Special Investigations Unit Manager

The Legal Department provides legal guidance to Blue Cross and Blue Shield of Alabama in the areas of preventive and defensive law. The associates in the Legal Department provide the vital legal guidance that helps Blue Cross continue its role as the market leader in an industry that is affected by continuous changing laws and regulations.

This position is responsible for the daily management of direct reports and activities in the Special Investigations Department. The Unit is responsible for the detection, case development and remediation in cases of suspected fraud, waste and abuse (FWA) involving commercial and government products lines. The Special Investigations department serves as the Special Investigation Unit (SIU) for the corporation and is responsible for FWA activities involving providers (i.e. facilities, physicians, and other health care providers), employer groups and members.

• Bachelor's Degree in a field relating to Healthcare, Healthcare Delivery, Legal Process, or Criminal Justice
• 3 years of relevant work experience in areas such as legal, healthcare, audit, investigations and/or law enforcement
• Understanding of statistics and an analytic aptitude
• Solid interpersonal skills and experience resolving diverse interests in order to accomplish corporate objectives, which includes making formal presentations, negotiating, working collaboratively with all levels of management, and representing a company in a positive manner external to the company
• Strong dispute resolution and negotiation skills in order to interface appropriately with many different provider types, external agencies, other Blue Plans, and external business partners
• Understanding of various issues affecting the health care industry and their interrelationship
• Understanding of legal and regulatory process as it applies to a commercial business/ insurance environment and an understanding of the commercial insurance business structure and process
• Knowledge of claims processing and provider reimbursement preferred
• Proven strategic leader with strong decision making skills preferred
• Proven experience mentoring and developing others preferred
• Strong organizational and time-management skills preferred
• Investigator (AHFI, CFE), Certified Professional Coder (CPC) and/or Professional healthcare practitioner license preferred
• CIA certification a plus
• CPA licensure a plus

By submitting a job application, I attest that all information to the best of my knowledge is true and accurate. Furthermore, I understand that any information provided by me throughout the job application process is subject to verification including, but not limited to work experience, education, assessment (test) and interviews.
We appreciate your interest in Blue Cross and Blue Shield of Alabama 'The Company'. The Company does not discriminate in hiring or employment on the basis of race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetics, status as a disabled or protected veteran, or because of citizenship status in the case of a citizen or intending citizen. No question on this application is intended to secure information to be used for such discrimination.
Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association