Investigator

Cahaba Safeguard Administrators, LLC is preparing for future business opportunities in your area.

 

About Our Company

Cahaba Safeguard Administrators, LLC is a wholly owned subsidiary of Blue Cross and Blue Shield of Alabama that was created to administer the provisions of any task orders under the Medicare contract.

 



Department Overview

The Cahaba Safeguard Administrators, LLC Benefit Integrity units identify, investigate and reduce fraud and abuse to the Medicare Program and support law enforcement with these investigations.  Benefit Integrity Investigations, Medical Review and Data Analysis partner to identify potential aberrancies that require further review to determine whether an actual loss to the Medicare/Medicaid Program has occurred.  Once potential fraud and abuse has been identified, the Benefit Integrity unit coordinates appropriate strategies for investigations.

 

 

General Responsiblities

The Investigator is responsible for reviewing, analyzing, and developing allegations of fraud and abuse against the Medicare Trust Fund in accordance with the regulatory guidelines set forth by CMS.  The Investigator will proactively work a caseload for possible referral to external governmental agencies for further investigation/prosecution. This position is responsible for prioritizing case workloads, researching Medicare and medical review guidelines, and state and federal laws.  This position is also responsible for requesting and analyzing data and medical records for case development in a multi-state jurisdiction with multiple benefit structures (including Part A, Part B and RHHI) and multiple claims processing systems.  In addition, the Investigator will actively communicate with law enforcement, CMS, providers, beneficiaries, Medicare Fair Hearings and Administrative Law Judges on a regular basis. 

This position may be filled at a higher level based on experience.

Qualifications

1. Bachelor degree
2. Knowledge of data analysis methods
3. Experience using Microsoft Word
4. Experience using Microsoft Excel
5. Experience in a position interpreting and communicating information orally and written
6. Experience in a position requiring negotiation skills
7. Experience in a position presenting information in formal and informal settings
8. Experience in a position requiring the ability to manage time and work tasks
9. Experience in a position exercising independent judgment and decision-making
10. Ability to travel up to 40%
11. Minimum one year experience in fraud, law enforcement investigations or a related field is preferred
12. Knowledge of claims processing systems is preferred
13. Experience using Access preferred
14. Experience using PowerPoint preferred

 

Work Schedule

The hours for this position are 8:00 a.m. to 4:45 p.m.

 

Conditions of Employment

Applicants selected for employment will be required to pass a pre-employment drug screening and background investigation which may include education, criminal, and work history verifications.

 

How to Apply

Information about current career opportunities can be found on our web site at www.bcbsal.com .  Click on Careers.

To apply, build a profile online and attach your resume by registering with our website.Click on the "Apply Now" button to login or register if this is your first time.

 

In Conclusion

Thank you for your interest in Cahaba Safeguard Administrators, LLC.  We look forward to receiving your application.  Upon review, if you can be considered further you will be contacted by one of our Human Resources representatives.

Again, thank you for your interest in our company.

Cahaba Safeguard Administrators, LLC is an affirmative action and equal opportunity employer.  As such, it is our policy to provide equal opportunity for all qualified persons and not discriminate against any associate or applicant for employment because of race, religion, color, sex, sexual orientation, age, national origin, handicap, disability, or  because he or she is a disabled veteran or a Vietnam Era Veteran.