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BCBST is hiring an Investigator II

Are you an experienced investigator with a strong eye for detail and a passion for protecting the integrity of healthcare? At BlueCross BlueShield of Tennessee, our Special Investigations Unit plays a critical role in identifying and addressing potentially fraudulent activity to safeguard our members and resources.

In this role, you will lead end-to-end fraud investigations-analyzing evidence, identifying patterns, conducting interviews, and developing clear, defensible case documentation-while presenting findings to leadership, supporting legal proceedings, and ensuring each case is evaluated for risk and impact. This opportunity is ideal for professionals with experience in white-collar crime or healthcare fraud investigations, particularly those who hold or are pursuing certifications such as CFE, AHFI, ALHC, or CIFI, and are driven to reduce financial loss, strengthen compliance, and enhance fraud prevention strategies across the organization.

Success in this role means delivering well-supported conclusions, identifying trends that strengthen internal controls, and serving as a trusted advisor by providing insights that enable confident decision-making.

Ready to take the next step?

Note:

• This is a remote role with occasional travel across Tennessee, including provider site visits and periodic time in our Chattanooga office. You'll join a collaborative team where your work has a direct impact on our business and the members we serve.
• Sponsorship is not available for this role.
• We foster a culture of innovation, including responsible use of AI-enabled tools to enhance how we serve our members.

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 BCBST-owned vehicle or 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

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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

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.