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Summary
About the Role
About You
- Bachelor's degree in Accounting, Finance, Business Administration, Nursing, IT or Related Field.
- 7 years of experience in the Health Insurance industry and/or Healthcare Fraud investigations.
- 3 years of experience in leading projects of varying size and complexity.
- Master's degree in Fraud, Forensics Accounting, Business or related field.
- 5 years in Financial Analysis in an acute care hospital or health insurance setting.
- 5 years in professional billing, facility Patient Financial Services, HIM, Internal Audit, Professional/Facility Reimbursement or Provider Contracting.
- Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), Certified Professional Coder- Hospital (CPC-H), Certified Outpatient Coder (COC), Accredited Healthcare Fraud Investigator (AHFI).
An independent licensee of the Blue Cross Blue Shield Association, Highmark Inc., together with its Blue-branded affiliates, collectively comprise the fifth largest overall Blue Cross Blue Shield-affiliated organization in the country with approximately 7.1 million members in Pennsylvania, Delaware, West Virginia and western and northeastern New York. The following entities, which serve the noted regions, are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield; CPA/SEPA: Highmark Inc. d/b/a Highmark Blue Shield; Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield; West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield; Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield; Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield. All references to “Highmark” are to Highmark Inc. and/or to one or more of its affiliated Blue companies. We're proudly part of Highmark Health.