Job Description
About Blue Cross Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us.
How Is This Role Important To Our Work? This position is responsible for executing the enterprise-wide fraud risk management and awareness program to address internal and external fraud risks. Participates in cross-functional fraud initiatives through collaboration with Operations, Enterprise Risk Management, Compliance, Internal Audit, Special Investigations Unit, Information Technology, and Finance, as well as other partners within the organization to implement changes to further prevent and detect fraud.
A Day In The Life Governance
- Create and communicate fraud policies across the organization and establish a process to monitor adherence to fraud policies.
- Implement a fraud prevention and detection framework to ensure a consistent approach to fraud across the enterprise through effective process discipline, execution, insight, and oversight.
- Enhance organizational fraud awareness through implementation of training programs to ensure associates are aware of potential fraud risks, mitigation strategies and how to report fraud.
Fraud Risk Assessment
- Assists in conducting routine Enterprise Fraud Risk Assessments (EFRA).
- Understand and quantify potential fraud risks associated with new or proposed processes or procedural changes, new products, or programs.
- Coordinate with Information Technology on cybersecurity efforts including social engineering tests to identify high risk areas.
Fraud Control Activities
- Leverage EFRA results, fraud expertise and partnerships with internal stakeholders and executive leadership to identify process control opportunities to mitigate fraud risk.
- Analyze data to determine areas with high fraud loss levels, or opportunities for loss, and develop solutions to mitigate fraudulent activity.
Fraud Risk Monitoring
- Utilize comprehensive reporting and analysis to monitor fraud trends and drive improvements.
- Track measurable benchmarks and reporting to evaluate effectiveness of fraud mitigation strategies.
Fraud Investigation and Corrective Action
- Conduct fraud investigations across a broad scope of functional areas within the organization.
- Conduct investigations and perform ad-hoc analysis.
Required Skills And Experiences - 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
- Strong communication, organization, analytical and project management skills.
- Demonstrated ability to analyze and interpret data and develop strategic recommendations.
- Certified Fraud Examiner (CFE) in good standing through the Association of Certified Fraud Examiners or ability to obtain certification within two years of hire.
Nice To Have - Bachelor's degree.
- Advanced knowledge of the health care and insurance industry.
- Thorough understanding and knowledge of BCBSMN operations, products, and systems.
- Proficient in the use of data analytics tools and superior Excel, Word, and PowerPoint skills.
Compensation And Benefits Pay Range: $88,600.00 - $117,400.00 - $146,200.00 Annual
Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.
We Offer a Comprehensive Benefits Package Which May Include - Medical, dental, and vision insurance
- Life insurance
- 401k
- Paid Time Off (PTO)
- Volunteer Paid Time Off (VPTO)
- And more
To discover more about what we have to offer, please review our benefits page.
Make A Difference Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to
[email protected].
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
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