Investigator II

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years , we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. About the Role This position is accountable for analytical and investigative activities (external and internal) related to claims, enrollment, accounting and other operations to detect, receive and review suspected fraud and to complete cases with all information and analysis for resolution, as the manager and prior approved guidelines may direct. What You'll Do Prepares and documents fraud cases, assembling evidence for potential prosecution or civil litigation. Provides evidence and/or testifies in cases where law enforcement agencies pursue prosecution. Personally handles field investigation work; and coordinates efforts with law enforcement state agencies and claims stakeholders. Represents the Company in conducting complex and potentially multi-million dollar settlement negotiations with attorneys and/or other responsible parties