Team Leader II - Fraud Investigations

With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.

Detroit, MI (Hybrid)

Blue Cross Blue Shield of Michigan

When you think of <a href="https://www.bcbsm.com/" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.&nbsp;<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="http://www.bcbsm.com/index/about-us/our-company.html" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />For Application Timeline &amp; Selection Process:&nbsp;<a href="https://s3.amazonaws.com/data.vizirecruiter.com/Images/BCBSMCareers+-+Quick+Reference+Guide.pdf" target="_blank" rel="noopener noreferrer">Click Here</a>. Learn more about your options as an external candidate. <a href="https://ejko.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_3/requisitions" target="_blank" title="BCBSM" rel="noopener noreferrer">Click here</a> to view open positions. http://www.bcbsm.com

keywords: position summary,position details,management,consulting,research,compliance,education,experience,skills,knowledge,departmental preferences,certification

Supervisor

Competitive Total Compensation Package

Overview: Responsible for planning, coordinating, and supervising the daily operations of the Fraud Investigations team to ensure timely, effective, and compliant investigation of suspected fraud, abuse, misconduct, and other activities that may impact Blue Cross Blue Shield of Michigan assets, operations, or reputation. Oversees investigative workflows, staff development, quality assurance, hotline operations, and compliance monitoring activities while serving as a technical resource and escalation point for complex investigations. Collaborates with internal business partners, Compliance, Human Resources, Audit, Legal, and external agencies to support fraud prevention, risk mitigation, regulatory compliance, and organizational integrity.
Responsibilities: <ul> <li> <p>Supervise and promote the professional development of assigned staff through selection, development, and exploration of more effective methods of managing projects and time.</p> </li> <li> <p>Research, (internally and externally), initiate, and plan strategic changes in assigned department(s)/area(s) to optimize technologies and personnel.</p> </li> <li> <p>Recommend and assist in acquisition of technology and other tools or equipment and resources to optimize departmental performance and output.</p> </li> <li> <p>Prioritize and assign work to employees and initiate corrective measures to resolve problems, including scheduling or adjusting overtime requirements as necessary.</p> </li> <li> <p>Interface with diverse levels of internal and external personnel to develop and maintain effective rapport and to resolve issues and inquiries.</p> </li> <li> <p>Administer and adhere to Corporate and departmental policies, practices and procedures.</p> </li> </ul>
Requirements: <p><strong>EDUCATION AND EXPERIENCE</strong>&nbsp;</p> <ul> <li> <p>Bachelor's Degree in related field preferred.</p> </li> <li> <p>A minimum of 90 college credits is required.</p> </li> <li> <p>Five (5) years of BCBSM/BCN and/or related field experience including at least two (2) years of experience in a leadership role.</p> </li> </ul> <p>&nbsp;</p> <p><strong>OTHER SKILLS AND ABILITIES&nbsp;</strong></p> <ul> <li> <p>Strong organizational, planning, analytical and communication skills.</p> </li> <li> <p>Excellent interpersonal skills necessary to interact with all levels of personnel.</p> </li> <li> <p>Working knowledge of PC application and/or mainframe systems preferred.</p> </li> <li> <p>Other related skills and/or abilities may be required to perform this job.</p> </li> </ul> <br /> <p><strong>DEPARTMENTAL PREFERENCES</strong></p> <ul> <li>Bachelor's degree in Criminal Justice, Business Administration, Healthcare Administration, Finance, Accounting, Compliance, or a related discipline preferred.</li> <li>Five (5) or more years of experience conducting fraud, compliance, audit, corporate investigations, healthcare investigations, financial investigations, or related investigative activities.</li> <li>Experience supervising a compliance hotline, ethics hotline, fraud reporting hotline, customer contact center, call center, or other high-volume intake operations.</li> <li>Experience managing investigative intake, case triage, case assignment, and escalation processes.</li> <li>Knowledge of healthcare fraud, financial fraud, abuse detection, corporate investigations, compliance monitoring, or risk management practices.</li> <li>Experience administering sanction and exclusion monitoring programs, including screening and monitoring activities required to support compliance with federal regulations and anti-money laundering and terrorist financing controls associated with the USA PATRIOT Act of 2001.</li> <li>Knowledge of federal and state exclusion databases, sanctions screening processes, and regulatory compliance requirements.</li> <li>Experience utilizing investigative, compliance, case management, reporting, analytics, or call center technologies.</li> <li>Professional certifications such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified Anti-Money Laundering Specialist (CAMS), Certified Compliance and Ethics Professional (CCEP), or similar credentials preferred.</li> <li>Demonstrated ability to analyze complex information, exercise sound judgment, maintain confidentiality, and communicate effectively with all levels of leadership and external stakeholders.</li> </ul>