NewClaims Investigator GallagherClaims InvestigatorFairfield, New JerseyRemoteFull timeSocial Profiling Online Tracking) report provides a detailed snapshot including identification, address history, relatives, DMV (state dependent), litigation records, property ownership, felony criminal history, business affiliations, professional licenses and ever-changing social media. Conducts basic to moderately complex claim investigations to collect information and often compile a comprehensive profile of a claimant for use in defense strategy and further potential investigation.
SIU Investigator - NY Labor Law Allied UniversalSIU Investigator - NY Labor LawEdison, New Jersey$32–$40 / 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 .
Claims Manager Contractor Garuda Labs IncClaims Manager ContractorNY$45–$50 / hourWhat You''ll Do: Report, oversee, monitor, and investigate insurance claims across all jurisdictions; Support Instawork with workers' compensation and occupational accident claims by running loss control surveys and training for teams involved in the claims reporting process as well as monthly data reporting requirements to carriers; Partner with insurance carriers to mitigate loss by evaluating and implementing tools, including but not limited to investigators and nurse case managers; Communicate frequently with internal stakeholders and third parties, including claims adjusters, brokers and other insurance personnel, injured Professionals, business Partners, doctors, and attorneys; Participate in monthly claim reviews to steer claims towards resolution; Maintain organized, accurate records of all claims and supporting documentation; Provide regular updates to senior management on claims activity; Analyze claims data to identify trends and areas for improvement; Develop, implement, and improve scalable processes and training to build a best-in-class claims function. Who You Are: 5+ years in insurance claims adjusting or management, including workers' compensation, occupational accident, and other injury and property damage claims; Impeccably organized; Detailed and process-oriented; Thorough knowledge of insurance lines and insurance laws across the United States; Composed handling high-priority escalations; Excellent verbal and written communication; Ability to analyze, classify, and rate risks, exposures, and loss expectancies; Marketplace risk experience preferred.
Senior Claims Specialist, Commercial E&O AXA SASenior Claims Specialist, Commercial E&ONY$105,300–$184,400 / yearBy combining a comprehensive and efficient capital platform, data-driven insights, leading technology, and the best talent in an agile and inclusive workspace, empowered to deliver top client service across all our lines of business property, casualty, professional, financial lines and specialty. This includes, building and refining effective working relationships with insured, brokers, claim handlers, underwriters, co-insurers, excess and reinsurers as well as external vendors including investigators and legal counsel.
Investigator Ethos Risk ServicesInvestigatorJersey City, NJPart 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 InvestigatorJersey City, NJFull 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 file by submitting case reports and uploading video footage via personal laptop at the end of the day.
Complex Claims Specialist Coalition IncComplex Claims SpecialistNYAs we continue to expand, we are seeking an experienced cyber claims adjuster to join our cyber claims team and to lend a hand in handling complex primary Cyber, Tech, and Media policies. Founded in 2017, Coalition combines comprehensive insurance coverage and innovative cybersecurity tools to help businesses manage and mitigate potential cyberattacks.
Senior Investigator, Special Investigations Unit (Aetna SIU) CVS Health CorpSenior Investigator, Special Investigations Unit (Aetna SIU)NY$46,988–$122,400 / yearAnticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $46,988.00 - $122,400.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations of fraud and abuse Required Qualifications 3 years working on health care fraud, waste, and abuse investigatory and audits required.
Investigator, Special Investigations Unit (Meritain Health) CVS Health CorpInvestigator, Special Investigations Unit (Meritain Health)NJ$46,988–$122,400 / yearDemonstrated proficiency in Microsoft Office Suite (including Excel, specifically with pivot tables), database search tools, and use of the Intranet/Internet to research information. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
EEO Investigator Integrated Resources, IncEEO InvestigatorNew York, NY$60–$65 / hourStrong people skills with the ability to effectively navigate within a large organizational structure. Ability to work in a fast-paced healthcare/hospital setting.
Surveillance Investigator Allied UniversalSurveillance InvestigatorEdison, New Jersey$20–$23 / 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 .
SIU Investigator Centene Corporation GroupSIU InvestigatorNJRemote$56,200–$101,000 / yearMinimum of five (5) years in healthcare field working in fraud, waste and abuse investigations and audits, (or) five years of insurance claims investigation experience or professional investigation experience with law enforcement agencies, (or) seven years of professional investigation experience involving economic or insurance related matters. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse.
Affirmative Civil Enforcement ACE Investigator Contact Government Services LLCAffirmative Civil Enforcement ACE InvestigatorNYPerforms sophisticated analyses of large-scale hard-copy and electronic data such as health care claims data, financial transaction data, accounting records, or bank records to develop investigative leads and to determine their potential relevance to the allegations at issue. • Performs analysis to clarify the target suspects or organizations pattern of operations to identify information relevant to the legal issues involved and to recommend valuable approaches to the AUSAs or other members of the investigative team.
