SIU Clinical Healthcare Fraud Investigator III Solugenix CorpSIU Clinical Healthcare Fraud Investigator IIILos Angeles, CA$45–$55.53 / hourTemporaryContractorFull timeThis position independently manages full-cycle investigations from intake through closure, develops investigative strategies, prepares evidentiary packages for regulatory or law enforcement referral, and provides clinical and operational insight into healthcare billing patterns and provider behaviors. Strong understanding of coding and reimbursement structures (including Current Procedural Terminology (CPT), Healthcare Common Procedure Coding Systems (HCPCS), International Classification of Diseases (ICD-10)), medical billing, and claims review processes.
NewSIU "Field" Investigator - P&C (San Diego metro) USAASIU "Field" Investigator - P&C (San Diego metro)San Diego, CA$77,120–$147,390 / yearCollects evidence of potential fraud through field or remote interviews and thorough searches of investigative databases, internal resources, Internet resources, public records, and forensic tools. Within defined guidelines and framework, protects USAA and our members from potential fraudulent claims by investigating questionable, suspect claims activity in compliance with state insurance fraud-related laws and regulations and policies and procedures.
Special Investigation Unit Investigator II Solugenix CorpSpecial Investigation Unit Investigator IILos Angeles, CA$43.29–$48.29 / hourTemporaryContractorFull timeAfter making a conditional offer and running a background check, if we are concerned about conviction that is directly related to the job, applicants will be given the chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report. Minimum of 3 years of experience in healthcare fraud investigation/detection and/or healthcare related specialty including but not limited to; Pharmacy, DME, Mental Health, Behavioral Health, Hospice, Home Health, Dental etc.
Special Investigation Unit Investigator III Solugenix CorpSpecial Investigation Unit Investigator IIILos Angeles, CA$42.71–$55.53 / hourTemporaryContractorFull timeThe Special Investigation Unit Investigator III performs in-depth evaluation of potential fraud & abuse cases and develops complex investigations that involve high dollar amounts, sensitive issues, or that otherwise meet criteria for fraud, waste & abuse. After making a conditional offer and running a background check, if we are concerned about conviction that is directly related to the job, applicants will be given the chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.
NewRegistered Nurse - Nursing Home Surveyor/Complaint Investigator Greenlife Healthcare StaffingRegistered Nurse - Nursing Home Surveyor/Complaint InvestigatorAlbany, NYParticipate in surveys or complaint investigations to include allegations of abuse and neglect, and perform surveillance activities/tasks at nursing homes (long-term care) to determine compliance with Federal and State regulations. Excellent communication (written and verbal) skills with the ability to relate effectively to providers, physicians, senior medical and administrative personnel, and residents/patients.
Senior Financial Analyst/Investigator Cameo Consulting GroupSenior Financial Analyst/InvestigatorWest End, PA$80,000–$90,000 / yearFull timeThese matters include civil and criminal health care fraud, grant fraud, Government contracting fraud, investment fraud, and other forms of white-collar crime. Presenting the evidence of a fraud scheme to a jury, judge, and opposing counsel often requires visual exhibits and other means of summarizing the information obtained.
Senior Civil Health Care Fraud Investigator Cameo Consulting GroupSenior Civil Health Care Fraud InvestigatorHarrisburg, PA$80,000–$100,000 / yearFull timeExamines, analyzes, presents, and secures evidence such as documents, emails, policies, text messages, payrolls, financial statements, billing statements, invoices, correspondence, computer data, and other records pertaining to the transactions, events, or allegations under investigation. - Works and regularly communicates with AUSAs to identify possible violations or causes of action, determines proof required to assist in affixing legal responsibility, and devises methods for obtaining, preserving, and presenting such evidence.
SIU Case Manager USAASIU Case ManagerPhoenix, AZ$85,040–$162,550 / yearReviews investigative findings of claims identified as having confirmed elements of fraud, concealment, misrepresentation, or intentional act by evaluating the evidence to determine transfer or appropriation of claims disposition. As a dedicated SIU case manager, within defined guidelines and framework you will evaluate and conclude claims identified by SIU Investigators as having elements of fraud or an intentional act.
SIU Investigative Analyst III Solugenix CorpSIU Investigative Analyst IIILos Angeles, CA$32.30–$41.99 / hourTemporaryContractorFull timeUses knowledge of healthcare coding conventions, fraud schemes, and general areas of vulnerability, reimbursement methodologies, and relevant laws to find suspicious patterns in claims data, provider enrollment data, and other sources. After making a conditional offer and running a background check, if we are concerned about conviction that is directly related to the job, applicants will be given the chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.
