Claritev CorpNewSenior 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.
Claritev CorpNewMedical 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.
Chubb LtdSIU Investigator Chubb LtdSIU InvestigatorChicago, IL$57,000–$83,000 / yearAn Associates or Bachelors degree in Criminal Justice or a related field, or five years of insurance claims investigation experience or five years of professional investigation experience with law enforcement agencies, or seven years of professional investigative experience involving economic or insurance fraud related matters. The Investigator will work collaboratively with the Claims Department and Legal to quickly identify and combat potential fraud in a business environment that values speed and service, allowing us to quickly process and pay legitimate claims for our policyholders.
U.S. Department of EducationCriminal Investigator, GS-1811-12/13 (MP) U.S. Department of EducationCriminal Investigator, GS-1811-12/13 (MP)Chicago, IL$89,508–$138,370 / yearSpecialized Experience for the GS-12 level: One year of specialized experience equivalent to the GS-11 grade level or equivalent public or private sector experience that has equipped you with the particular knowledge, skills, and abilities to perform successfully the following duties or work assignments below: Conducting the full range of criminal investigations of greater than average complexity and importance using accepted methodology and problem-solving techniques. If you are claiming eligibility under the Veterans Employment Opportunities Act (VEOA), you must submit: A copy of your DD-214 that shows active service and character of discharge (member copy 4, Separated Members only) OR a certification of expected discharge or release from active duty under honorable conditions within 120 days from the date of application (Current Active Duty Members only).
U.S. Department of EducationCriminal Investigator (Open Continuous) U.S. Department of EducationCriminal Investigator (Open Continuous)Chicago, IL$57,188–$97,087 / yearGrade-point average (G.P.A) -- Applicants must have a grade-point average of 3.0 or higher out of a possible 4.0 (B or better) as recorded on their official transcript or as computed based on 4 years of education or as computed based on courses completed during the final 2 years of the curriculum; OR 3.5 or higher out of a possible 4.0 (B or better) based on the average of the required courses completed in the major field or the required courses in the major field completed during the final 2 years of the curriculum. #### Specialized Experience for the GS-11 level One year of specialized experience equivalent to the GL/GS-9 grade level or equivalent public or private sector experience that has equipped you with the particular knowledge, skills, and abilities to perform successfully the following three (3) duties or work assignments below: Experience conducting the full range of criminal investigations of average complexity and importance using accepted methodology and problem-solving techniques.
Centene Corporation GroupClinical Investigator I (Special Investigation Unit) Centene Corporation GroupClinical Investigator I (Special Investigation Unit)ILRemote$56,200–$101,000 / yearLicenses/Certifications: Coding certification from an accredited organization (American Academy of Professional Coders or American Health Information Management Association), RN, LPC, LPN, LCSW, LMHC, PT, OT, or ST or related license. Ideal background includes reviewing medical records for fraud investigations, as well as experience from a specialist physician's office focused on record review and documentation quality.
Contact Government Services LLCAffirmative 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.
SGI Global, LLCAffirmative Civil Enforcement (ACE) Investigator SGI Global, LLCAffirmative Civil Enforcement (ACE) InvestigatorHammond, INThe 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.
Elevance Health IncNewInvestigator II Elevance Health IncInvestigator IIChicago, IL$78,320–$128,160 / yearWe are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance.
Allied UniversalSurveillance Investigator Allied UniversalSurveillance InvestigatorMerrillville, Indiana
Contact Government Services LLCHealthcare Fraud Investigator Contact Government Services LLCHealthcare Fraud InvestigatorChicago, IL$85,000–$105,000 / yearCommunication skills, Ability to interact professionally and effectively with all levels of staff, including AUSAs, support staff, client agencies, debtors, debtor attorneys, and their staff, court personnel, business executives, witnesses, and the public. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently accurately and under pressure, and be enthusiastic about learning and applying knowledge to provide excellent litigation support to the client.
Contact Government Services LLCSenior Financial Investigator Contact Government Services LLCSenior Financial InvestigatorChicago, IL$107,114.45–$141,560.16 / yearEstablishes and verifies relationships among all facts and evidence obtained or presented to confirm the authenticity of documents, corroborate witness statements, and otherwise build proof necessary to successful case resolution. • Establishes and/or verifies relationships among all facts and evidence obtained or presented to confirm the authenticity of documents, corroborate witness statements, and otherwise build proof necessary for successful litigation.
Centene Corporation GroupManager, SIU Prepay Investigations Centene Corporation GroupManager, SIU Prepay InvestigationsIL$87,700–$157,800 / yearPrevious experience as a lead or supervisor in a pre-payment process managing cross functional teams or supervisory experience including hiring, training, assigning work and managing the performance of staff preferred. Position Purpose: Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends and schemes.
Warrior Insurance NetworkNewLitigation Specialist Warrior Insurance NetworkLitigation 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. 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?.
Allstate Insurance CompanyCatastrophe Field Property Adjuster Allstate Insurance CompanyCatastrophe Field Property AdjusterIL$51,500–$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.
First Chicago Insurance CompanyNewLitigation Specialist First Chicago Insurance CompanyLitigation 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.
First Chicago Insurance Company (FCIC)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.
Contact Government Services LLCSenior Auditor Contact Government Services LLCSenior AuditorChicago, IL$80,000–$150,000 / yearAnalyze and calculate ability to pay settlements and judgments, including analyzing debt covenants, borrowing capacity, adjusted earnings, and earnings per share financial ratios, accounts receivable, and accounts payable aging schedules, tax considerations, assessing collectability, and developing payment terms and schedules. CGS is seeking a Senior Auditor who will assist the district legal staff by conducting medical claims data analysis, forensic investigations, financial damages, statistical sampling, and ability-to-pay analyses, which serve a significant role in determinations regarding investigations, prosecutions, settlements, and recovery in these matters, which can be voluminous and complex.
Chubb LtdNewField Compliance Analyst Chubb LtdField Compliance AnalystChicago, IL$48,000–$67,000 / yearThe company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally. As a Chubb corporate employee, you have access to one of the most comprehensive benefit plans in the business, designed to meet your needs and help you reach your financial goals.
G-PACNewWorkers Comp Attorney G-PACWorkers Comp AttorneyChicago, ILThis is an opportunity to work with a firm that has built its reputation on advocating for injured workers and securing meaningful results for clients navigating complex workplace injury claims. Our team works closely with medical providers, vocational experts, investigators, and other professionals to build strong, evidence-driven claims on behalf of injured workers.
TriWest Healthcare AllianceProgram Integrity Clinical Specialist (RN or PA Req'd) TriWest Healthcare AllianceProgram Integrity Clinical Specialist (RN or PA Req'd)Chicago, ILRemoteFull timeTechnical 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.