UNKNOWN

ADAPTED_NOW

The ACE Investigator will support Assistant United States Attorneys (AUSAs) in the investigation and development of complex civil fraud matters involving healthcare fraud, procurement fraud, grant fraud, and abuse of federal programs and funds. Utilize electronic databases and investigative tools including CLEAR/Accurint, LexisNexis, PACER, SAM.gov, and USASpending.gov to identify witnesses, subjects, and corporate relationships.

SGI is seeking an Affirmative Civil Enforcement (ACE) Investigator to provide investigative support services at the United States Attorney's Office (USAO), Northern District of Indiana, in Hammond, Indiana. The ACE Investigator will support Assistant United States Attorneys (AUSAs) in the investigation and development of complex civil fraud matters involving healthcare fraud, procurement fraud, grant fraud, and abuse of federal programs and funds. Responsibilities include conducting investigative research, analyzing financial and documentary evidence, coordinating with federal agencies, participating in witness interviews, and preparing detailed investigative reports to support litigation and enforcement actions.Position is contingent upon award<h3>Job Duties</h3><ul><li>Conduct thorough and systematic investigations involving healthcare fraud, procurement fraud, grant fraud, and abuse of federal funds and programs</li><li>Work independently or with the ACE Coordinator to generate and develop new fraud investigations</li><li>Meet semi-annually with designated agency personnel to support fraud case development and investigative coordination</li><li>Conduct investigations to determine the merits and collection potential of assigned civil fraud matters</li><li>Analyze financial records, claims data, medical records, email productions, contracts, and other documentary evidence</li><li>Utilize electronic databases and investigative tools including CLEAR/Accurint, LexisNexis, PACER, SAM.gov, and USASpending.gov to identify witnesses, subjects, and corporate relationships</li><li>Prepare interim and final investigative reports suitable for use by AUSAs in intervention, declination, settlement, and litigation decisions</li><li>Participate in witness interviews jointly with AUSAs, federal agents, and investigators, and prepare memoranda of interview</li><li>Perform damages, loss, and overpayment calculations with factual support</li><li>Coordinate with federal investigative agencies including HHS-OIG, FBI, DCIS, DEA, and agency program personnel</li><li>Organize and manage investigative files, documentary evidence, and case materials for litigation support</li><li>Assist AUSAs with trial preparation, including development of exhibits, summaries, charts, and evidentiary materials</li><li>Provide litigation support during hearings, depositions, and trial proceedings</li><li>Prepare weekly activity reports detailing investigative activities and completed tasks</li><li>Perform other duties as assigned in support of ACE investigations and litigation activities</li></ul><h3>Qualifications</h3><ul><li>Qualified personnel must possess sufficient experience, education, training, and skills to satisfactorily perform the requirements</li><li>Preferred candidate will have five (5) years of full-time investigator experience</li><li>Contractor personnel assigned in performance of this contract shall be acceptable to the USAO in terms of personal/professional conduct, technical knowledge, and experience</li><li>U.S. Citizenship required</li><li>Must meet Department of Justice residency requirements</li><li>Ability to obtain and maintain required background investigation and security requirements</li></ul>SGI Global provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws.

SGI Global, LLC

Affirmative Civil Enforcement (ACE) Investigator

Customer Support/Service

Department of Health and Human Services

Documentaries

Equal Employment Opportunity (EEO)

Federal Assistance

Federal Bureau of Investigation (FBI)

Federal Government

Federal Laws and Regulations

File Management

Financial Analysis

Fraud Investigation

Genetics

Healthcare

Investigative Reports

Legal Support Skills

LexisNexis

Litigation

Litigation Settlement

Medical Records

Organizational Skills

Purchasing/Procurement

Research Skills

SGI Systems

State Laws and Regulations

United States Citizen

United States Drug Enforcement Agency (DEA)

OTHER

FEED

HOUR

Overview:
Company Overview: Advance Your Career in Insurance Claims with Allied Universal® Compliance and Investigation Services. Allied Universal® Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you’re ready to grow with the best, explore a career with us and make a difference.

