{"id":2207141,"url":"https://alion.io/job/premera-investigator-iii","title":"Investigator III","company":{"id":18095,"name":"Premera","domain":"premera.com","url":"https://alion.io/company/premera","size_band":"501-1000","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Workday","truth_index":{"grade":"A","score":92,"open_postings":6,"ghost_share":0,"stale_share":0.333,"repost_share":0,"time_to_fill_p50_days":55,"computed_at":"2026-10-25T05:49:26Z"}},"role":"Operations","role_family":"Operations","seniority":"middle","employment_type":"full_time","work_mode":"hybrid","remote_scope":null,"remote_scope_basis":null,"remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["Mountlake Terrace, United States"],"countries":["US"],"hiring_countries":[],"hiring_countries_total":0,"salary":{"min":80200,"max":118300,"currency":"USD","period":"year","gross":null,"usd_annual":118300},"salary_estimate":null,"experience_years_min":null,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[],"status":"live","first_seen_at":"2026-08-18T00:00:00Z","employer_posted_date":"2026-08-18","last_verified_at":"2026-10-22T14:04:29Z","board_verified":false,"closed_at":null,"days_open":68,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":68},"description":"Workforce Classification:\nHybridJoin Our Team: Do Meaningful Work and Improve People’s Lives\nOur 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.\nPremera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we’re able to better serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace.\nLearn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/.\nAs a member of Premera’s Special Investigations Unit (SIU), the Investigator III leads complex investigations into allegations of external fraud, waste, and abuse (FWA). This role manages medium to -high complexity cases from initiation through resolution, producing thorough, -well documented investigative reports that may be subject to legal discovery. The Investigator III conducts detailed analysis, collaborates closely with SIU colleagues, and balances multiple investigations simultaneously. In this role, you will also work to identify and recover improper payments resulting from fraudulent or misrepresentative billing, while ensuring all investigative activities comply with- company policies, regulatory requirements, and applicable laws. As a not-for-profit- organization, Premera offers the opportunity to do this work with a genuine focus on doing what’s right for our members-supported by leaders who believe in the impact this team makes, not just the metrics.\nThis hybrid role can be based in Anchorage, Mountlake Terrace, or Spokane.\nWhat you’ll do:\nAnalyze healthcare claim data and vet referrals to detect fraudulent activity and independently determine the most effective and efficient method of investigation for each individual case.\nPerform investigative field work to include on-site office visits, record collection, and surveillance.\nInterview suspects and witnesses.\nPrepare cases, testify and give depositions to law enforcement and regulatory agencies for potential criminal prosecution.\nParticipate in settlement negotiations with attorneys and other responsible parties.\nPerform root cause analysis of identified issues and prepare post-investigative reports directed towards the prevention of fraud.\nMake recommendations for creating SIU policies, procedures, workflows and process improvements.\nDevelop and maintain collaborative and liaison relationships with Blue Cross Blue Shield Association (BCBSA), Blue Cross Blue Shield (BCBS) Plans, HHS OIG, other carriers' anti-fraud professionals, law enforcement and regulatory agencies.\nMay attend webinars and conferences like BCBSA, National Health Care Anti-Fraud Association (NHCAA), and Association of Certified Fraud Examiners (ACFE) to keep apprised of developments in health care fraud.\nWhat you’ll bring:\nBachelor’s degree in business administration, health care administration, finance, accounting, nursing or criminal justice or (4) years of work experience in field of study. (Required)\n(3) years of experience in fraud investigation, special investigation unit, or a related field. (Required)\nCertified Professional Coder (CPC), Certified Fraud Examiner (CFE), or Accredited Health Care Fraud Investigator (AHFI). (Preferred)\n(2) years of active experience in auditing and investigating in the healthcare industry. (Preferred)\nSignificant experience with relevant technology, such as background check systems, claims processing platforms, data mining, and fraud detection software.\nDemonstrated knowledge of institutional and/or professional payment methodologies.\nStrong 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).\nStrong computer aptitude and experience with spreadsheet and database software, e.g., Excel, Access, Focus.\nDemonstrated strong technical writing skills - ability to write reports and business correspondence and to prepare case files.\nAbility to exercise a very high level of discretion when handling sensitive information.\nPremera total rewards\nOur 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:\nMedical, vision, and dental coverage with low employee premiums.\n\nVoluntary benefit offerings, including pet insurance for paw parents.\n\nLife and disability insurance.\n\nRetirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.\n\nWellness 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.\n\nGenerous paid time off to reenergize.\n\nLooking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.\n\nEmployee recognition program to celebrate anniversaries, team accomplishments, and more.\n\nFor 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.\nCommuter perks make your trip to work less impactful on the environment and your wallet.\n\nFree convenient on-site parking.\n\nSubsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.\n\nParticipate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.\n\nOur complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.\n\nNeed a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.\n\nEqual employment opportunity/affirmativeaction:\nPremera is an equal opportunity/affirmativeaction 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.\nIf you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at  or via phone at 425-918-4785.\nThe 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.\nThe salary range for this role is posted below; we generally target up to and around the midpoint of the range.\n National Plus Salary Range:\n$80,200.00 - $118,300.00*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.\nWe’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 an environment where all employees are celebrated for their unique skills and contributions.","description_format":"text","description_chars":7683,"description_truncated":false,"requirements":{"experience_years_min":null,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":{"level":"bachelor","optional":false},"security_clearance":false,"languages":[]},"benefits":["401k plan","Health insurance"],"hiring_locations":[{"name":"United States","iso":"US","kind":"country"}],"hiring_excludes":[],"relocation_offered":false,"industries":[],"lifecycle":[{"event":"open","at":"2026-10-10T00:08:31Z"}],"visa":[],"liveness":{"score":28,"band":"fade","label":"Fading","p_open":0.9,"p_active":0.713,"p_room":0.44,"age_days":68,"expected_fill_days":55,"reasons":["conf:63","velocity","win:tail","crowd:"],"computed_at":"2026-10-25T05:49:26Z"},"pay":{"stated_usd_annual":118300,"is_top_pay":true},"html_url":"https://alion.io/job/premera-investigator-iii","json_url":"https://alion.io/job/premera-investigator-iii.json","meta":{"generated_at":"2026-10-25T09:35:07Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":13748,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-10-26T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":18095},"rest":"https://alion.io/mcp/rest/get_company?id=18095"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Fpremera-investigator-iii"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Fpremera-investigator-iii"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Fpremera-investigator-iii"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/premera-investigator-iii\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Fpremera-investigator-iii"}]}