Field Property Claims Adjuster: Seattle, WA Farmers Group, Inc.Field Property Claims Adjuster: Seattle, WASeattle, WARemote$23.22–$55.59 / hourExposure to some or all of the following environments when in the field: Uncontrolled outside environmental conditions, Excessive noise levels, Chemicals Chemical/Biological conditions, Moving mechanical parts, Areas considered dangerous, Conditions which could affect the respiratory system or skin such as fumes, odors, dust, mists, gases, oils, smoke, soot, or poor ventilation. Candidates Must be Willing and Able to: Climb Ladders to inspect roofs, and be comfortable working on rooftops, multiple times per day, Work in small, confined spaces that have been damaged; such as attics and crawlspaces.
Special Investigations Unit (SIU) - Field Investigator Ethos Risk ServicesSpecial Investigations Unit (SIU) - Field InvestigatorSeattle, WAPart timeOur dynamic Ethos team is seeking a Special Unit Investigations (SIU) Field Investigator to conduct field investigations, gather and analyze evidence, and produce detailed reports that support claims decisions. Case Documentation: Conduct in-person interviews and obtain accurate, detailed statements from all parties involved, and retrieve relevant documents to support investigative findings.
Investigator Ethos Risk ServicesInvestigatorSeattle, WAFull timePrevious Experience: Demonstrated proficiency in covert surveillance techniques, capturing high-quality video footage, and preparing thorough, well-organized investigative reports. This role involves performing both stationary and mobile surveillance, obtaining video and photographic evidence, and preparing thorough, detailed reports for clients.
Entry-Level Investigator Ethos Risk ServicesEntry-Level InvestigatorSeattle, WAFull timeOur Full-Time Entry-Level Field Investigator position will help launch your career by providing you with an industry leading FULLY PAID Investigator Training Program - no prior experience necessary! Documentation: Finalize case files by submitting case reports and uploading video footage via personal laptop at the end of the day.
NewSpecial Investigations Unit (SIU) Investigator II or III DOE Cambia Health Solutions IncSpecial Investigations Unit (SIU) Investigator II or III DOERenton, WAWhat You Will Do at Cambia: Receives, analyzes and coordinates fraud and abuse complaints from internal sources (customer services, claims processing, underwriting, professional affairs) and external sources (members, providers, state and federal regulatory agencies, law enforcement), then conducts and coordinates moderately complex investigations with expertise across various case types, participating in post-audit exit interviews where appropriate. Maintains continuing education through anti-fraud and legal issue seminars, holds at least one professional credential (CPC, CPC-H or CPC-P), reviews pertinent articles and regulatory requirements, and provides post-audit education to providers to correct discrepancies, and trains new Investigators and other Cambia employees in detection of abusive or fraudulent billing practices.
NewSpecial Investigations Unit (Siu) Investigator II Or III DOE Cambia HealthSpecial Investigations Unit (Siu) Investigator II Or III DOERenton, WAWhat You Will Do at Cambia: Receives, analyzes and coordinates fraud and abuse complaints from internal sources (customer services, claims processing, underwriting, professional affairs) and external sources (members, providers, state and federal regulatory agencies, law enforcement), then conducts and coordinates moderately complex investigations with expertise across various case types, participating in post-audit exit interviews where appropriate. Maintains continuing education through anti-fraud and legal issue seminars, holds at least one professional credential (CPC, CPC-H or CPC-P), reviews pertinent articles and regulatory requirements, and provides post-audit education to providers to correct discrepancies, and trains new Investigators and other Cambia employees in detection of abusive or fraudulent billing practices.
Auditor/Investigator I Qlarant Quality Solutions IncAuditor/Investigator IWACollects data for audits/investigations into claims, utilizing a combination of analytical skills and attention to detail, reviewing documentation, interviewing involved parties, and communicating with various stakeholders to gather relevant information for successful resolution and closure. Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs.
Surveillance Investigator Allied UniversalSurveillance InvestigatorSeattle, Washington$20–$24 / hourThe Surveillance Investigator will perform discreet mobile and stationary surveillance of a Claimant to confirm current activities and capabilities to assist with the administration of an insurance claim. Conduct independent investigations of insurance claims across a range of coverage types, including workers’ compensation, general liability, property and casualty, and disability .