Job Description:
Allied Universal® is hiring a Surveillance Investigator. The 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. <ul style="margin: 0px; padding: 0px; font-family: verdana;"><li style="margin: 0px 0px 0px 22px; padding: 0px; font-size: 10pt; font-family: Verdana, Verdana_MSFontService, sans-serif;" aria-setsize="-1" data-leveltext="" data-font="Symbol" data-listid="15" data-list-defn-props="{"335552541":1,"335559685":1440,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="13" data-aria-level="1">Multiple positions available!<span style="margin: 0px; padding: 0px; font-size: 10pt; font-family: Verdana, Verdana_EmbeddedFont, Verdana_MSFontService, sans-serif; color: #000000;" data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335551550":1,"335551620":1,"335559685":700,"335559737":-20,"335559738":0,"335559739":0,"335559740":279,"335559991":360}"> </li></ul><ul style="margin: 0px; padding: 0px; font-family: verdana;"><li style="margin: 0px 0px 0px 22px; padding: 0px; font-size: 10pt; font-family: Verdana, Verdana_MSFontService, sans-serif;" aria-setsize="-1" data-leveltext="" data-font="Symbol" data-listid="15" data-list-defn-props="{"335552541":1,"335559685":1440,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="14" data-aria-level="1">Must possess a valid driver's license with at least one year of driving experience<span style="margin: 0px; padding: 0px; font-size: 10pt; font-family: Verdana, Verdana_EmbeddedFont, Verdana_MSFontService, sans-serif; color: #333333;" data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559685":700,"335559737":-20,"335559738":0,"335559739":0,"335559740":279}"> </li></ul><ul style="margin: 0px; padding: 0px; font-family: verdana;"><li style="margin: 0px 0px 0px 22px; padding: 0px; font-size: 10pt; font-family: Verdana, Verdana_MSFontService, sans-serif;" aria-setsize="-1" data-leveltext="" data-font="Symbol" data-listid="15" data-list-defn-props="{"335552541":1,"335559685":1440,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="15" data-aria-level="1">Pay Rate: $20 - $23 / hr<span style="margin: 0px; padding: 0px; font-size: 10pt; font-family: Verdana, Verdana_EmbeddedFont, Verdana_MSFontService, sans-serif; color: #2d2d2d;" data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559685":700,"335559737":-20,"335559738":0,"335559739":0,"335559740":279}"> </li></ul> RESPONSIBILITIES:<ul><li>Conduct independent investigations of insurance claims across a range of coverage types, including workers’ compensation, general liability, property and casualty, and disability</li><li>Utilize various surveillance techniques and equipment to monitor subjects covertly</li><li>Document and report observations, activities, and any relevant information in a clear and concise manner</li><li>Collaborate with other investigators and law enforcement agencies as needed to gather information and coordinate efforts</li><li>Maintain confidentiality and adhere to legal and ethical standards in conducting surveillance operations</li></ul>QUALIFICATIONS (MUST HAVE):<ul><li>High school diploma or equivalent</li><li>Post offer, must be able to successfully complete the Allied Universal Investigations' training/orientation course</li><li>Minimum of one (1) year of verifiable work experience, preferably involving investigations or other protective service-related field</li><li>Flexibility to work varied and irregular hours/days including weekends and holidays</li><li>Ability to type reports in Microsoft Word format with minimal grammatical and punctuation errors</li><li>Proficient in utilizing laptop computers, video cameras and cell phones</li><li>Capable of maintaining focus and multitasking effectively in a dynamic environment</li><li>Demonstrated ability to manage stressful situations with composure and professionalism</li><li>Ability to work in a very independent environment</li></ul>PREFERRED QUALIFICATIONS (NICE TO HAVE):<ul><li>Associate’s Degree or higher, preferably in Criminal Justice</li><li>Security/Loss Prevention experience</li><li>Military experience</li><li>Law enforcement experience</li><li>Prior insurance investigations experience</li><li>Prior educational or professional incident reporting and/or investigations experience</li></ul>BENEFITS:<ul><li>Medical, dental, vision, basic life, AD&D, retirement plan and disability insurance</li><li>Seven paid holidays annually, sick days available where required by law</li><li>Vacation time offered at an initial accrual rate of 3.08 hours biweekly; unused vacation is only paid out where required by law</li></ul>

Closing:
Allied Universal® is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: www.aus.com If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: www.aus.com/offices.

Requisition ID:
2026-1602137

Allied Universal provides unparalleled service, systems and solutions to the people and business of our communities, and is North America's leading security services provider. With over 140,000 employees, Allied Universal delivers high-quality, tailored solutions, which allows clients to focus on their core business. For more information: 866.825.5433 or <a href="http://www.aus.com/" target="_blank">www.AUS.com</a>

Allied Universal

Surveillance Investigator

Accidental Death and Dismemberment (AD&D)

Cellular Telephone

Computer Skills

Criminal Justice

Data Collection

Disability Insurance

Driver's License

High School Diploma

Insurance

Insurance Claims

Laptop PC

Law Enforcement

Legal

Legal Standards

Loss Prevention

Microsoft Word

Military

Multitasking

Protective Services

Surveillance

[AW]-iCims

Conduct prompt investigations by securing statements from the involved parties/witnesses and obtaining all necessary documents, including but not limited to, police reports, medical specials, photographs, and/or appraisals. Ability to research and interpret case law, statute, and coverage forms in order to properly adjust and conclude claims.

