Investigator I

Horizon Connect @ Wall BCBSNJ

. Gather, analyze, and interpret documentation to conduct investigations .

Posted 9/15/2026full-timeRemote • Connecticut • United StatesJuniorMid-Level💰 $50,100 - $67,095 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in claims processing and investigative analysis, with proficiency in NASCO and NCompass systems. Strong analytical and organizational skills are essential for effective data interpretation and resolution of fraudulent activities.

Highest-signal resume keywords

Nasco Claim ProcessingNCompass Inquiry HandlingClaims Processing Systems KnowledgeData Analysis and InterpretationMicrosoft Excel Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingData AnalysisRoot Cause AnalysisInvestigative DocumentationEvidence Preparation

Soft Skills

Organizational SkillsInterpersonal SkillsAnalytical Skills

Tools & Technologies

NASCONCompassCognosImage/FileNetClearQuest

Industry Keywords

Fraud InvestigationBlue Card ProcessClaims SuspensionASO AccountsService Level Agreements

Tech Stack

Tools & technologies

Cognos

About the role

Key responsibilities & impact

Gather, analyze, and interpret documentation to conduct investigations
Support investigators in researching and resolving fraudulent activity
Analyze exposure, provider, and claims data using relevant systems and software
Manage Special Investigations Unit pended claims to meet SLAs and service standards for ASO accounts and Blue Card requirements
Ensure timely, accurate, and efficient resolution of pended claims in NASCO and the BPM tool
Serve as primary contact for fraud claim inquiries and referrals
Research, document, and track issues in Blue Card admin and/or BPM tools; forward issues and track resolution
Conduct investigative activities on less complex case reviews, including analyzing coding and preparing, documenting, and assembling evidence for potential prosecution and civil litigation
Collect and submit information for claim suspension entries via ClearQuest tickets and update claim suspensions
Create and maintain UCSW/NCompass alerts and handling instructions; share active claim suspension listings for financial reporting and claim savings tracking
Investigate Fraud Hotline calls, including member and provider outreach, medical-record requests, and claim review
Follow established procedures and research across multiple systems and tools; share systems and tool knowledge with Investigative and/or PPR staff
Analyze and review confidential and highly sensitive investigative materials concerning employees, subscribers, providers, and groups
Assist with claims and/or UCSW/NCompass inventory reports, daily aging reports, and process automation reports
Collect, collate, analyze, and interpret data and documents for investigations and subpoena fulfillment

Requirements

What you’ll need

Bachelor’s degree or relevant experience in lieu of degree required
Two (2) years’ experience with Nasco claim processing
One (1) year experience with NCompass inquiry handling
Specific knowledge of claims processing and customer service systems (NASCO adjustment and pend processing, UPS, UCSW, Research Station, Cognos, and Image/FileNet)
Knowledge of ITS/Blue card process preferred
Knowledge of Microsoft products (Word, Excel, and Access) preferred
Demonstrated ability in MS Office applications, particularly Excel and Access
Strong organizational skills
Strong interpersonal skills
Strong analytical skills and ability to interpret data and conduct root cause analysis preferred
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Benefits

Comp & perks

Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement