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.
SIU Investigator Allied UniversalSIU InvestigatorChicago, Illinois$27–$32 / 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 .
Senior Fire Investigator, IAAI-CFI EFI Global IncSenior Fire Investigator, IAAI-CFIAddison, ILRemoteNowHiring #CertifiedFireInvestigator #FireInvestigator #FireInvestigation #IAAICFI #FireForensics #OriginAndCause #ForensicInvestigation #RemoteJobs #CareerOpportunity #ProfessionalGrowth #GreatPlaceToWork #PropertyClaims #ExpertWitness #JoinOurTeam. Over the last four decades, we have grown from a boutique firm specializing in handling insurance fraud and arson cases and providing expert witness testimony, into a recognized global leader in engineering failure analysis, origin-and-cause investigations, environmental consulting, laboratory testing and specialty consulting.
NewDirector of National Claims - Financial Institutions Alliant Insurance Services, Inc.Director of National Claims - Financial InstitutionsChicago, ILResponsible for the design, development and management of a comprehensive property & casualty claims management practice to service existing financial institution clients, account teams and assist in securing new clients. We operate through a network of specialized national platforms and local offices to offer our clients a comprehensive portfolio of solutions built on innovative thinking and personal service.
MRSGM NA Logistics Claims Manager - First Party Munchener Ruckversicherungs-Gesellschaft Aktiengesellschaft (Munich Re)MRSGM NA Logistics Claims Manager - First PartySchaumburg, ILWe are in search of an experienced insurance professional responsible for investigating, evaluating, and settling complex cargo damage claims by examining policies, gathering evidence, analyzing loss details, negotiating settlements with involved parties, and ensuring compliance with company guidelines, often handling high-value or intricate claims with a focus on minimizing losses; requiring strong knowledge of cargo insurance policies, shipping regulations, and claims handling procedures. Complex Claim Management - Leading the handling of large or complex cargo claims involving multiple parties, legal disputes, or significant financial exposure.
Senior Fire Investigator, Iaai-Cfi EFI GlobalSenior Fire Investigator, Iaai-CfiAurora, ILRemoteNowHiring #CertifiedFireInvestigator #FireInvestigator #FireInvestigation #IAAICFI #FireForensics #OriginAndCause #ForensicInvestigation #RemoteJobs #CareerOpportunity #ProfessionalGrowth #GreatPlaceToWork #PropertyClaims #ExpertWitness #JoinOurTeam. Over the last four decades, we have grown from a boutique firm specializing in handling insurance fraud and arson cases and providing expert witness testimony, into a recognized global leader in engineering failure analysis, origin-and-cause investigations, environmental consulting, laboratory testing and specialty consulting.
Senior Fire Investigator, IAAI-CFI EFI GlobalSenior Fire Investigator, IAAI-CFIChicago, IllinoisRemoteNowHiring #CertifiedFireInvestigator #FireInvestigator #FireInvestigation #IAAICFI #FireForensics #OriginAndCause #ForensicInvestigation #RemoteJobs #CareerOpportunity #ProfessionalGrowth #GreatPlaceToWork #PropertyClaims #ExpertWitness #JoinOurTeam. Over the last four decades, we have grown from a boutique firm specializing in handling insurance fraud and arson cases and providing expert witness testimony, into a recognized global leader in engineering failure analysis, origin-and-cause investigations, environmental consulting, laboratory testing and specialty consulting.
Surveillance Investigator Allied UniversalSurveillance InvestigatorChicago, Illinois$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 .
(Remote) Sr. Special Investigator Efinancial LLC(Remote) Sr. Special InvestigatorDes Plaines, ILRemote$91,545–$118,470 / yearProven ability to independently plan and conduct structured investigative interviews, including complex or adversarial interviews, with strong written communication skills and a demonstrated track record of producing investigative reports and case summaries used in regulatory or legal proceedings. Draft clear, concise, and well-supported fraud case summaries and investigative reports for SIU leadership, legal counsel, and compliance teams as well as reports to state departments of insurance and national fraud databases within required timeframes.
Surveillance Investigator The Robison GroupSurveillance InvestigatorJoliet, ILThrough our operating brands, HVACi, StrikeCheck, National Fire Experts, Donan Engineering, BSC Forensics, Component Testing Laboratories, The Robison Group, VRC Investigations, TechLoss, Mecanica Scientific Services, and HMI we are respected as the industry leader for our scale and our track record of conducting expert, specialized, and accurate investigations. Individuals selected for the position will be expected to perform investigations of workers compensation claims, liability investigations, multi-line insurance claims, criminal and civil background checks, and other investigative tasks.
Senior Fraud and Waste Investigator, Medicaid Humana IncSenior Fraud and Waste Investigator, MedicaidILRemote$71,100–$97,800 / yearThe Senior Fraud and Waste Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Make decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction.
Affirmative Civil Enforcement ACE Investigator Contact Government Services LLCAffirmative Civil Enforcement ACE InvestigatorChicago, ILPerforms 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.
Program Integrity Investigator (Healthcare Fraud Waste & Abuse) TriWest Healthcare AllianceProgram Integrity Investigator (Healthcare Fraud Waste & Abuse)Chicago, ILRemoteFull 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).
Affirmative Civil Enforcement (ACE) Investigator Contact Government Services LLCAffirmative Civil Enforcement (ACE) InvestigatorHammond, IN$60,000–$100,000 / yearUtilizes electronic databases (e.g., CLEAR/Accurint, LexisNexis, PACER, SAM.gov, USASpending.gov) to identify and locate witnesses and subjects, verify corporate structure and ownership, and develop documentary evidence to support investigations. For the past nine years we've been growing our government-contracting portfolio, and along the way we've created valuable partnerships by demonstrating a commitment to honesty, professionalism, and quality work.
Affirmative Civil Enforcement (Ace) Investigator CONTACT GOVERNMENT SERVICESAffirmative Civil Enforcement (Ace) InvestigatorChicago, IL$51,435.30–$66,131.10 / yearPerforms 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. Skills and attributes for success: The investigator will generate new investigations, and to continue with ongoing investigation and civil actions involving fraud in areas such as healthcare, contracting, and grants, as well as other fraud and abuse of federal public funds and programs.
Surveillance Investigator VRC InvestigationsSurveillance InvestigatorChicago, IllinoisVRC 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.
General Liability Claim Representative The Travelers Companies IncGeneral Liability Claim RepresentativeDowners Grove, IL$67,000–$110,600 / yearInvestigates each claim through prompt contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. 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.
Claim Examiner-Commercial Auto/Trucking Bodily Injury (hybrid) RLI CorpClaim Examiner-Commercial Auto/Trucking Bodily Injury (hybrid)Chicago, IL$68,556–$98,036 / yearThis approach rises from and is supported by our talented, ethical and smart team of employee owners united around a single purpose: to work alongside our customers and partners when they need us, in unexpected ways, with exceptional results. Our goal is to attract, develop and retain the best employee talent from diverse backgrounds while promoting an environment where all viewpoints are valued and individuals feel respected, are treated fairly, and have an opportunity to excel in their chosen careers.
Claim Examiner-Commercial Auto/Trucking Bodily Injury (Hybrid) RLI Corp.Claim Examiner-Commercial Auto/Trucking Bodily Injury (Hybrid)Chicago, IL$80,897–$115,682 / yearThis approach rises from and is supported by our talented, ethical and smart team of employee owners united around a single purpose: to work alongside our customers and partners when they need us, in unexpected ways, with exceptional results. Our goal is to attract, develop and retain the best employee talent from diverse backgrounds while promoting an environment where all viewpoints are valued and individuals feel respected, are treated fairly, and have an opportunity to excel in their chosen careers.
General Liability Claim Representative TravelersGeneral Liability Claim RepresentativeChicago, IllinoisInvestigates each claim through prompt contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. 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.
Intel Analyst Allied UniversalIntel AnalystChicago, ILAllied 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.
Janitor Allied UniversalJanitorChicago, ILAllied 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.
NewRegional Account Manager Allied UniversalRegional Account ManagerChicago, ILProficient in professionally conveying Allied Universal Compliance and Investigations' message to clients, potential clients, and other employees, demonstrating strong oral and written communication skills. Establish relationships with clients to distinguish Allied Universal Compliance and Investigations from the current provider and deliver tailored solutions professionally and effectively.
SIU Major Case Manager (Medical Provider) USAASIU Major Case Manager (Medical Provider)Chicago, IL$119–$310Performs leadership and management tasks, i.e., providing coaching, evaluating performance, review of time sheets, managing time off, conducting quarterly check-ins/ride-alongs, etc. As a dedicated SIU Major Case Manager (Medical Provider), you will be responsible for operational management of Claims fraud investigative teams.
Litigation Specialist Warrior Insurance NetworkLitigation SpecialistBedford Park, ILRemote$75,000–$100,000 / yearFull timeConduct 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. 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? .