YEAR

Are you unhappy at your present job? Are you going nowhere in your current position? Is it time for a change?Are you an experienced Litigation Specialist looking to join a growing company where you will be rewarded for your hard work, and have future upward career growth opportunities?If you answered YES to the above, it's time to talk to First Chicago Insurance Company!We offer: <ul><li>Competitive Salaries</li><li style="line-height:14.15pt">Excellent benefits</li><li style="line-height:14.15pt">Growth opportunities!</li></ul>Apply only if you consider yourself a career professional who loves to work, because we work hard here!We are seeking an experienced Litigation Claims Specialist!The Litigation Specialist will be responsible for handling litigated and/or complex injury claims stemming from Personal Auto and Commercial Auto Liability policies. DUTIES & RESPONSIBILITIES: <ul style="text-align:left"><li>Handle litigation claims in accordance with established office procedures</li><li>Determine coverage and draft any applicable reservations of rights letters</li><li>Conduct prompt investigations by securing statements from the involved parties/witnesses and obtaining all necessary documents, including but not limited to, police reports, medical specials, photographs, and/or appraisals</li><li>Litigation Management including strategizing with defense counsel and experts on defense cases, as well as declaratory judgment actions</li><li>Maintain an appropriate diary on all open files</li><li>Conduct business with vendors in a manner which maintains a reasonable expense factor and upholds the company's reputation for quality service</li><li>Ability to research and interpret case law, statute, and coverage forms in order to properly adjust and conclude claims</li><li>Evaluates and determine potential use of experts and/or field investigators</li><li>Maintain claim files and document all claim activity in accordance with applicable regulations and company policies.</li><li>Prepare and present claim evaluations to secure appropriate settlement authority</li><li>Establish and maintain proper indemnity and expense reserves</li><li>Conduct onsite review of defense counsel as required by management</li><li>Adhere to the rules and regulations of the Department of Insurance specific to the loss state</li><li>Additional duties as deemed necessary by direct supervisor / management</li></ul>QUALIFICATIONS REQUIRED:<ul style="text-align:left"><li>7-10 years of applicable auto claims handling experience</li><li>5 years minimum of full file auto claims experience for fully remote work consideration!</li><li>Prior non-standard auto claims experience a plus, not required!</li><li>Knowledge of legal and medical terminology</li><li>Excellent negotiation, communication, organizational and interpersonal skills</li><li>Ability to pass written examinations where required by state statutes to become a licensed claim adjuster</li><li>In office position for onboarding and training and then Work From Home flexibility (3/2).</li></ul>First Chicago Insurance Company provides a competitive benefits package to all full- time employees. Following are some of the perks First Chicago employees receive:<ul><li>Competitive Salaries</li><li>Commitment to your Training & Development</li><li>Medical and Dental</li><li>Short Term Disability/Long Term Disability</li><li>Life Insurance</li><li>Flexible Spending Account</li><li>Telemedicine Benefit</li><li>401k with a generous company match</li><li>Paid Time Off and Paid Holidays</li><li>Tuition Reimbursement Training Programs</li><li>Wellness Program</li><li>Fun company sponsored events</li><li>And so much more!</li></ul>Estimated Compensation Range: $75k/year-$100k/year**Published ranges are estimates. Offered compensation will be based on experience, skills, education, certifications, and geographic location. In addition, starting salary may vary by position depending on whether the position is in-office, hybrid or remote.

First Chicago Insurance Company (FCIC)

Litigation Specialist

Calendar Management

Case Law

Claims Processing

Communication Skills

Corporate Policies

File Maintenance

Interpersonal Skills

Interpret Regulations

Life Insurance

Medical Terminology

Negotiation Skills

Procedure Development

Regulations

Statutory Laws

Training/Teaching

Work From Home

Writing Skills

[Applicantpro] First Chicago Insurance Company (FCIC)

FULL_TIME

Technical Skills: Knowledge of TRICARE policies and procedures, knowledge of Case Management, Utilization Management, and Quality Management practices and principles, and knowledge of Managed Care concepts, alternative care treatments, and community resources. • Research and investigate medical issues as they relate to potential fraud and abuse cases, to include perform anti-fraud and abuse pre-payment reviews or post-payment reviews.