Manager of Special Investigations Unit Solugenix CorpManager of Special Investigations UnitLos Angeles, CA$55–$63.86 / hourTemporaryContractorFull timeProvide leadership to investigators and be accountable for tracking KPI’s, metrics, recovery, and savings, etc., provides feedback to staff on performance, resolves problems, provides guidance to team members when needed, and takes necessary steps to address poor performance, including corrective action up to termination. Manage the day-to-day operations of the SIU by leading a team of investigators, driving key initiatives across the team to improve processes and generate incremental Fraud and Abuse (F&A) opportunities, and executing the overall strategic direction of the SIU.
Claims Investigator - Full Time CoventBridge GroupClaims Investigator - Full TimeQueens, New York$26–$30 / hourThe company provides top tier data privacy and security practices, deploys robust case management technology customized to clients’ needs and delivers worldwide coverage via its 700+ employees and affiliates worldwide. CoventBridge Group is a global leader in full-service investigations providing: Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs.
NewInsurance Claims Investigator Data Surveys IncInsurance Claims InvestigatorHowell, MIhas been leading the private insurance investigative industry for over 50 years, servicing the self-insured, defense attorneys and all major insurance carriers defending against fraudulent claims. Insurance Claims Investigators at Data Surveys, Inc. are required to utilize their own personal vehicles for any necessary road travel throughout the week.
Warranty Claims Investigator Amrize LtdWarranty Claims InvestigatorNashville, TNRemote workforce position with regular travel in the field performing in-depth investigations to complete analysis of roofing systems exhibiting issues, requiring extensive knowledge of all construction practices as they relate to Elevate/GenFlex roofing systems. Quick and thorough completion of all paperwork including photographs related to each claim to properly document Amrize Building Envelope position for presentation and future reference including possible litigation.
Claims - Investigator I Cincinnati Financial CorpClaims - Investigator ICincinnati, OH$60,000–$80,000 / yearShare your talents to help us reach for continued success as we bring value to the communities we serve and demonstrate that Actions Speak Louder in Person. ''165728'',''true'',''165728'',''false'',''Submission for the position: Claims - Investigator I - (Job Number: 2600529)'',''false'',''165728'',''false'',''true'',''Claims - Investigator I'',''2600529'',''US-MO-St.
Claims Investigator State of IndianaClaims InvestigatorIndianapolis, INHowever, a High School Diploma or High School Equivalent (HSE) and at least 3+ years of experience in claims including 1+ years of supervisory experience applying the outlined knowledge, skills, and abilities in a similar role may be considered. A robust, comprehensive program of leave policies covering a variety of employee needs, including but not limited to: 150 hours of paid New Parent Leave and up to eight weeks of paid Childbirth Recovery Leave for eligible mothers.
Retail Claims Investigator Rebel Convenience StoresRetail Claims InvestigatorUpland, CA$25–$30We’re looking for a detail-oriented Claims Investigator to support the fair, accurate, and timely resolution of general liability, property damage, and Injury claims across our convenience store and fuel station locations. If you have a background in investigations and enjoy uncovering facts, assessing risk, and supporting sound outcomes, then this may just be the role for you!
SIU Claims Investigator Lemieux & Associates LLCSIU Claims InvestigatorSyracuse, NY$25–$32 / hourWe are dedicated professionals with a motivational management style with proven ability to recruit, develop and direct highly successful teams that consistently excel. Lemieux & Associates, a national leader in the investigative industry, is seeking experienced SIU/Claims Investigators in the Syracuse or surrounding area.
SIU Claims Investigator - Spanish Speaker Lemieux & Associates LLCSIU Claims Investigator - Spanish SpeakerStamford, CT$25–$32 / hourOur leadership team brings over 25 years of field experience and is committed to fostering a professional, results-driven environment. Join Lemieux & Associates, a trusted leader in investigative services, and make an impact with your surveillance expertise.
Claims Investigator-Adjustor - SR-23 County of HawaiiClaims Investigator-Adjustor - SR-23Hilo, HIClaims Investigator-Adjustor - SR-23 Salary $67,056.00 Annually Location Future vacancies with immediate vacancy in Hilo, HI Job Type Permanent & Temporary Positions Job Number 2025-00144 Department Corporation Counsel Opening Date 10/05/2025 Closing Date Continuous Description Benefits Questions Duties Summary Investigates, adjusts, and negotiates for settlement of claims of real and personal property damage for and against the County of Hawaii; conducts investigative work in contemplation of litigation and anticipated cases; handles personal injury cases not covered by insurance carried by the County of Hawaii; and performs other related duties as required. Minimum Qualification Requirements Training and Experience: A combination of education and experience substantially equivalent to:graduation from an accredited college or university with a baccalaureate degree (scan and attach a copy of your official transcript to your application), andthree (3) years of investigational or law enforcement work, of whichone (1) year shall have involved the investigation or the adjustment of claims relating to personal, medical, and property damages, andpossession of a valid State of Hawaii drivers license (Class 3) or any other valid comparable drivers license at time of filing.