CPC Investigator Horizon Healthcare ServicesCPC InvestigatorNewark, New JerseyThe Certified Professional Coder (CPC) is responsible for performing reviews, audits and coding oversight of medical records to ensure the appropriate CPT codes, diagnosis codes and modifiers according to Generally Accepted Medical Coding Guidelines, CPT-4; HCPCS; ICD-10 Guidelines; and, CMS Correct Coding. $70,500 - $94,395 This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.
CPC Investigator Blue Cross and Blue Shield AssociationCPC InvestigatorNewark, NJ$70,500–$94,395 / yearThe Certified Professional Coder (CPC) is responsible for performing reviews, audits and coding oversight of medical records to ensure the appropriate CPT codes, diagnosis codes and modifiers according to Generally Accepted Medical Coding Guidelines, CPT-4; HCPCS; ICD-10 Guidelines; and, CMS Correct Coding. The incumbent will also be responsible for handling low level investigative activities (external) related to claims, enrollment, accounting, receive and review suspected fraud and to complete cases with all information and analysis for resolution, as the manager and prior approved guidelines may direct.
Auditor/Investigator II Qlarant Quality Solutions IncAuditor/Investigator IINJCollects 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.
Asset Protection Investigator (GME + eBay) Collectors Holdings, Inc.Asset Protection Investigator (GME + eBay)Jersey City, NJ$61,396–$99,678 / yearWork with the Head of Global Asset Protection to proactively identify gaps/areas of improvement with respect to digital security systems (access control, video surveillance, video storage) or physical processes that create exposure to theft. Excellent analytical skills and broad experience documenting investigations with the ability to think outside the box, handle multiple projects simultaneously, and build relationships with internal and external stakeholders.
Registered Nurse - Nursing Home Surveyor/Complaint Investigator Greenlife Healthcare StaffingRegistered Nurse - Nursing Home Surveyor/Complaint InvestigatorNew York, New York$60About Greenlife Healthcare Staffing: We are committed to our core values: integrity, honesty, and transparencyFinding a new position as a physician or allied health professional or filling a critical vacancy in your practice, clinic, hospital, or skilled care facility can be stressful and time-consuming. Position Overview: We are seeking a dedicated and experienced Registered Nurse – Nursing Home Surveyor / Complaint Investigator to join our team across New York City (Bronx, Kings, Richmond, Manhattan, and Queens).
EEO Investigator Atria ConsultingEEO InvestigatorNew York, NY$55–$60 / hourWhen determining a team member's base salary and/or hourly rate, various factors may be taken into account as applicable (such as location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget, and internal equity). Candidates must be comfortable working in a fast-paced healthcare environment and traveling to various facilities throughout New York City as needed.
Surveillance Investigator VRC InvestigationsSurveillance InvestigatorNewark, New JerseyVRC provides their investigators with necessary equipment and comparable pay, to include drive time, above normal commute mileage reimbursement, company paid licensing fees in most states and allowance for non-reimbursed business expenses. We currently have career opportunities for experienced, self-determined, and highly motivated SURVEILLANCE INVESTIGATORS that would like to join our team of professionals in our efforts to deter and combat insurance fraud.
Investigator - Network Services - Full Time CoventBridge GroupInvestigator - Network Services - Full TimeStaten Island, NY$26–$30 / hourCoventBridge Integrity Systems delivers investigative services, technology, and expertise that help healthcare and government organizations protect critical programs, strengthen oversight, and address fraud, waste, abuse, and operational risk. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; 888-932-7364; humanresources@coventbridge.com.
Claim Specialist Coalition IncClaim SpecialistNYAs we continue to expand, we are seeking an experienced cyber claims adjuster to join our cyber claims team and to lend a hand in handling complex primary Cyber, Tech, and Media policies. Founded in 2017, Coalition combines comprehensive insurance coverage and innovative cybersecurity tools to help businesses manage and mitigate potential cyberattacks.
Janitor Allied UniversalJanitorParamus, NJAllied 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 Administrations (TSA) Third-Party Canine (3PK9) Program.
Security Project Manager Allied UniversalSecurity Project ManagerNYThis role requires strong project management skills combined with a working knowledge of access control systems, CCTV/video surveillance, and basic IP networking principles to effectively coordinate vendors, internal stakeholders, and technical teams. Allied 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.
Security Technical Business Analyst Allied UniversalSecurity Technical Business AnalystNYAllied 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 Administrations (TSA) Third-Party Canine (3PK9) Program.
Sales Executive Allied UniversalSales ExecutiveNY$70,000–$85,000 / yearAllied 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.
