to support investigations and decision-making.
Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards
Benefits
- Affordable medical, dental and vision coverage accepted throughout the United States
- Employer funded Lifestyle Spending Accounts, Health Savings Accounts and Health Reimbursement Arrangements
- Employer-paid life and disability insurance
- 401(k) retirement plan with company match and immediate vesting
- Paid holidays, paid time off (PTO), PTO donation program, and paid parental leave
- Voluntary benefits including Accident, Hospital Indemnity, Critical Illness, Term/Whole Life, Cancer Care Insurance, and more.
Additional company perks
- Robust mental health offerings including an Employee Assistance Program, Learn to Live, meQ.
- Comprehensive learning and development opportunities and an Educational Assistance Program.
- 16 hours of paid volunteer time with a $200 donation to a charity of your choice upon completion of all volunteer hours.
- Employee recognition, community initiative events and yearly company outings.
- Workplace flexibility offering different options for working arrangements and the freedom to make time for important commitments.
- Opportunities to connect through employee committees.
Equal opportunity employment
Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.
For questions, please email [email protected].
This job posting will be closed 08/1/25 at 8:00 a.m. (CT). No further applications will be considered.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