Claims Investigator, Total Loss & Client Recovery Allied Solutions LLCClaims Investigator, Total Loss & Client RecoveryCarmel, INThis position will also review database information found in systems such as Unitrac, insurance company websites, Lexis Nexis, ISO, and other automobile databases to investigate the applicability of insurance coverage to certain claim types prior to the assignment to a Claims Adjuster or Analyst. Associates in this position must process and investigate a high volume of incoming claim assignments, evaluate coverage through an investigative set of online tools and databases, as well as insurance records within our insurance tracking system.
Special Claims Field Investigator Great American Insurance CompanySpecial Claims Field InvestigatorOHRemote$67,000–$79,000 / yearAt Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Professional designation (i.e., Certified Fraud Examiner, Private Investigator license, etc.) from a recognized National Investigation Organization or State Agency preferred.
Surveillance / Claims Investigator - Part-Time Allied UniversalSurveillance / Claims Investigator - Part-TimeFargo, NDAllied Universal SkillBridge Program Allied Universal partners with the U.S. Department of Defense (DoD) SkillBridge Program to support transitioning service members with up to 180 days of on-the-job training during their final months of active duty, while they continue to receive full DoD pay and benefits. Dog Detection Spotlight - Kyle and Maverick As part of Allied Universal Enhanced Protection Services' fleet of detection canine teams, Kyle and Maverick are trained and certified to screen cargo under the U.S. Transportation Security Administration's (TSA) Third-Party Canine (3PK9) Program.
SIU / Claims Investigator - Part Time Allied UniversalSIU / Claims Investigator - Part TimeLynchburg, VA$30–$36 / hourAcquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance. High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud.
SIU / Claims Investigator - Central / South VA Allied UniversalSIU / Claims Investigator - Central / South VACharlottesville, VAAcquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance. High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud.
SIU / Claims Investigator - Northern VA / DC Area Allied UniversalSIU / Claims Investigator - Northern VA / DC AreaFredericksburg, VAAcquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance. High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud.
Senior Medical Claims Investigator Claritev CorpSenior Medical Claims InvestigatorNaperville, ILUtilize analytics, data mining and coordination of benefit techniques to client paid claims data, develop creative and innovative algorithms and queries that facilitate identification of new savings opportunities. The incumbent will employ data mining and coordination of benefit techniques to analyze and audit hospital and physician claims to identify errant claim payments.
Claims Investigator Allied UniversalClaims InvestigatorMelville, NY$28–$32 / hourAllied Universal SkillBridge Program Allied Universal partners with the U.S. Department of Defense (DoD) SkillBridge Program to support transitioning service members with up to 180 days of on-the-job training during their final months of active duty, while they continue to receive full DoD pay and benefits. Dog Detection Spotlight - Kyle and Maverick As part of Allied Universal Enhanced Protection Services' fleet of detection canine teams, Kyle and Maverick are trained and certified to screen cargo under the U.S. Transportation Security Administration's (TSA) Third-Party Canine (3PK9) Program.
Surveillance / Claims Investigator - Part Time Allied UniversalSurveillance / Claims Investigator - Part TimeFargo, NDSurveillance / Claims Investigators validate the facts of loss for Insurance claims through scene Investigations, claimant and witness Interviews, document retrieval and data Interpretation. Associate's degree in Criminal Justice with a minimum of four (4) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims.
Claims Investigator - Part Time Allied UniversalClaims Investigator - Part TimeCollege Park, MD$24–$28 / hourClaim Investigators validate the facts of loss for Insurance claims through scene Investigations, claimant and witness Interviews, document retrieval and data Interpretation. Associate's degree in Criminal Justice with a minimum of four (4) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims.
Field Investigator - SIU Claims Auto-Owners Insurance CompanyField Investigator - SIU ClaimsColumbia, MissouriOur group of caring associates create financial security by helping individuals and businesses make a new start when a loss occurs. Able to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company’s underwriting guidelines for coverage.
Medical Claims Investigator Claritev CorpMedical Claims InvestigatorNaperville, IL$50,000–$55,000 / yearThe incumbent will employ data mining and coordination of benefit techniques to analyze and audit hospital and physician claims to identify errant claim payments. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.