Vice President, Government and Commercial Programs Allied UniversalVice President, Government and Commercial ProgramsNYRemote$130,000–$160,000 / yearThe Vice President, Government and Commercial Programs is responsible for all government and commercial healthcare operations in addition to managing interactions with government entities while concurrently developing and executing strategies to drive commercial growth and Profit & Loss (P&L) responsibility across both public and private sectors. Responsible for the day-to-day oversight of the operational efficiency and effectiveness of the clinical auditing, compliance and special investigations unit organization, to include special programs such as Physician, Managed Care, Pharmacy, PACE, and Special Needs.
US Senior Medical Director, Rare Hematology SanofiUS Senior Medical Director, Rare HematologyMorristown, NJ$206,250–$343,750 / yearThe mission of this team is to support the company by functioning as the internal expert in rare hematologic conditions - focusing on recent launch in Immune Thrombocytopenia (ITP), and potentially including warm Autoimmune Hemolytic Anemia (wAIHA), and Sickle Cell Disease (SCD) among other rare blood disorders - and helping Health Care Professionals and Payers optimize patient care and treatment outcomes through evidence-based decisions. The Senior Medical Director will establish and maintain collaborative medical and scientific relationships with key external physicians and internal constituencies from multiple functional groups - including, but not limited to, Medical Affairs, Clinical Research, Regulatory, Science, Marketing, Sales, Commercial Operations, and Patient and Product Services - while maintaining full compliance with all relevant company, industry, legal, and regulatory requirements.
US Medical Director, Indolent Systemic Mastocytosis (ISM) SanofiUS Medical Director, Indolent Systemic Mastocytosis (ISM)Morristown, NJ$178,500–$257,833.33 / yearThe Medical Director will establish and maintain collaborative medical and scientific relationships with key external physicians and internal constituencies from multiple functional groups including, but not limited to, Medical Affairs, Clinical Research, Regulatory, Science, Marketing, Sales, Commercial Operations, and Patient and Product Services - while maintaining full compliance with all relevant company, industry, legal, and regulatory requirements. The mission of this team is to support the company by functioning as the internal expert in rare blood disorders and therapies and helping Health Care Professionals and Payers optimize patient care and treatment outcomes through evidence-based decisions.
NewCertified Professional Coder, Special Investigations Unit (Aetna SIU) CVS Health CorpCertified Professional Coder, Special Investigations Unit (Aetna SIU)NJ$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.
Senior Product Architect Echo IT Solutions, IncSenior Product ArchitectJersey City, NJShape High-Impact Use Cases: Drive the collaboration across Fraud and Claims Operations, Evergreen (GenAI Agentic team) and Cypress platform teams to define and refine use cases spanning intake, investigation, evidence gathering, decision support, and resolution. Validate Target-state Workflows: Shape end-to-end workflows that enable agentic solutions, ensuring alignment with real-world execution while improving efficiency, consistency, usability, and automation outcomes.
Associate Director, Global Strategic Feasibility Lead BeOne Medicines AGAssociate Director, Global Strategic Feasibility LeadNY$143,300–$193,300 / yearActual compensation packages are determined by several factors that are unique to each candidate, including but not limited to job-related skills, depth of experience, certifications, relevant education or training, and specific work location. Close partnership with global program & study management team for design and delivery of the studies, for early to late-stage medicines development across global clinical operations (GCO).
Denials Coordinator - Hospital Billing Patient Financial Services - Corporate 42nd Street - Full-Time - Days Mount Sinai Health SystemDenials Coordinator - Hospital Billing Patient Financial Services - Corporate 42nd Street - Full-Time - DaysNY$65,885–$98,827 / yearKey responsibilities include analyzing claim denial reasons, identifying denial trends, sharing trends and findings with owner areas, coordinating the appeals process, collaborating with departments to prevent future denials, maintaining documentation including issue logs with updates, denied dollars and resolutions, and acting as a resource for staff regarding denial-related issues and payer rules. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time - discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.
Special Investigations Unit Clinical Certified Coder Metroplus Health Plan IncSpecial Investigations Unit Clinical Certified CoderNY$100,000–$110,000 / yearMetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics.
Bodily Injury Adjuster - Represented, Moderate/Complex (AL,NC,SC) Remote Allstate Insurance CompanyBodily Injury Adjuster - Represented, Moderate/Complex (AL,NC,SC) RemoteNYRemote$53,500–$84,625 / yearYou'll wear a few hats to fill a few roles throughout your day that all require a level of experience: The Customer Service Expert -you'll live into Allstate's Claims Culture by caring, empowering, and restoring, and you will accomplish that by being compassionate, clear, and a committed partner in each casualty claim. As a Represented Bodily Injury Adjuster, your main focus will be investigating automobile accidents involving single or multiple vehicles, which result in property damage and/or bodily injury with attorney/litigation involved.