LogoFresh Jobs Ahead
H
Horizon Connect @ Wall BCBSNJ
Sog‘liqni saqlashTibbiy sug‘urta
Horizon Connect @ Wall BCBSNJ nomi Horizon Blue Cross Blue Shield of New Jersey bilan bog‘liq mahalliy dastur yoki ofisni anglatadiganga o‘xshaydi. U tibbiy sug‘urta sohasi bilan aloqador bo‘lib, Nyu-Jersi shtatining Uoll hududida a’zolar va tibbiy xizmat ko‘rsatuvchilar bilan mahalliy aloqa hamda hamkorlikka e’tibor qaratishi ko‘rinadi. Ochiq manbalardagi ma’lumotlar cheklanganligi sababli, ushbu profil mustaqil kompaniyaning kengroq tavsifidan ko‘ra tashkilot nomida ko‘rsatilgan aloqani aks ettiradi.
LinkedIn
Kompaniyadagi ish o‘rinlari

Investigator II, Health Insurance Fraud

Investigate suspected health insurance fraud, including claims and Federal Employee Program eligibility cases, for Horizon Blue Cross Blue Shield of New Jersey. Build case records, coordinate with law enforcement and stakeholders, and support legal proceedings.

USAmerika Qo‘shma ShtatlariCTKonnektikutNJNyu-JersiNYNyu-YorkPAPensilvaniya
63 000 $ – 84 420 $ / yil
MasofaviyTo‘liq stavkaJuniorO‘rta darajaDiplom talab qilinmaydiTalab Qilinadigan Til: inglizchaTergovchiUmumiy

Tavsif

  • Review claims, enrollment, accounting, and operational activity to identify and investigate suspected fraud.
  • Prepare fraud case files and assemble evidence for possible criminal prosecution or civil litigation.
  • Provide evidence and testify when law enforcement agencies pursue prosecution.
  • Conduct field investigations and coordinate with law enforcement, state agencies, and claims stakeholders.
  • Represent the company in complex settlement negotiations with attorneys and other responsible parties.
  • Testify in fraud-related legal proceedings as needed.
  • Follow the latest Federal Employee Health Benefits Carrier Letter procedures and guidelines.
  • Investigate Federal Employee Program cases, including eligibility matters.
  • Maintain the FEP SIU Tracking System with case activity, subpoenas, financial details, audits, referrals, settlements, and convictions.
  • Liaise with the BCBSA FEP SIU Consultant.
  • Handle hotline calls concerning fraud in the FEP program.

Talablar

  • A high school diploma or GED is required.
  • At least two years of experience in claims, customer service, or relevant law enforcement is required.
  • Knowledge of ITS or Blue Card is preferred.
  • Basic knowledge of health insurance operations, such as claims, enrollment, and underwriting.
  • Basic knowledge of special investigation unit operations in health insurance.
  • Strong verbal and written communication skills.
  • Ability to manage confrontational situations effectively.
  • Proficiency with Microsoft Office applications, especially Excel and Access.
  • Strong organizational abilities.
  • Willingness to travel as needed for investigations within the company’s service area.
  • Must live in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

Imtiyozlar

  • Medical, dental, and vision coverage.
  • Retirement plans.
  • Generous paid time off.
  • Incentive plans.
  • Wellness programs.
  • Paid volunteer time off.
  • Tuition reimbursement.

O‘xshash ish o‘rinlari

LifeStance Health

Remote Billing Solutions Coordinator

LifeStance Health
5 001 – 10 000 Xodimlar
H1B vizasi homiysiKonsaltingSog‘liqni saqlashSug‘urta
USAmerika Qo‘shma Shtatlari
20 $ / soat
MasofaviyTo‘liq stavkaJuniorO‘rta darajaDiplom talab qilinmaydiTalab Qilinadigan Til: inglizchaHisob-kitob koordinatoriUmumiy

Support patients and care teams with billing, insurance, and account questions at LifeStance Health. Handle payments, insurance records, and revenue cycle issues through remote phone and digital channels.

Ochish
Neptune Retail Solutions

Program Coordinator, Retail Marketing

Neptune Retail Solutions
1 001 – 5 000 Xodimlar
Chakana savdoElektron tijoratMarketing
USAmerika Qo‘shma ShtatlariNJNyu-JersiMasofaviyTo‘liq stavkaJuniorO‘rta darajaDiplom talab qilinmaydiTalab Qilinadigan Til: inglizchaDastur koordinatoriUmumiy

Coordinate retail marketing campaigns and client programs supporting Canadian sales, from kickoff through execution and invoicing. Manage timelines, meetings, campaign materials, and coordination between clients and internal teams.

Ochish