Director, Special Investigations Unit

E-Verify Program

Director of Special Investigations Unit overseeing fraud prevention and investigation at Blue Cross NC. Leading high-performing teams to combat fraud, waste, and abuse in healthcare.

Posted 4/14/2026full-timeRemote • Kentucky, North Carolina, South Carolina, Wisconsin, Wyoming • 🇺🇸 United StatesLead💰 $130,560 - $208,896 per yearWebsite

About the role

Key responsibilities & impact

Establishes and operationalizes SIU strategic plan.
Leads an organization that effectively identifies sources of FWA.
Oversees the SIU staff comprised of analysts, investigators, nurses, and data analytics personnel.
Creates an environment that assures full compliance with all legal and regulatory mandates.
Maintains a comprehensive understanding of emerging and current FWA trends and schemes.
Develops fraud detection analytics, including a comprehensive analytics process.

Requirements

What you’ll need

Bachelor’s degree in preferably business administration, health care administration, finance, accounting, nursing or criminal justice.
Minimum of 5 years supervisory experience.
10 years of investigative experience of which 3 years must be in law enforcement, a juris doctorate, fraud certification, medical coding certification, or a medical professional such as a doctor or registered nurse.
Certified Fraud Examiner and/or Accredited Healthcare Fraud Investigator.

Benefits

Comp & perks

Medical, dental, and vision coverage along with numerous health and wellness programs.
Parental leave and support plus adoption and surrogacy assistance.
Career development programs and tuition reimbursement for continued education.
401k match including an annual company contribution.

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

fraud detection analyticsdata analyticscomplianceinvestigative techniquesmedical coding

Soft Skills

leadershipstrategic planningorganizational skillscommunication

Certifications

Certified Fraud ExaminerAccredited Healthcare Fraud Investigator