- City of New York (New York, NY)
- …stipulated in their agreement to repay. Claims &Collection is recruiting for (4) four Fraud Investigator II to function as a Senior Fraud Investigator ... Job Description Claims and Collections pursues monetary recoveries owed to...discuss their cases and obtain additional information (if necessary) FRAUD INVESTIGATOR - 31113 Qualifications 1. A… more
- Elevance Health (Atlanta, GA)
- **Clinical Fraud Investigator II** **Location** : _Hybrid1:_ This role requires associates be in the office 1-2 days per week, fostering collaboration and ... employment, unless an accommodation is granted as required by law. The **Clinical Fraud Investigator II** is responsible for identifying issues and/or entities… more
- Allied Universal (Billings, MT)
- …**required** **prior to applying** Allied Universal(R) is hiring a Surveillance / Claims Investigator . Surveillance / Claims Investigators validate the ... + One or more of the following professional industry certifications + Certified Fraud Investigator (CFE) + Certified Insurance Fraud Investigator… more
- Allied Universal (Las Vegas, NV)
- …as needed to ensure a full schedule** Allied Universal(R) is hiring a SIU / Claims Investigator . SIU / Claims Specialists investigate claims with ... extensive knowledge of Insurance policies and the components of fraud to determine If claims warrant reporting...more of the following professional industry certifications: + Certified Fraud Investigator (CFE) + Certified Insurance … more
- CVS Health (Hartford, CT)
- …and every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU). In ... will manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct high level, complex… more
- Command Investigations (FL)
- …hire. Visit our website and find out why at www.GoCommand.com . The Claims /Surveillance Investigator should demonstrate proficiency in the following areas: + ... setting the bar high for investigative excellence. Seeking experienced Insurance Fraud Investigators with commercial or personal lines experience, with multi-lines… more
- CareFirst (Baltimore, MD)
- …**Education Level:** Bachelor's Degree **Licenses/Certifications Preferred:** + Certified Insurance Fraud Investigator (CIFI) + Certified Expert Coder-AHIMA or ... anti- fraud software analysis, and appropriately sourced reference materials. Investigator ensures timely maintenance and organization of case file documentation… more
- State of Arkansas (Little Rock, AR)
- …audit, or a similar investigative role. Specialized certifications (eg, Certified Fraud Examiner, Certified Forensic Investigator ) may be required. PREFERRED ... *Presenting evidence * Interviewing witnesses Job Summary: Review Incident and Accident claims as assigned by the lead investigator Perform a thorough… more
- Molina Healthcare (St. Petersburg, FL)
- …ASSOCIATION** : + Health Care Anti- Fraud Associate (HCAFA). + Accredited Health Care Fraud Investigator (AHFI). + Certified Fraud Examiner (CFE). To all ... **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation,… more
- State of Georgia (Fulton County, GA)
- …Job Alerts The Office of the Attorney General Georgia Department of Law Nurse Investigator - Medicaid Fraud Division *To move forward in the recruiting process ... Nurse Investigator Georgia - Fulton - Atlanta (https://ga.referrals.selectminds.com/jobs/64040/other-jobs-matching/location-only) Hot...will serve within the Audits section of the Medicaid Fraud Division. Job Summary Under the direction of the… more
- Command Investigations (Detroit, MI)
- …Candidates may have an advantage where they possess: MACP experience A djuster/PIP claims experience Prior experience as a private investigator Prior law ... experienced candidates to join our special investigations unit as an ACP Investigator . SuperiorX Investigations is the premier servicer for insurers and defense… more
- City of New York (New York, NY)
- …exceed the allowable levels. Claims and Collections (C&C) is recruiting (1) one Fraud Investigator II to function as a Senior Investigator , who will: ... Job Description APPLICANTS MUST BE PERMANENT IN THE FRAUD INVESTIGATOR CIVIL SERVICE TITLE The...of Revenue that houses DSS Accountability Office (DSS-AO) (C&C). Claims and Collections (C&C) collects cash assistance overpayments from… more
- Centene Corporation (Austin, TX)
- …has strong background in healthcare fraud investigations and Accredited Health Care Fraud Investigator or a Certified Fraud Examiner. _** **Position ... Purpose:** Investigate allegations of healthcare fraud and abuse activity. Assist in planning, organizing, and executing special claims investigations or audits… more
- EFI Global (Detroit, MI)
- …buildings or residences. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Investigates assigned claims suspected of insurance fraud , this includes large loss, ... grown from a boutique firm specializing in handling insurance fraud and arson cases and providing expert witness testimony,...large fire loss, and multiple claims . + Ensures that assigned cases are investigated and… more
- Kemper (Henderson, NV)
- …: The SIU Desk Investigator I is responsible for the investigation of simple claims that may contain elements of fraud or claims otherwise deemed ... nature. These investigations may include single exposure losses and non-represented PIP/Med Pay claims . A Special Desk Investigator I may also handle task-based… more
- SGI Global, LLC (Mobile, AL)
- …and agency partners to develop complex civil cases-particularly under the False Claims Act-involving fraud , civil rights violations, and procurement misconduct. ... Full Time SGI Global is seeking a Senior Civil Investigator to support the Affirmative Civil Enforcement (ACE) program...plays a vital role in investigating and developing civil fraud cases and other enforcement actions that protect taxpayer… more
- EFI Global (Los Angeles, CA)
- …buildings or residences. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Investigates assigned claims suspected of insurance fraud , this includes large loss, ... grown from a boutique firm specializing in handling insurance fraud and arson cases and providing expert witness testimony,...learn more about EFI Global. Seeking a certified fire investigator in the greater Los Angeles area. Must hold… more
- CVS Health (Carson City, NV)
- …it all with heart, each and every day. The SIU Senior Investigator conducts complex investigations to effectively pursue the prevention, investigation and ... prosecution of healthcare fraud and abuse, to recover lost funds, and to...prepayment environment - Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc. - Researches… more
- Travelers Insurance Company (Downers Grove, IL)
- …summarize and prioritize information to uncover potentially fraudulent activity. The investigator , supporting a Claim Center, will investigate claims deemed ... law and local office expectations. + Identifies cases for potential insurance fraud prosecution and submits questionable claims to the National Insurance… more
- Elevance Health (Indianapolis, IN)
- ** Investigator II** **Supporting the Payment Integrity line of business** _Location:_ **Hybrid 1** : This role requires associates to be in-office **1-2** days per ... to recover, eliminate and prevent unnecessary medical-expense spending. The ** Investigator II** is responsible for the identification, investigation and development… more