Fraud Investigator jobs
- Amerihealth CaritasHybrid work in Columbus, OH 43215
- Full-time
- Tuition reimbursement
- Health insurance
- Paid time off
- Paid holidays
- Analyzes data as part of the investigative process using available fraud detection software and corporate resources.
- Valid driver’s license required.
Civil Health Care Fraud Investigator position for the United States Attorney’s Office (USAO)
Easily applyOften replies in 3 daysInfotech Innovations, Inc.Harrisburg, PA 17102(Midtown area)- $40 - $45 an hour
- Full-time +1
- Health insurance
- Paid time off
- Traces funds derived from fraud and identifies assets of subjects.
- Minimum 10 years of experience in any combination of law enforcement, criminal justice…
Fraud Liaison
Easily applyOften replies in 2 daysBusey BankChampaign, IL 61820- $71,000 - $90,000 a year
- Full-time
- Employee stock purchase plan
- Health insurance
- 401(k) matching
- Paid time off
- Vision insurance
- Health savings account
- Collaborates and coordinates closely with business line teams and second line fraud teams involved in fraud management to ensure a cohesive and consistent…
Senior Civil Health Care Fraud Investigator
Easily applyNewArdelle AssociatesHarrisburg, PA 17102(Midtown area)- $40.97 - $46.06 an hour
- Full-time
- 401(k)
- Health insurance
- 401(k) matching
- Paid time off
- Dental insurance
- Traces funds derived from fraud and identifies assets of subjects.
- The ideal candidate should possess expertise in document analysis related to fraud cases and…
- Zions BancorporationMidvale, UT 84047
- $46,875 - $62,500 a year
- Paid training
- Tuition reimbursement
- Paid parental leave
- Parental leave
- Health insurance
- 401(k) matching
- Basic working knowledge of fraud detection/prevention principals, BSA/AML Compliance as it applies to suspicious activity for money laundering, terrorist…
- Zions BancorporationMidvale, UT 84047
- $52,878 - $77,550 a year
- Full-time
- Paid training
- Tuition reimbursement
- Paid parental leave
- Parental leave
- Health insurance
- 401(k) matching
- Good knowledge of high risk transactions, fraud risks and typologies.
- Basic working knowledge of BSA/AML Compliance as it applies to suspicious activity for…
- TikTokHybrid work in San Jose, CA
- $96,000 - $217,023 a year
- Paid parental leave
- Parental leave
- Health insurance
- 401(k) matching
- Vision insurance
- Dental insurance
- Develop key metrics to track progress and monitor fraud trends - Create standard operating procedures as needed for scaled manual operations workflows - Provide…
Healthcare Fraud Investigator
Easily applyContact Government Services, LLCHybrid work- $85,000 - $105,000 a year
- Analyze data for evidence of fraud, waste and abuse.
- Minimum three (3) years of professional work experience in healthcare, fraud, or other related…
Roles in forensic accounting
Forensic Accountant
Easily applyConfidentialAlexandria, VA 22314- $90,000 - $115,000 a year
- Full-time
- 8 hour shift +1
- 401(k)
- Health insurance
- Paid time off
- Vision insurance
- Dental insurance
- Life insurance
Forensic Accountant
Easily applyWu & Reddy, a Prof. Corp.Irvine, CA 92618- $35 - $48 an hour
- Full-time
- Overtime
- Paid training
- On-the-job training
- 401(k)
- Health insurance
- 401(k) matching
- Paid time off
Senior Civil Health Care Fraud Investigator
Easily applyContact Government Services, LLCHarrisburg, PA- $100,000 - $200,000 a year
- Full-time
- 401(k)
- Health insurance
- Paid time off
- Vision insurance
- Dental insurance
- Flexible spending account
- Justice experience, and health care fraud investigation.
- Traces funds derived from fraud and identifies assets of subjects.
- ToyotaPlano, TX
- $30 - $35 an hour
- 401(k)
- Vision insurance
- Dental insurance
- Conduct fraud investigations, SSN updates, skip tracing, collections, and recovery.
- The Investigator will receive and review suspicious activity and fraud…
- View all Toyota jobs in Plano, TX - Plano jobs - Fraud Analyst jobs in Plano, TX
- Salary Search: Fraud Analyst / Admin salaries in Plano, TX
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Opportunities in compliance analysis
Compliance Specialist II
Easily applyMedBenNewark, OH 43055- Full-time
- Monday to Friday
- Referral program
- Tuition reimbursement
- 401(k)
- Health insurance
- 401(k) matching
- Paid time off
Regional Risk Manager - West
Easily applyPediatric AssociatesRemote- From $71,681.78 a year
- Full-time
- Tuition reimbursement
- Parental leave
- 401(k)
- Health insurance
- Paid time off
- Employee discount
- Summerlin Hospital Medical CenterLas Vegas, NV 89144
- Full-time
- Health insurance
- 401(k) matching
- Paid time off
- Vision insurance
- Dental insurance
- 3MMaplewood, MN 55144(Battle Creek area)
- $145,676 - $178,049 a year
- Health insurance
- Retirement plan
- Vision insurance
- Health savings account
- Dental insurance
- Flexible spending account
- As a Fraud Investigator, you will actively lead and participate in fraud investigations.
- Working in a project-driven environment to support and lead multiple…
- View all 3M jobs in Maplewood, MN - Maplewood jobs
- Salary Search: Fraud Investigator salaries
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- Flagstar BankTroy, MI
- $48,821.25 - $77,265.00 a year
- Full-time
- Health insurance
- Vision insurance
- Dental insurance
- Disability insurance
- Knowledge of fraud monitoring systems.
- Perform daily wire and ACH fraud detection reviews.
