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As one of the nations leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. The Investigator is responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving the full range of products at the AmeriHealth Caritas Family of Companies (ACFC).

Your career starts now. We are looking for the next generation of health care leaders. This position is remote however, you must live and be able to travel within Ohio as business needs. At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to hear you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com. The Investigator is responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving the full range of products at the AmeriHealth Caritas Family of Companies (ACFC). Major Accountabilities: + Ensures compliance with all requirements related to Special Investigation Units and fraud, waste and abuse investigations. + Conducts investigations of potential fraud, waste and/or abuse with a focus on thoroughness and attention to detail, quality, timeliness and cost control. + Conducts comprehensive interviews with providers, members and witnesses to obtain information which would be considered admissible under generally accepted criminal and civil rules of evidence. + Proactively performs research using the Internet, data analysis tools, etc., to analyze aberrantclaims billing and practice patterns. + Analyzes data as part of the investigative process using available fraud detection software and corporate resources. + Represents ACFC in conducting settlement negotiations with providers, counsel and/or other associated parties. + Prepares and submits investigative reports covering all phases of the investigation. + Interprets and conveys highly technical information to others. + Establishes and maintains liaison with public officials, law enforcement and others to obtain assistance in conducting investigations. + Performs necessary functions to support all aspects of SIU investigations and responsibilities to include, but not limited to: Intake; Screening; Reviews; Referrals; Recoveries; and Provider Investigative Site Visits. Education/ Experience: + Bachelor's degree with a minimum of two years of experience in the healthcare field working in fraud, waste, and abuse investigations and audits OR + An associate's degree, with a minimum of four years of experience working in healthcare fraud, waste, and abuse investigations and audits. + Experience and training/certifications commensurate with position requirements in lieu of formal educational requirements for the Lead SIU Investigator position may be considered. + Valid driver’s license required + Data Analytics experience preferred. + Ability to work independently with minimal supervision, and manage a high volume of assignments. + Strong verbal and written communication skills. + High degree of integrity and confidentiality required handling information that is considered personal and confidential. + Analytical skills and ability to make deductions; logical and sequential thinker. + A minimum of 3-5 years experience conducting comprehensive health care fraud investigations; interacting with state, federal and local law enforcement agencies. Other Skills: + Health care industry and/or Medicare/Medicaid/Pharmacy/Behavioral Health/Pharmacy Benefit Management knowledge required. + Clinical Experience preferred + SIU and/or State Medicaid regulatory compliancework experience preferred. + Knowledge and proficiency in claims adjudication standards & procedures preferred. + Solid knowledge of Medicaid, Medicare, and pharmacy benefit laws and requirements; federal, state, civil and criminal statutes. + Experience with decision support tools used for data analysis. + Advanced knowledge and experience working on various approaches to fraud, waste and abuse. + Working knowledge of Microsoft applications, especially Excel required. + Knowledge of available resources (internal and external) to assist in investigations. Diversity, Equity, and Inclusion At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve. We keep our associates happy so they can focus on keeping our members healthy. Our Comprehensive Benefits Package Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more. As a company, we support internal diversity through: Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

<h2>Leaders in health care solutions for those most in need</h2>
AmeriHealth Caritas is the nation's leader in providing comprehensive health care solutions for those in most need and the chronically ill. We impact the lives of more than&nbsp;5.7 million members nationwide. With more than 30 years of experience managing care for individuals and families in publicly-funded programs, we have become known for developing&nbsp;<a href="http://www.amerihealthcaritas.com/corporate/innovation.aspx" target="_self">innovative solutions</a> that help improve health outcomes while&nbsp;<a href="http://www.amerihealthcaritas.com/who-we-serve/government/cost-savings.aspx" target="_self">reducing costs</a>.
<h3>Our mission, our goal</h3>
Our mission is to help people get care, stay well and build healthy communities. Our goal is to provide responsible managed care solutions, including Medicaid, Medicare, and CHIP - plus behavioral health, pharmacy benefits management and third-party management and administrative services.

AmeriHealth Caritas

Special Investigator-Health Insurance Fraud (Ohio residency required)

Adjudication

Administrative Skills

Analysis Skills

Behavioral Health

Billing

Biotech and Pharmaceutical

Clinical Medicine

Communication Skills

Compensation and Benefits

Cost Control

Data Analysis

Decision Support

Detail Oriented

Diversity

Driver's License

Federal Laws and Regulations

Fraud Investigation

Health Insurance

Healthcare

Internet Research

Interviewing Skills

Investigative Reports

Law Enforcement

Maintain Compliance

Managed Care

Medicaid

Medicare

Microsoft Excel

Microsoft Product Family

Negotiation Skills

Pharmacy

Presentation/Verbal Skills

Product Management

Regulatory Compliance

Regulatory Requirements

State Laws and Regulations

Willing to Travel

Writing Skills

FULL_TIME

FEED

OTHER

Job Responsibilities: Research and resolve client complaints, including review of complaint correspondence and documents, account records, and recorded client interactions, and interviews of clients, registered representatives, or other Firm employees . The successful candidate in this position will join a team of WMEO Investigators from a diverse range of backgrounds and experience who review, research, resolve, and respond to the client complaints related to investments.