We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only).Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.Veteran, Military Spouse or Military Affiliated are encouraged to apply!Job Summary Under the direction of the Director, Program Integrity, assists in the identification, analysis, case development and reports of any suspected fraud and/or abuse as defined by TRICARE. Reviews medical records for fraud and abuse issues. Complies with Program Integrity requirements within the TRICARE West Region; assists with trending and reporting requirements; and interfaces with TRICARE beneficiaries, providers and subcontractors on fraud and abuse issues. Assists with the update of education and training. Assists with the update of policy and procedure protocols for the Program Integrity unit.Education & Experience Required: • Registered Nurse or Physician's Assistant with at least five years varied clinical experience in a managed care setting • Education or experience to perform anti-fraud and abuse pre-payment and post-payment reviews • 3 years utilization review, quality management, or case management experience • Must be a U.S. Citizen • Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation Preferred: • Experience in the preparation and presentation of teaching materials; assessment evaluations, and writing skills • Certified Coder (CPC, CPC-P, CCA, CCS-P), AHFI, CFE, or other related certificationKey Responsibilities • Resource clinician for Program Integrity staff. • Research and investigate medical issues as they relate to potential fraud and abuse cases, to include perform anti-fraud and abuse pre-payment reviews or post-payment reviews. • Conducts medical records and claims reviews for potential fraud and abuse issues, as well as medical necessity, benefit coverage, utilization and quality of care issues and outcomes. • Coordinate and compile written Investigative Summary Reports in conjunction with PI investigators upon completion of records review. • Maintains the confidentiality and non-discoverability of all fraud and abuse, quality assurance, quality management and risk management issues. • Facilitate and support the Program Integrity Goals and Objectives. • Readily accesses and interprets TRICARE and Medicare coverage guidelines, policies and procedures as well as TriWest policies and procedures. • Effective utilization of the antifraud artificial intelligence software. • Effective utilization of all documentation systems related to fraud and abuse activities and reporting systems.• Participates in DHA directed investigation, data collection and medical record reviews for fraud and abuse case development. • Performs as a witness in court as requested. • Prepares and submits medical records for peer review as appropriate. • Ensures accuracy, completeness and timely submission of all required reports, review audits, case development activities and documents. • Collaborates with all government agencies as directed to support the fraud and abuse efforts. • Participates and contributes to program integrity education and training for beneficiaries, providers, subcontractor and TriWest staff regarding fraud and abuse. • Participates in system enhancements for reporting fraud and abuse activities. • Participates in the annual review of Program Integrity policies, procedures and desk procedures. • Demonstrates effective use of documentation systems for communication, tracking, trending and reporting purposes. • Establishes and maintains effective working relationships with all levels of TriWest employees, government and subcontractor staff. • Demonstrates flexibility and adaptability. • Other duties as assigned. • Regular and reliable attendance is required.Competencies Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate. Computer Literacy: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions. Delegation Skills: Provide clear performance expectations for projects and ensure adequate access to resources for completion. High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow. Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment. Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented. Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues. Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment. Technical Skills: Knowledge of TRICARE policies and procedures, knowledge of Case Management, Utilization Management, and Quality Management practices and principles, and knowledge of Managed Care concepts, alternative care treatments, and community resources. Proficient with Current Procedural Terminology coding.Working Conditions Working Conditions: • Availability to cover any work shift • Department of Defense security clearance required • Repetitive data entry with telephone headset and long periods of sittingCompany Overview Taking Care of Our Nation's Heroes. It's Who We Are. It's What We Do. Do you have a passion for serving those who served? Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve®! Our job is to make sure that America's heroes get connected to health care in the community. At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.DoD StatementOur Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.BenefitsWe're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes: <ul><li> Medical, Dental and Vision Coverage </li><li> Paid time off </li><li> 401(k) Retirement Savings Plan (with matching) </li><li> Short-term and long-term disability, basic life, and accidental death and dismemberment insurance </li><li> Tuition reimbursement </li><li> Paid volunteer time </li></ul> TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $90,000 to $95,000 per year.Equal Employment OpportunityTriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

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Claims Investigator Jobs in Justice, IL

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Claims Investigator Jobs in Justice, IL

Affirmative Civil Enforcement (ACE) Investigator SGI Global, LLC

Surveillance Investigator Allied Universal

Litigation Specialist First Chicago Insurance Company (FCIC)

Program Integrity Clinical Specialist (RN or PA Req'd) TriWest Healthcare Alliance

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