- Using a risk-based approach, the investigator evaluates loss…
- View all Flagstar Bank jobs in Troy, MI - Troy jobs
- Salary Search: Fraud Investigator salaries
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Positions in loss prevention
Information Assurance Analyst
Easily applyOften replies in 1 dayAreliRemote in United States- $70 - $80 an hour
Safety Director
Easily applyOften replies in 1 daySpherion Mid OhioColumbus, OH 43231- Up to $140,000 a year
- Full-time
- Health insurance
- 401(k) matching
- Paid time off
- Vision insurance
- Health savings account
- Dental insurance
- Gridiron IT Solutions LLCRemote
- $70,000 - $90,000 a year
- Full-time +1
- Minimum of 30 hours per week
- Pet insurance
- AD&D insurance
- 401(k)
- Health insurance
- Vision insurance
- Health savings account
- United Community BankGreenville, SC 29601
- $42,061 - $106,438 a year
- Full-time
- Weekends as needed +1
- Coach investigators on delivering clear, empathetic, and professional communication to customers impacted by fraud.
- Associate or Bachelor’s degree preferred.
Fraud Dispute Analyst
Easily applyCorpayHybrid work in Brentwood, TN 37027- Full-time
- Monday to Friday
- Health insurance
- Paid time off
- Employee discount
- Vision insurance
- Dental insurance
- Experience in fraud analysis and detection is a plus.
- Assisting the Risk Management team in performing trending and forecasting of fraud in various financial…
- View all Corpay jobs in Brentwood, TN - Brentwood jobs - Fraud Analyst jobs in Brentwood, TN
- Salary Search: Fraud Dispute Analyst salaries in Brentwood, TN
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Fraud Dispute Analyst
Easily applyCorpayHybrid work in Brentwood, TN 37027- Full-time
- Monday to Friday
- Health insurance
- Paid time off
- Employee discount
- Vision insurance
- Dental insurance
- Experience in fraud analysis and detection is a plus.
- Assisting the Risk Management team in performing trending and forecasting of fraud in various financial…
- View all Corpay jobs in Brentwood, TN - Brentwood jobs - Fraud Analyst jobs in Brentwood, TN
- Salary Search: Fraud Dispute Analyst salaries in Brentwood, TN
- See popular questions & answers about Corpay
- Louis VuittonIrving, TX
- $80,000 - $110,000 a year
- Health insurance
- Retirement plan
- Paid time off
- Employee discount
- Vision insurance
- Dental insurance
- Develop fraud standards and fraud risk rules in collaboration with global standards.
- Analyze business operations and identify links between fraudulent…
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Special Investigator-Health Insurance Fraud (Ohio residency required) - job post
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Full job description
Your career starts now. We are looking for the next generation of health care leaders.
This position is remote however, you must live and be able to travel within Ohio as business needs.
At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to hear you.
Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Discover more about us at www.amerihealthcaritas.com.
The Investigator is responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving the full range of products at the AmeriHealth Caritas Family of Companies (ACFC).
Major Accountabilities:
- Ensures compliance with all requirements related to Special Investigation Units and fraud, waste and abuse investigations.
- Conducts investigations of potential fraud, waste and/or abuse with a focus on thoroughness and attention to detail, quality, timeliness and cost control.
- Conducts comprehensive interviews with providers, members and witnesses to obtain information which would be considered admissible under generally accepted criminal and civil rules of evidence.
- Proactively performs research using the Internet, data analysis tools, etc., to analyze aberrantclaims billing and practice patterns.
- Analyzes data as part of the investigative process using available fraud detection software and corporate resources.
- Represents ACFC in conducting settlement negotiations with providers, counsel and/or other associated parties.
- Prepares and submits investigative reports covering all phases of the investigation.
- Interprets and conveys highly technical information to others.
- Establishes and maintains liaison with public officials, law enforcement and others to obtain assistance in conducting investigations.
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Performs necessary functions to support all aspects of SIU investigations and responsibilities to include, but not limited to: Intake; Screening; Reviews; Referrals; Recoveries; and Provider Investigative Site Visits.
Education/ Experience:
- Bachelor's degree with a minimum of two years of experience in the healthcare field working in fraud, waste, and abuse investigations and audits OR
- An associate's degree, with a minimum of four years of experience working in healthcare fraud, waste, and abuse investigations and audits.
- Experience and training/certifications commensurate with position requirements in lieu of formal educational requirements for the Lead SIU Investigator position may be considered.
- Valid driver’s license required
- Data Analytics experience preferred.
- Ability to work independently with minimal supervision, and manage a high volume of assignments.
- Strong verbal and written communication skills.
- High degree of integrity and confidentiality required handling information that is considered personal and confidential.
- Analytical skills and ability to make deductions; logical and sequential thinker.
- A minimum of 3-5 years experience conducting comprehensive health care fraud investigations; interacting with state, federal and local law enforcement agencies.
Other Skills:
- Health care industry and/or Medicare/Medicaid/Pharmacy/Behavioral Health/Pharmacy Benefit Management knowledge required.
- Clinical Experience preferred
- SIU and/or State Medicaid regulatory compliancework experience preferred.
- Knowledge and proficiency in claims adjudication standards & procedures preferred.
- Solid knowledge of Medicaid, Medicare, and pharmacy benefit laws and requirements; federal, state, civil and criminal statutes.
- Experience with decision support tools used for data analysis.
- Advanced knowledge and experience working on various approaches to fraud, waste and abuse.
- Working knowledge of Microsoft applications, especially Excel required.
- Knowledge of available resources (internal and external) to assist in investigations.
Diversity, Equity, and Inclusion
At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve. We keep our associates happy so they can focus on keeping our members healthy.
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.