Field Investigator - SIU Claims Auto-Owners Insurance GroupField Investigator - SIU ClaimsColumbia, MOOur group of caring associates create financial security by helping individuals and businesses make a new start when a loss occurs. Able to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage.
Special Claims Desk Investigator Great American Insurance CompanySpecial Claims Desk InvestigatorOHRemote$70,000–$80,000 / yearPerforms basic searches and prepares basic reports, utilizing databases, and technology that support investigations: May participate in identifying enhancements to improve performance and functionality of technology applications. At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results.
Claims Fraud Investigator Zurich Insurance Group LtdClaims Fraud InvestigatorAZRemoteOur hybrid work model is thoughtfully designed around employee needs offering autonomy to complete focused work from a preferred location, while still supporting meaningful in-person collaboration when it adds value. Under general direction and within defined authority limits, this role is responsible for conducting insurance fraud investigations involving complex schemes, multi claim patterns, organized activity, and non medical major case work.
$19.22/HR Claims Adjusters, Examiners & Investigators Moore Healthcare group$19.22/HR Claims Adjusters, Examiners & InvestigatorsFort Lauderdale, FLEutis Staffing is seeking detail-oriented and motivated Claims Adjusters, Examiners, and Investigators to join a dynamic team in Fort Lauderdale, Florida. This position offers hands-on experience reviewing claims, conducting investigations, analyzing documentation, and ensuring compliance with established policies and procedures.
Warranty Claims Supervisor Amrize LtdWarranty Claims SupervisorNashville, TNWork closely with the Warranty Services Leak response coordinators (WSC) in developing regional relationships with their adjacent Investigator to facilitate smooth communication and clarity of Holcims position - Including training in knowledgeable review of contractor submitted repairs and photographs to determine proper liability. Reviews monthly reports of overall activity and claims expenses to Warranty Claims Manager and Director of Warranty Services based on the project claim data, including pending and active claim expense reporting.
Claims Examiner (Henrico, State Employees Only) Commonwealth of VirginiaClaims Examiner (Henrico, State Employees Only)Henrico, VA$38,000–$40,000 / yearMust successfully obtain and demonstrate requisite skill set (knowledge, skills and abilities) for position and meet the certification requirements, as defined by DOL, to become certified as an agency Unemployment Claims Investigator no later than one year from the commencement of the training program to remain in position. You will also prepare reports, maintain confidential claim files, coordinate with financial institutions to ensure accurate payments, provide mentoring and training to staff, and support system testing and administrative functions as needed.
Bristol West Claims Liability Claims Representative-Hybrid Farmers Group, Inc.Bristol West Claims Liability Claims Representative-HybridPhoenix, AZRemoteTrains to interact professionally and courteously with stakeholders including policyholders, claimants, agents, witnesses, repair fa cilities, contractors, police and fire departments, state and country fraud and arson specialists, special investigators, attorneys, medical professionals and other persons incident to the investigation and processing of claims. Learns skills such as conducting thorough i nvestigations, establishing damages, determining liability, negotiating settlements, making claim payments, confirming policy coverage, and explaining claim determination to parties incident to the claim.
Claims Intake Specilist Nesco Resource, LLCClaims Intake SpecilistNew York City, NY$33–$40 / hourNesco Resource has partnered with a well-established, nationally recognized company with a long-standing presence in critical infrastructure and public service to identify a Claims Intake Specialist. - Prolonged sitting while answering phones at a computer terminal for the majority of the workday required.
Investigations Manager - Claims CoventBridge GroupInvestigations Manager - Claims$55,000–$60,000 / yearThe Investigations Manager is part of the Operations Team and provides supervision and direction of investigative field staff to ensure a highly motivated, quality-focused investigative team to complete investigations of insurance claims filed for a variety of coverage to include worker’s compensation, general liability, property and casualty, disability, life and health care. CoventBridge Group is the global leader in full-service investigations providing Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs.
Claims Processors x2 - San Francisco CA Lee Hecht HarrisonClaims Processors x2 - San Francisco CASan Francisco, CA$25–$27 / hourPosition Summary: The Claims Processor provides customer service and processes routine health, and welfare claims on assigned accounts according to plan guidelines and adhering to Company policies and regulatory requirements. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria.
Claims Superintendent Professional Liability W. R. Berkley CorpClaims Superintendent Professional LiabilityMoorestown, NJ$120,000–$130,000 / yearThe company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role includes: Base Salary Range: $120,000 - $130,000 The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. The position requires close collaboration with defense counsel, internal stakeholders, and external partners to ensure effective claim outcomes, adherence to policy terms, and alignment with best practices for high‑severity loss management.
