Investigator III

Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we’re able to better serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for.

As a member of Premera’s Special Investigations Unit (SIU), the
** Investigator III
** leads complex investigations into allegations of external fraud, waste, and abuse (FWA). This role manages medium to high complexity cases from initiation through resolution, producing thorough, well documented investigative reports that may be subject to legal discovery. The Investigator III conducts detailed analysis, collaborates closely with SIU colleagues, and balances multiple investigations simultaneously. In this role, you will also work to identify and recover improper payments resulting from fraudulent or misrepresentative billing, while ensuring all investigative activities comply with company policies, regulatory requirements, and applicable laws.

As a not-for-profit organization, Premera offers the opportunity to do this work with a genuine focus on doing what’s right for our members—supported by leaders who believe in the impact this team makes, not just the metrics. Bachelor’s degree in business administration, health care administration, finance, accounting, nursing or criminal justice or (4) years of work experience in field of study.

(3) years of experience in fraud investigation, special investigation unit, or a related field. Certified Professional Coder (CPC), Certified Fraud Examiner (CFE), or Accredited Health Care Fraud Investigator (AHFI). Two (2) years of active experience in auditing and investigating in the healthcare industry. Significant experience with relevant technology, such as background check systems, claims processing platforms, data mining, and fraud detection software.

Demonstrated knowledge of institutional and/or professional payment methodologies. Strong understanding of health insurance reimbursement methodologies, including familiarity with International Classification of Diseases (ICD-10 CM), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS). Strong computer aptitude and experience with spreadsheet and database software, e.g., Excel, Access, Focus. Demonstrated strong technical writing skills - ability to write reports and business correspondence and to prepare case files.

Ability to exercise a very high level of discretion when handling sensitive information.
* Medical, vision, and dental coverage with low employee premiums.
* Voluntary benefit offerings, including pet insurance for paw parents.
* Life and disability insurance.
* Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.
* Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.
* Generous paid time off to reenergize.
* Employee recognition program to celebrate anniversaries, team accomplishments, and more.

At Premera, we make healthcare work better. By focusing on improving our customers’ experience purposefully and serving their needs passionately, we make the process easier, less costly, and more positive. Through empathy and advocacy, we change lives.
As the leading health plan in the Pacific Northwest, we provide comprehensive health benefits and services to more than 2 million customers, from individuals to Fortune 100 companies. Our services include innovative programs focused on health management, wellness, prevention, and patient safety. We deliver these programs through health, life, vision, dental, disability, and other related products and services.
Premera Blue Cross is headquartered in Mountlake Terrace, WA, with operations in Spokane and Anchorage. The company has operated in Washington since 1933 and in Alaska since 1952. With more than 80 years of experience in the region, we deliver innovation, choice, and expertise.
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