OTHER

FEED

UNKNOWN

Previous 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.

ABOUT US: Ethos Risk Services is a leading insurance claims investigation and medical management company, specializing in surveillance and fraud detection. At the forefront, we provide accurate data and actionable insights that translate into better decision-making for our clients. JOB SUMMARY:Our dynamic Ethos team is seeking an Experienced Field Investigator to conduct surveillance and investigative activities to identify potential fraudulent insurance claims. This role involves performing both stationary and mobile surveillance, obtaining video and photographic evidence, and preparing thorough, detailed reports for clients. KEY RESPONSIBILITIES:<ul><li>Case Preparation: Prepare for surveillance assignment by reviewing Ethos' preliminary reports and case information.</li><li>Field Surveillance: Perform covert surveillance from your vehicle by tracking and capturing high-quality video evidence of surveillance targets.</li><li>Report Writing: Draft detailed and court-ready investigative reports summarizing activity and key findings.</li><li>Documentation: Finalize case file by submitting case reports and uploading video footage via personal laptop at the end of the day.</li><li>Communication: Work closely with the field supervisor and operations teams, receiving regular guidance and mentorship.</li></ul> REQUIREMENTS:<ul><li>Previous Experience: Demonstrated proficiency in covert surveillance techniques, capturing high-quality video footage, and preparing thorough, well-organized investigative reports.</li><li>Driver's License: Valid driver's license and proof of automobile insurance.</li><li>Personal Vehicle: A well-maintained vehicle that is always reliable (preferably with tinted windows).</li><li>Surveillance Equipment: A handheld camcorder with high-quality zoom and a covert camera device. Use of stabilization equipment (gimbals, tripods, etc.) is strongly encouraged.</li><li>Technology: A reliable laptop, cell phone, and internet service are needed for communication and administrative tasks.</li><li>Private Investigator License: Active Private Investigator license or willingness to obtain one (where required by state).</li></ul> WORKING CONDITIONS:<ul><li>While we aim to keep assignments within a 2-hour drive of your residence, occasional further travel and overnight stays (covered by the company) may be required</li><li>Most surveillance cases start at 6:00AM. End time can vary depending on activity and a typical workday can vary from 3-12 hours.</li><li>Weekends/holidays are common workdays as claimants are more likely to be active.</li><li>This is an independent role often requiring long hours alone in your vehicle, regardless of weather conditions.</li><li>Must remain alert with no external distractions, ready to use videography equipment to document subjects.</li></ul> Ethos Risk Services is an equal opportunity employer that does not discriminate on the basis of religious creed, sex, national origin, race, veteran status, disability, age, marital status, color or sexual orientation or any other characteristic. A background check will be conducted, in accordance to the local state law and regulations. Job Posted by ApplicantPro

Ethos Risk Services

Investigator

Administrative Skills

Auto Insurance

Cellular Telephone

Driver's License

Insurance Claims

Internet/Online Service

Investigative Reports

Laptop PC

Mentoring

Mobile Devices

Operations Management

Organizational Skills

Reporting Skills

Risk

Surveillance

Willing to Travel

Talent Acquisition

ADAPTED_NOW

This role is also responsible for the identification and monitoring of emerging FWA trends and conducting research and interactions on claims, industry and other sources (internal and external) of data and information to identify potential FWA and support ongoing fraud investigations. Act as the Program Integrity liaison and ensure collaboration with state and federal agencies and facilitate accurate deployment and ongoing monitoring of state-specific regulations and ongoing partnership with state regulators in managing Medicaid and Medicare programs.

Job Summary: The Special Investigations Unit (SIU) Investigator Lead is the face of the SIU with external federal and state regulatory agencies and is responsible for regulatory communications to ensure timeliness with these oversight agencies. This role is also responsible for the identification and monitoring of emerging FWA trends and conducting research and interactions on claims, industry and other sources (internal and external) of data and information to identify potential FWA and support ongoing fraud investigations. Utilizes a variety of data analytics platforms to mine large volumes of data to identify and mitigate fraudulent claim activity, discover patterns and anomalies in billing behavior. This is a high case load volume, fast paced environment. Essential Functions: Identify risks and guard against fraud, waste, and abuse by interacting with internal and external business partners through development and monitoring of the Annual Program Integrity Fraud, Waste and Abuse Plan Develop and implement innovative best practices to align with future growth and ongoing regulatory oversight Act as the Program Integrity liaison and ensure collaboration with state and federal agencies and facilitate accurate deployment and ongoing monitoring of state-specific regulations and ongoing partnership with state regulators in managing Medicaid and Medicare programs Engage in external fraud associations, forming relationships with industry leads, (i.e. other MCEs, NHCAA, etc.) Predict emerging fraud, waste and abuse trends and communicate strategy to monitor and identify risk to CareSource Identify opportunities for cost avoidance through prepayment review, provider education, or other preventative measures Responsible for regulatory reporting accuracy and other ad hoc regulatory inquiries Ensure that the team is submitting a consistent high volume of quality FWA referrals to our state partners Lead investigation on-sites and serve as a mentor for the team Conduct and assist investigators with complex investigations Collaborate with data analytics team and utilize RAT STATS on Statistically Valid Random Sampling Manage case turn-around times to promote efficiency in investigations and to mitigate risk to CareSource Meet quality standards of case documentation Generate leads in our fraud detection system to result in investigations that will prevent risk to CareSource. Trend data to identify potential opportunities (e.g., variances, significant outliers, percentile ranked groups) for quality improvement or focused investigations Identify trends and patterns using standard corporate processes, tools, reports, and databases, as well as leveraging other processes and data sources such as policies, coding guidelines, and regulations that would support the hypothesis being developed Manage and decision claims pended for investigative purposes Maintain a working knowledge of all state and federal laws, rules, and billing guidelines for various provider specialty types Prepare and conduct in-depth complex interviews relevant to investigative plan Execute and manage provider formal corrective action plans Participate in meetings with operational departments, business partners, and regulatory partners to facilitate investigative case development Participate in meetings with Legal General Counsel to drive case legal actions, formal corrective actions, negotiations with recovery efforts, settlement agreements, and preparation... For full info follow application link. CareSource is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity, genetic information, protected veteran status or any other characteristic protected by applicable federal, state or local law.