L&I INVESTIGATOR 3 State of WashingtonL&I INVESTIGATOR 3Everett, WA$71,136–$95,676 / yearL&I Investigations Program is looking for an Investigator 3! This position supports the mission of the Investigations Program, which works to identify, combat, and prevent fraud, theft, abuse, and violations perpetrated by injured workers, employers, providers, and other entities in support of "Keeping Washington Safe and Working". Full-time employees who work full monthly schedules qualify for holiday compensation if they are employed before the holiday and are in pay status for at least 80 nonovertime hours during the month of the holiday; or for the entire work shift preceding the holiday.
NewInvestigator PNWInvestigatorSeattle, WashingtonExaminations & Technical Evidence: Attend and record PIP examinations, CR 35 examinations, or similar proceedings when appropriate, and assist with obtaining or preserving vehicle data, including Event Data Recorder information, based on training and case needs. Documentation & Testimony: Maintain thorough investigation notes and records, prepare clear written summaries of findings, preserve evidence appropriately, and be comfortable providing deposition or trial testimony regarding investigative work when required.
NewInvestigator The Advocates - PNWInvestigatorSeattle, WA$75,000–$90,000 / yearExaminations & Technical Evidence: Attend and record PIP examinations, CR 35 examinations, or similar proceedings when appropriate, and assist with obtaining or preserving vehicle data, including Event Data Recorder information, based on training and case needs. Documentation & Testimony: Maintain thorough investigation notes and records, prepare clear written summaries of findings, preserve evidence appropriately, and be comfortable providing deposition or trial testimony regarding investigative work when required.
Auditor/Investigator II Qlarant Quality Solutions IncAuditor/Investigator IIWACollects data for audits/investigations into claims, utilizing a combination of analytical skills and attention to detail, reviewing documentation, interviewing involved parties, and communicating with various stakeholders to gather relevant information for successful resolution and closure. Essential Functions: Conducts routine and impartial audits/investigations from start to closure into customer claims, ensuring accurate and fair assessments of claims validity.
Program Integrity Investigator (Healthcare Fraud Waste & Abuse) TriWest Healthcare AllianceProgram Integrity Investigator (Healthcare Fraud Waste & Abuse)Seattle, WARemoteFull timeComplies with the Veterans Affairs Community Care Network (CCN) and TRICARE T-5 contracts; DHA and TRICARE program guidelines and pertinent Federal regulatory requirements; assists supervisors with FWA trending and reporting requirements; coordinates and assists with investigations and prosecutions by federal agencies interfaces directly with Veterans, Military members and family (as warranted), providers, subcontractors, and other TriWest departments on FWA issues; assist supervisor with the education and training of TriWest, subcontractor, and provider personnel on current FWA matters; prepares appropriate responses to provider compliance issues and complaints referred to Program Integrity by other TriWest departments or external referrals. The PI Investigator t is responsible for the identification, analysis, case development, and reporting of suspected fraud, waste and abuse (FWA) cases as defined by the Department of Veterans Affairs (VA), the Healthcare Finance Administration (HCFA) and the Department of Defense, Defense Health Agency for the TRICARE program; requests and reviews issue-related medical claims and records for FWA and/or administrative and clerical error(s).
Field Site Inspector Allied UniversalField Site InspectorTacoma, Washington$23–$28 / hourKnowledge of Regulations: Familiarity with industry regulations, such as those from the National Committee for Quality Assurance (NCQA) and The Joint Commission (TJC), Medicare Provider Enrollment, or other healthcare profession or facility credentialing, is highly preferred. The Field Site Inspector will perform site visit inspection services for Medicare and Medicaid providers/suppliers in accordance with established requirements.
Field Site Inspector - Part Time Allied UniversalField Site Inspector - Part TimeEverett, Washington$23–$28 / hourKnowledge of Regulations: Familiarity with industry regulations, such as those from the National Committee for Quality Assurance (NCQA) and The Joint Commission (TJC), Medicare Provider Enrollment, or other healthcare profession or facility credentialing, is highly preferred. The Field Site Inspector will perform site visit inspection services for Medicare and Medicaid providers/suppliers in accordance with established requirements.
Certified Professional Coder, Special Investigations Unit (Aetna SIU) CVS Health CorpCertified Professional Coder, Special Investigations Unit (Aetna SIU)WA$43,888–$93,574 / yearThe Certified Professional Coder (CPC) will perform medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. Uses department resources regularly and follows workflows with minimal assistance or intervention to perform daily work to meet metrics.