Catastrophe Field Property Adjuster- Chicago Area Allstate Insurance CompanyCatastrophe Field Property Adjuster- Chicago AreaChicago, IL$56,000–$105,000 / yearYou'll wear a few hats that will 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 Property claim. We're hosting onsite interviews on the week of August 17th in our Chicago Suburban office, offering you the chance to meet our hiring team in person and discover how you can join Allstate's trusted catastrophe claims team.
Large Loss Contents Property Adjuster - Chicagoland, IL Allstate Insurance CompanyLarge Loss Contents Property Adjuster - Chicagoland, ILChicago, IL$68,000–$117,700 / yearYou'll wear a few hats that will 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 Property claim. Active Listening, Communication, Critical Thinking, Customer Service, Empathy, Mitigation, Multitasking, Property Adjusting, Time Management, Working Independently, Xactimate (Estimating Software).
NewProperty Adjuster - Field Estimating - Chicago, IL Allstate Insurance CompanyProperty Adjuster - Field Estimating - Chicago, ILChicago, IL$56,000–$105,000 / yearYou'll wear a few hats that will 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 claim. The Problem Solver -you'll utilize multiple tools to get the job done in a fast-paced environment, including estimate tools, job aids, and additional settlement platforms, all while using your sharp critical thinking skills.
Catastrophe Field Property Adjuster Allstate Insurance CompanyCatastrophe Field Property AdjusterIL$56,000–$105,000 / yearYou'll wear a few hats that will 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 Property claim. Your daily tasks will include driving to properties, conducting inspections, evaluating policies and endorsements for coverage, preparing estimates in the Xactimate program, and settling claims on site with customers.
Certified Professional Coder, Special Investigations Unit (Aetna SIU) CVS Health CorpCertified Professional Coder, Special Investigations Unit (Aetna SIU)IL$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.
Large Loss Property Adjuster - Field Estimating - Chicago, IL Allstate Insurance CompanyLarge Loss Property Adjuster - Field Estimating - Chicago, ILChicago, ILYou'll wear a few hats that will 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 claim. As a requirement of employment, individuals who currently hold an active insurance license must terminate all existing appointments prior to onboarding and must not hold any outside appointments at any point during employment.
NewLitigation Specialist First Chicago Insurance CompanyLitigation SpecialistILRemote$75,000–$100,000 / yearConduct 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.
NewLitigation Specialist First Chicago Insurance Company (FCIC)Litigation SpecialistBedford Park, ILRemote$75,000–$100,000 / yearConduct 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.
Manager Special Investigations Health Care Service CorpManager Special InvestigationsChicago, IL$92,700–$167,500 / yearJOB REQUIREMENTS: Bachelor's Degree in Criminal Justice, Finance or Accounting or related field and 5 years of direct law enforcement/investigation experience, including supervision of cases and investigators OR 9 years of direct professional work experience in the detection, investigation and/or prosecution of complex health care fraud schemes with the following professional certifications: Accredited Healthcare Fraud Investigator (AHFI), Certified Professional Coder (CPC), and/or Certified Fraud Examiner (CFE). This position will be responsible for managing healthcare fraud and internal fraud investigations initially focusing on IL Medicaid; managing and training investigators as well as support staff; establishing and maintaining liaison with healthcare providers and law enforcement; and coordinating anti-fraud activities with other departments at HCSC.
Bodily Injury Adjuster - Represented/Litigation, Moderate (IL/WI) Remote Allstate Insurance CompanyBodily Injury Adjuster - Represented/Litigation, Moderate (IL/WI) RemoteILRemote$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. Bodily Injury Claims, Business Communications, Claims Evaluation, Critical Thinking, Fraud Investigations, Information Collection, Legal Negotiations, Liability Analysis, Problem Solving, Time Management.
Bodily Injury Adjuster - Represented, Complex/Severe (IL, WI) Remote Allstate Insurance CompanyBodily Injury Adjuster - Represented, Complex/Severe (IL, WI) RemoteILRemote$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. The Problem Solver -you'll utilize multiple tools to get the job done in a fast-paced environment, including estimate tools, job aids, and additional settlement platforms, all while using your sharp critical thinking skills.
Senior Manager Special Investigations Health Care Service CorpSenior Manager Special InvestigationsChicago, IL$92,700–$167,500 / yearLead the design, implementation, and ongoing optimization of pre-payment review process to identify and prevent fraudulent, wasteful, abusive, or non-compliant claims prior to payment and oversee, monitor and make decisions regarding pre-payment review status of providers. This position is responsible for managing health care fraud and internal fraud investigations; managing and training investigators and support staff; establishing and maintaining liaison with health care providers and law enforcement; and coordinating anti-fraud activities with other departments at HCSC.