Responsible for planning, organizing, directing, controlling and leading multiple investigative units and related administrative staff for Blue Cross Blue Shield of Michigan (BCBSM). Set vision and identify strategic direction for the investigative units and related administrative staff. Support corporate goals and objectives.
Direct activities of multiple functional areas, including but not limited to planning, staff development, problem solving and communications.
Establish goals and objectives for the investigative units and related administrative staff that support continuous quality improvement.
Manage and develop investigative and administrative unit leadership to ensure best practices are being employed to address fraud, waste and abuse as it affects BCBSM’s customers and the corporation.
Provide effective and efficient solutions to complex business problems. Interact with other corporate units to identify business solutions that help achieve corporate goals and objectives.
Provide high level oversight and leadership to business unit and lead change effectively.
" Qualifications"
Bachelor's Degree in Criminal Justice, Business Administration or related field is required. Master's Degree in related field is preferred.
Nine (9) years of experience investigating financial fraud, internal affairs, organized crime, white-collar crime or complex investigations working directly with federal, state or local law enforcement agencies is required.
Five (5) years of experience leading a team is required.
Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), or Certified Professional Coder (CPC) certification(s) is preferred.
Excellent analytical, organizational, planning, problem solving, verbal and written communication skills.
Ability to maintain composure and confidence in risk situations and work under minimal direction.
Comprehensive knowledge of legal and investigative procedures used in the detection and successful prosecution of health care fraud cases.
Advanced knowledge of witness and suspect interviews, evidence gathering, surveillance, undercover activity and investigative report writing as well as criminal law and procedures.
Advanced understanding of federal and state judicial processes related to fraud prosecutions.
Advanced understanding of accounting procedures and proactive data processing systems.
Ability to work effectively in a team environment.
All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.
