- Galileo Financial Technologies, LLC (Jacksonville, FL)
- …. The Role We are seeking a talented and self-motivated Senior Fraud Investigator to support our Fraud Investigations team. This role will be ... regulatory institutions and Galileo policies and procedures. The Senior Fraud Investigator is responsible for conducting holistic reviews of Fraud Investigators'… more
- SGI Global, LLC (Minneapolis, MN)
- …| Full Time SGI Global is seeking an Affirmative Civil Enforcement (ACE) Investigator /Analyst to support the United States Attorney's Office, District of ... Minnesota to support the Assistant United States Attorneys (AUSAs) within the...ACE efforts, including participating in witness interviews. + Analyzing claims data using Excel and other tools to identify… more
- AIG (Atlanta, GA)
- …and reporting on findings. The investigator will provide assistance to the claims adjuster in progressing the claim and will leverage knowledge and expertise ... customers to manage risk. Join us as a Principal Claims Investigator to play your part in...business involving claimants, brokers, lawyers, medical providers, etc., to support the Claims organization. + Obtain and… more
- CareFirst (Baltimore, MD)
- …timely, effective and result in an overall achievement of unit goals. + Investigator researches and analyzes claims data using company anti-fraud software, ... **PURPOSE:** The role of the Special Investigations Unit (SIU) Investigator is to assist in the reduction and recuperation...Independently conduct low to medium level investigations and provide support as part of an assigned team to all… more
- Travelers Insurance Company (Morristown, NJ)
- …issues/trends in the claim or underwriting environment. + Provides primary technical support , as subject matter expert, to field offices on questions of fire and ... Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is… more
- Elevance Health (Lake Mary, FL)
- …paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use ... **Pharmacy Investigator Senior** **Hybrid** : This role requires associates...week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured… more
- Elevance Health (Columbus, OH)
- …paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use ... ** Investigator II** **Locations:** Indianapolis, IN, Nashville, TN, Columbus,...week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured… more
- Amrize (Nashville, TN)
- …the end-to-end leak coordination process - overseeing approximately $500,000 in annual claims expenses - while providing critical administrative support to the ... Warranty Investigator Coordinator Requisition ID: 15358 Location: Nashville, TN,...owners to justify expenditures while maintaining strong business relationships. ** Claims & Administrative Support ** + Material Logistics:… more
- USAA (New York, NY)
- …us special and impactful. **The Opportunity** We are looking for a SIU Investigator (mid-level). This is a Desk position. Within defined guidelines and framework, ... protects USAA and our members from potential fraudulent claims by investigating questionable, suspect claims activity...(now or in the future) you will need immigration support (ie, H-1B, TN, F-1, STEM OPT Training Plans,… more
- Humana (Oklahoma City, OK)
- …first** Humana's Special Investigations Unit is seeking a Senior Fraud & Waste Investigator to join the Oklahoma Medicaid Team. This team of Investigators conducts ... of fraud, waste, and abuse involving providers who submit claims to Humana's Oklahoma Medicaid line of business. As...line of business. As the Senior Fraud and Waste Investigator , you will serve as Humana's Program Integrity Officer,… more
- MyFlorida (Orlando, FL)
- LAW ENFORCEMENT INVESTIGATOR II - 79000848 Date: Jan 7, 2026 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... No: 867815 Agency: Business and Professional Regulations Working Title: LAW ENFORCEMENT INVESTIGATOR II - 79000848 Pay Plan: Career Service Position Number: 79000848… more
- Magellan Health Services (Boise, ID)
- …Prepare correspondence + Obtain and preserve physical and documentary evidence to support investigations + Maintain comprehensive case files + FRAUD, WASTE AND ABUSE ... methodologies, and relevant laws to find suspicious patterns in claims data, provider enrollment data, and other sources +...accuracy + Prepare clear and concise investigatory reports to support findings of potential fraud, waste and abuse +… more
- MVP Health Care (Schenectady, NY)
- …justice or a related field, and minimum of five years ofinsurance claims investigation experience; or five years of professional investigation experience with law ... experience involving economic or insurance relatedmatters. + A clinical investigator must have in addition to the above requirements:...and CPT Assistant coding guidelines as they relate to claim data. + Working knowledge of MS Office (Word,… more
- AmeriHealth Caritas (Columbus, OH)
- …services. Discover more about us at www.amerihealthcaritas.com. The Investigator is responsible for conducting comprehensive investigations of reported, ... to obtain assistance in conducting investigations. + Performs necessary functions to support all aspects of SIU investigations and responsibilities to include, but… more
- Idaho Division of Human Resources (ID)
- Pesticide Investigator , Senior - Lewiston and Post Falls Posting Begin Date: 2025/09/09 Category: Agriculture Sub Category: Natural Resources Work Type: Full Time ... The Idaho Department of Agriculture is currently recruiting for a Pesticide Investigator , Senior in the division of Agriculture Resources located in Lewiston and… more
- Point32Health (Canton, MA)
- …about who we are at Point32Health (https://www.point32health.org/) . **Job Summary** The Investigator I is an essential team member of the Special Investigation Unit ... ("FWA") investigations under the direction of the Manager, FWA Prepayment Review. The Investigator I works closely with other members of the SIU to set investigative… more
- Centene Corporation (Harrisburg, PA)
- …Purpose:** Conduct comprehensive reviews of medical records and documents supporting claims for providers, suppliers, and pharmacies to include but not limited ... inpatient, outpatient, ancillary, behavioral health care, laboratory, etc. Provides investigative support to the Special Investigations Unit (SIU) related to coding… more
- Manulife (FL)
- …: + Successfully completes high-quality, sophisticated long term care claims investigations + Independently develops and drives a detailed investigative ... + Acquires and reviews internal / external documents to support investigative activity and findings + Conducts interviews of...and trains more junior investigators on long term care claim cases and processes + Ability to travel on… more
- Marshfield Clinic (Marshfield, WI)
- **Come work at a place where innovation and teamwork come together to support the most exciting missions in the world!** **Job Title:** Subrogation Investigator ... Required: Two years previous work experience in collections, legal, claims processing, or subrogation related field. Preferred/Optional Experience: **Marshfield… more
- Highmark Health (Pittsburgh, PA)
- …(OFAC) to ensure payments are not issued to unauthorized parties. + Provides support as needed to internal and external law enforcement and regulatory agencies, ... Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of provider facility payment… more