CareSource Management Services LLC

SIU Investigator Lead (Must live in OH or surrounding states)

Best Practices

Billing

Claims Management

Corrective Action

Data Analysis

Data Processing

Database Report Tools

Documentation Standards

Federal Government

Federal Laws and Regulations

Financial Trend Analysis

Fraud Investigation

Lead Generation

Medicaid

Medicare

Quality Management

Quality Metrics

Regulations

Research Skills

Risk Analysis

Risk Management

State Laws and Regulations

Statistical Sampling

Training/Teaching

Trend Analysis

Weyerhaeuser

When sourcing resumes, please PRIORITIZE candidates who have: - Worked in or with rural healthcare communities (WV, Appalachian region, or any rural/HPSA-designated area). SUMMARY TABLE #TitleMinimum ExperiencePriority1Program Director / PI7-10 yrs grant/workforce/healthcare adminCritical - named on application.

POSITION 1: Program Director / Principal Investigator JD for Recruitment:<ul><li>Overall accountability for MSCF Rural Healthcare Apprenticeship program</li><li>Primary liaison to WV Department of Health MSCF Program Manager and RHTP Director</li><li>Oversees milestone achievement, budget compliance, and grant agreement terms</li><li>Signs certifications and invoice packages for reimbursement draws</li><li>Ensures MOE (Maintenance of Effort) compliance and no-supplanting requirements</li><li>Approves all budget revisions before submission to State</li><li>Minimum 7-10 years in workforce development, grant program management, or healthcare administration</li><li>Prior experience managing federal/state grants under 2 CFR 200 strongly preferred</li><li>WV or Appalachian regional experience a plus</li></ul> SUMMARY TABLE <table border="1"><tbody><tr><td>#</td><td>Title</td><td>Minimum Experience</td><td>Priority</td></tr><tr><td>1</td><td>Program Director / PI</td><td>7-10 yrs grant/workforce/healthcare admin</td><td>Critical - named on application</td></tr></tbody></table> This grant specifically serves rural West Virginia communities and HPSA (Health Professional Shortage Area) designated counties. The evaluation criteria heavily favor candidates with rural healthcare experience. When sourcing resumes, please PRIORITIZE candidates who have: 
- Worked in or with rural healthcare communities (WV, Appalachian region, or any rural/HPSA-designated area) 
- Experience with rural workforce development, rural health staffing, or rural community health programs 
- Knowledge of rural healthcare workforce shortages and underserved area dynamics 
- Any prior work with rural hospitals, rural health clinics, FQHCs, or rural health systems 
- Experience placing or training healthcare workers in rural or remote settings 
WV-based or Appalachian-region candidates are a significant plus but not mandatory. What matters most is demonstrable rural healthcare experience that we can reference in the application narrative. 
For each resume submitted, please also note: 
- Candidate's geographic background / areas worked 
- Any specific rural or HPSA-area experience highlights 
- Availability to be named on the application All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

22nd Century Technologies, Inc., is one of the fastest growing IT Service Integrator and Workforce Solution companies in the United States. Founded in 1997, 22nd Century Technologies is a Certified National Minority Business Enterprise with 6,000+ people including 600+ Cyber SMEs nationwide supporting our customers in all 50 states, Canada, and Mexico. With HQs in Somerset, NJ and Mclean, VA, 22nd Century has 14 offices throughout the United States. As part of our unrelenting focus on quality and compliance, 22nd Century Technologies’ delivery is based on Certified Matured Processes including CMMI L3 Dev & SVC, ISO 20000, ISO 27001, and ISO 9001 quality processes. With a strong focus on the public sector, 22nd Century currently holds government contracts with 14 out of 15 Federal Executive agencies including DoD, 37 other Federal agencies, 50 States, 115+ Local agencies, and 37 School Districts. In the last three years, we have expanded our services to Fortune 500 and other commercial clients and currently support 80+ commercial clients.
Recognized among “Best Company to Work For” by Forbes, 22nd Century Technologies, Inc., consistently exceeds our clients’ expectations by focusing on their absolute satisfaction with jobs while keeping our employees motivated.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Investigator Jobs in Charleston, WV

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Investigator Jobs in Charleston, WV

Investigator Ethos Risk Services

SIU Investigator Lead (Must live in OH or surrounding states) CareSource Management Services LLC

Program Director / Principal Investigator 22nd Century Technologies, Inc.

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