FWA Triage and Liaision - Hybrid

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.AZ Blue offersa variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week

• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week

• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

• Onsite: daily onsite requirement based on the essential functions of the job

• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

This position is hybrid within the state of AZ only.This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.

PURPOSE OF THE JOB

The Fraud, Waste, and Abuse (FWA) Triage and Liaison serves as a vital point of contact and coordinator within the organization, responsible for receiving, assessing, and facilitating the investigation of suspected instances of fraud, waste, and abuse. This position ensures prompt and accurate evaluation of reports, collaborating with internal and external stakeholders (including vendors and segment General Managers).

QUALIFICATIONS

REQUIRED QUALIFICATIONS

Required Work Experience

• 2 years of experience in compliance, investigations, auditing, or a related field
• Familiarity with laws and regulations related to fraud, waste, and abuse, such as the False Claims Act, Anti-Kickback Statute, and relevant federal/state regulations.
• Experience with healthcare fraud shield systems and demonstrated ability to tailor such systems to meet business requirements.

Required Education

• Bachelor's degree in Criminal Justice, Business Administration, Public Health, Compliance, or related field

Required Licenses

• N/A

Required Certifications

• N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

• 4 years of experience in compliance, investigations, auditing, or a related field

Preferred Education

• Advanced degree preferred

Preferred Licenses

• N/A

Preferred Certifications

• N/A

ESSENTIALJOB FUNCTIONS AND RESPONSIBILITIES

• Receive, review, and categorize incoming reports of suspected fraud, waste, and abuse from internal and external sources.
• Conduct initial triage to determine the severity, credibility, and urgency of reported cases.
• Document findings, maintain systematic case records, and ensure information is handled confidentially and in compliance with organizational policies and relevant laws.
• Liaise with investigation teams, compliance officers, legal counsel, vendors, segment General Managers, and other relevant stakeholders to coordinate follow-up actions and tailor strategies for each business line.
• Facilitate communication between whistleblowers, complainants, investigative bodies, vendors, GMs, and multiple departments, ensuring clarity and timely responses.
• Track the progress and outcomes of referred cases, providing regular status updates as appropriate.
• Identify trends, patterns, and potential systemic issues through analysis of reported FWA cases.
• Prepare reports and present findings to management, compliance committees, or regulatory agencies as necessary.
• Master and adapt healthcare fraud shield systems to optimize detection of FWA in both pre-payment and post-payment scenarios, customizing these tools for each line of business in collaboration with segment GMs.
• Support training and awareness initiatives related to fraud, waste, and abuse prevention.
• Assist in the development and continuous improvement of protocols for FWA detection and response, ensuring these protocols meet the specific needs of each segment.
• Multitask and collaborate effectively with multiple departments to support organizational goals and ensure seamless operations.
• Hybrid or onsite work environment depending on organizational needs.
• Occasional travel may be required for training, meetings, or casework.
• Position may entail handling sensitive or distressing information.
• The position has an onsite expectation of 1 day per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
• This role will also function as a backup for the Fraud, Waste, Abuse Reporting Analyst position, providing coverage during absences, vacations, or other times when support is required.
• Perform all other duties as assigned.

REQUIRED COMPETENCIES

Required Job Skills

• Proficiency in case management systems, Microsoft Office Suite, and data analysis tools.

2. Required Professional Competencies

• Strong multitasking, analytical, organizational, and interpersonal communication skills.
• Ability to handle confidential and sensitive information with integrity

3. Required Leadership Experience and Competencies

• Demonstrated ability to work independently and collaboratively across departments in a fast-paced environment.

PREFERRED COMPETENCIES

Preferred Job Skills

• Experience in healthcare, insurance, or government programs dealing with FWA issues.

Preferred Professional Competencies

• Certification in compliance, fraud examination, or auditing (e.g., CFE, CHC, CIA) is an asset.
• Strong problem-solving and conflict resolution skills.
• Excellent written and verbal communication skills, including the ability to prepare clear and concise reports.

Preferred Leadership Experience and Competencies

• Commitment to upholding ethical standards and promoting a culture of accountability.

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.