About Blue Cross

Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.9 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us. Please note that effective 11/23/2021, all associates must be fully vaccinated for COVID19 unless legally entitled to a reasonable accommodation related to religious or medical exemptions.

How Is This Role Important To Our Work?

This position is responsible for leading all aspects of and carrying out the enterprise-wide fraud risk management and awareness program to address internal and external fraud risks. Owns the cross-functional fraud initiatives through collaboration with the Operations, Enterprise Risk Management, Compliance, Internal Audit, Special Investigations Unit, Information Technology, and Finance teams, as well as other internal partners to implement changes to further prevent and detect fraud.

A Day In The Life:

Governance

• Facilitates the creation of fraud policies and communicate policies across the organization and establish a process to monitor adherence to fraud policies. Develops a fraud prevention and detection framework to ensure a consistent approach to fraud across the enterprise through effective process adherence, execution, insight, and oversight.
• Improves organizational fraud awareness through development of training programs to ensure associates are aware of potential fraud risks, mitigation strategies and how to report fraud.

Fraud Risk Assessment

• Coordinates and conducts routine Enterprise Fraud Risk Assessments (EFRA).
• Understands and quantifies potential fraud risks associated with new or proposed processes or procedural changes, new products, or programs.
• Meets and discusses results of the EFRA with various leaders throughout the organization including the Executive Leadership Team (ELT).
• Coordinates with Information Technology on cybersecurity efforts including social engineering tests to identify high risk areas.

Fraud Control Activities

• Uses EFRA results, fraud expertise and partnerships with internal associates and leadership to identify process control opportunities to mitigate fraud risk.
• Analyzes data to determine areas with high fraud loss levels, or opportunities for loss, and develops solutions to mitigate fraudulent activity.

Fraud Risk Monitoring

• Develops comprehensive reporting and analysis to supervise fraud trends and drive improvements.
• Develops and watches measurable benchmarks and reporting to evaluate efficiency of fraud mitigation strategies.

Fraud Investigation and Corrective Action

• Oversees and conducts fraud investigations across a broad scope of functional areas within the organization.
• Proactively investigates and researches fraud and risk management trends in the industry.
• Conduct investigations and perform ad-hoc analysis.

Nice To Have:

• Bachelor’s degree.
• Sophisticated knowledge of the health care and insurance industry.
• Thorough understanding and knowledge of Stella operations, products and systems.
• Proficient in the use of data analytics tools and superior Excel, Word and PowerPoint skills.

Required Skills and Experiences:

• 8 years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Excellent organizational skills, excellent analytical skills, strong problem resolution skills, strong project management skills, and ability to adapt to a changing environment and work independently.
• Proven ability to analyze and interpret data and develop strategic recommendations.
• Excellent communication, relationship building, proven collaboration and consultation skills.
• Ability to influence leadership through clear presentation and communication of sophisticated data analysis.
• Certified Fraud Examiner (CFE) in good standing through the Association of Certified Fraud Examiners or ability to acquire certification within one year of hire!

Make a difference

Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.

Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.

All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.