Claims Superintendent - CGL, Construction Defect, Long Term Exposure W. R. Berkley CorpClaims Superintendent - CGL, Construction Defect, Long Term ExposureMoorestown, NJ$110,000–$140,000 / yearThe Claims Superintendent - CGL, Construction Defect, Long Term Exposure will be responsible for determining and discharging the companys contractual obligations under its various policy contracts involving coverage analysis, investigation, legal defense, and loss and expense reserving. Berkley Corporation, a Fortune 500® Company and one of the nations premier commercial lines property casualty insurance providers, we have the resources, support and industry data to provide exceptional service and exciting solutions for our clients and partners.
Senior Claims Supervisor HCA HealthcareSenior Claims SupervisorNashville, TNIdeally, this individual has experience managing physician practice and hospital claims and litigation management, is familiar with physician practice and hospital operations (including medical staff issues), state malpractice laws, possesses strong negotiation skills and has demonstrated ability to independently problem solve and proactively manage and resolve claims. Build and maintain strategic alliances and collaborative partnerships with the HCI Risk Management team, HCA Legal Department, Clinical and Physician’s Services Group and other corporate departments that will mutually benefit the Claims Department and the organization.
Field Property Claims Adjuster-Fort Wayne, IN Farmers Group, Inc.Field Property Claims Adjuster-Fort Wayne, INFort Wayne, INRemotePersonal contacts are a major part of activity and include policyholders, claimants, agents, witnesses, repair facilities, contractors, police and fire departments, state and county fraud and arson personnel, special investigators, attorneys, expert witnesses, members of the medical profession and all other persons incident to the investigation and processing of claims. Investigates, confirms coverage, determines liability, establishes damages, reports status and negotiates the settlement of assigned cases (has authority to make payment of assigned claims within prescribed limits).
Field Property Claims Adjuster-Rockford, IL Farmers Group, Inc.Field Property Claims Adjuster-Rockford, ILRockford, ILRemotePersonal contacts are a major part of activity and include policyholders, claimants, agents, witnesses, repair facilities, contractors, police and fire departments, state and county fraud and arson personnel, special investigators, attorneys, expert witnesses, members of the medical profession and all other persons incident to the investigation and processing of claims. Investigates, confirms coverage, determines liability, establishes damages, reports status and negotiates the settlement of assigned cases (has authority to make payment of assigned claims within prescribed limits).
Field Property Claims Adjuster-Grand Junction, CO Farmers Group, Inc.Field Property Claims Adjuster-Grand Junction, COGrand Junction, CORemote$23.22–$36.23 / hourPersonal contacts are a major part of activity and include policyholders, claimants, agents, witnesses, repair facilities, contractors, police and fire departments, state and county fraud and arson personnel, special investigators, attorneys, expert witnesses, members of the medical profession and all other persons incident to the investigation and processing of claims. Investigates, confirms coverage, determines liability, establishes damages, reports status and negotiates the settlement of assigned cases (has authority to make payment of assigned claims within prescribed limits).
Bristol West Injury Claims Attorney Representative Farmers Group, Inc.Bristol West Injury Claims Attorney RepresentativeLake Mary, FLThis may include policyholders, claimants, agents, witnesses, repair facilities, contractors, police and fire departments, state and county fraud and arson personnel, special investigators, members of the medical profession and all other persons incident to the investigation and processing of claims. Through training, continuously improves skills applicable to including but not limited to claims investigation, liability determination, coverage confirmation, establishing damages, evaluating bodily injury damages and negotiation of claims settlement.
Field Property Claims Adjuster - Wisconsin Farmers Group, Inc.Field Property Claims Adjuster - WisconsinMilwaukee, WIPersonal contacts are a major part of activity and include policyholders, claimants, agents, witnesses, repair facilities, contractors, police and fire departments, state and county fraud and arson personnel, special investigators, attorneys, expert witnesses, members of the medical profession and all other persons incident to the investigation and processing of claims. Possesses adequate hearing, with or without correction, to communicate with co-workers, resp ond promptly to auditory signals or alarms, and discern sounds essential for maintaining safety and productivity in the workplace.
Field Property Claims Adjuster- Metro Denver, CO Farmers Group, Inc.Field Property Claims Adjuster- Metro Denver, CODenver, CORemote$23.22–$36.23 / hourPersonal contacts are a major part of activity and include policyholders, claimants, agents, witnesses, repair facilities, contractors, police and fire departments, state and county fraud and arson personnel, special investigators, attorneys, expert witnesses, members of the medical profession and all other persons incident to the investigation and processing of claims. Investigates, confirms coverage, determines liability, establishes damages, reports status and negotiates the settlement of assigned cases (has authority to make payment of assigned claims within prescribed limits).