Workforce Classification:

Join Our Team: Do Meaningful Work and Improve People’s Lives

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we are fostering a culture that emphasizes employee growth, collaborative innovation, and inspired leadership. We are dedicated to creating an environment where employees can excel and where top talent is attracted, retained, and thrives. As a testament to these efforts, Premera has been recognized on the 2025 America's Dream Employers list. In 2024, Newsweek honored Premera as one of America's Greatest Workplaces, America's Greatest Workplaces for Diversity, and America's Greatest Workplaces for Mental Wellbeing. Additionally in 2024, Forbes ranked Premera among America’s Best Midsize Employers for the fourth time.

Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/.

As a member of Premera's Special Investigations Unit (SIU), the Investigator II is responsible for developing, collecting, and evaluating information and data, including financial data, in support of investigations of external fraud. The reports prepared by this position are potentially discoverable material, so accuracy and close attention to detail are vital. In this role, you will work in a collaborative environment with other SIU personnel to perform analysis and obtain analytical information of significance to support case investigations. You will also conduct proactive fraud detection using available data mining technology, and will track, collect, evaluate, and distribute Requests for Information (RIA) to include subpoenas in accordance with applicable laws and HIPPA regulations. You may also be responsible for reporting the SIU budget, performance metrics, and data analysis for SIU compliance/performance audits, to be delivered to management and/or external organizations.

This is a hybrid role with onsite days required.

What you’ll do:

• Evaluate internal and external referrals for potential fraud, waste, and abuse allegations and exercise discretion and independent judgment to determine if the referral/matter should be opened as a fraud investigation.
• Compile, manipulate, interpret, and document complex claims payment data to determine the company’s potential financial exposure to a given fraud scheme.
• Gather and analyze data and information from internal and external sources including data extracts, claims systems, payment and medical policies, contracts, public record information systems, other insurance carriers, and law enforcement officers.
• Use public record information and develop internal/external relationships to identify and research suspected external fraud.
• Manage multiple investigative and fraud detection projects concurrently by prioritizing work. Initiate proactive fraud detection using data mining and analysis of trends.
• Identify root causes of fraud and proactively address solutions such as improved procedures, contract language, and medical policies.
• Develop and maintain relationships with SIU personnel at other insurance carriers, national trade organizations, and law enforcement officers.
• Support other investigative staff in field work, such as on-site medical records audits and preparation of cases.
• Maintain internal liaison relationships with data analysts, quality auditors, research analysts, medical review nurses, operations associates and others that may assist in fraud detection and investigation.
• Collect and preserve detailed evidence for successful prosecution of cases.
• Report all investigative activity to Manager, Director, senior management, and external organizations as required.
• Assist in developing, planning, and reporting the SIU budget.
• Participate in special projects, committees, and task forces as assigned.

What you’ll bring:

• Bachelor’s Degree in Business Administration, Healthcare Administration, Finance, Accounting, Nursing or Criminal Justice, or (4) years of equivalent experience (Required)
• (5) years of work experience, including (2) years of experience in the health care industry. (Required)
• 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.

Premera total rewards

Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:

• 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.

• Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.

• Employee recognition program to celebrate anniversaries, team accomplishments, and more.

For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.

• Commuter perks make your trip to work less impactful on the environment and your wallet.

• Free convenient on-site parking.

• Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.

• Engaging on-site events and activities include food trucks, health and wellness, DEI and disaster preparedness fairs, coffee connects, and more.

• Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.

• Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785.

The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.

The salary range for this role is posted below; we generally target up to and around the midpoint of the range.

National Plus Salary Range:

*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.

We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating a diverse and inclusive environment where all employees are celebrated for their unique skills and contributions.