As part of Wealth Management Executive Office (WMEO), you are at the center of keeping JP Morgan Chase strong and resilient. The successful candidate in this position will join a team of WMEO Investigators from a diverse range of backgrounds and experience who review, research, resolve, and respond to the client complaints related to investments. When someone joins the WMEO, you will feel that this is a place where we promote work life balance, career progression, and a positive culture. As a Wealth Management Executive Office VP Senior Investigator in J.P. Morgan Wealth Management, you will be responsible for researching and resolving non-sales and sale practice client complaints from clients, attorneys and regulators. Your role will also involve communicating resolutions to clients, attorneys and regulators, and escalating matters when necessary. Job Responsibilities: <ul><li> Research and resolve client complaints, including review of complaint correspondence and documents, account records, and recorded client interactions, and interviews of clients, registered representatives, or other Firm employees </li><li> Investigate all regulator (i.e., SEC, FINRA, etc.) and attorney complaints </li><li> Communicate resolutions verbally or via written response </li><li> Ensure that potential complaint-related FINRA filings are submitted to the Firm's Registration department for review </li><li> Partner with the Firm's Legal department on resolutions for regulatory and attorney complaints </li><li> Assist the Firm's Legal department as needed on responses to regulatory inquiries regarding client complaints, and pending arbitration and/or litigation involving client complaints </li><li> Identify and escalate operational and employee sales misconduct-related concerns </li></ul> Required qualifications, capabilities, and skills: <ul><li> Bachelor's Degree</li><li> Series 7 required </li><li> At least 5 years of securities industry experience </li><li> Strong phone and verbal communication skills </li><li> Experience with J. P. Morgan Wealth Management </li><li> Advanced writing ability </li></ul> Preferred qualifications, capabilities, and skills: <ul><li> J.D. Degree preferred </li><li> Experience handling complaints preferred </li><li> Series 66, 9/10, 24, 53, 4, and Life and Health desirable </li><li> At least 5 years of securities industry experience</li><li> Experience communicating with clients over the phone strongly preferred</li><li> Experience with the Private Bank helpful</li></ul>This role does not offer visa sponsorship.This is an in-office position and will require the incumbent to work on site five days a week. Chase is a leading financial services firm, helping nearly half of America's households and small businesses achieve their financial goals through a broad range of financial products. Our mission is to create engaged, lifelong relationships and put our customers at the heart of everything we do. We also help small businesses, nonprofits and cities grow, delivering solutions to solve all their financial needs. We offer a competitive total rewards package including base salary determined based on the role, experience, skill set and location. Those in eligible roles may receive commission-based pay and/or discretionary incentive compensation, paid in the form of cash and/or forfeitable equity, awarded in recognition of individual achievements and contributions. We also offer a range of benefits and programs to meet employee needs, based on eligibility. These benefits include comprehensive health care coverage, on-site health and wellness centers, a retirement savings plan, backup childcare, tuition reimbursement, mental health support, financial coaching and more. Additional details about total compensation and benefits will be provided during the hiring process. We recognize that our people are our strength and the diverse talents they bring to our global workforce are directly linked to our success. We are an equal opportunity employer and place a high value on diversity and inclusion at our company. We do not discriminate on the basis of any protected attribute, including race, religion, color, national origin, gender, sexual orientation, gender identity, gender expression, age, marital or veteran status, pregnancy or disability, or any other basis protected under applicable law. We also make reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as mental health or physical disability needs. Visit our FAQs for more information about requesting an accommodation.Equal Opportunity Employer/Disability/Veterans

<img alt=" " height="1" src="https://ars2.equest.com/?response_id=3355f9902a5c2f4734b3a7804aae505f&view" width="1"/>

JPMorgan Chase Bank, N.A.

Wealth Management Executive Office Sr Investigator

Attorney

Banking Services

Customer Relations

Financial Services

Legal

Litigation

Mail Processing

Nonprofit

Private Banking

Regulations

Resolve Customer Issues

Sales

Securities

Securities and Exchange Commission (SEC)

Series 66

Small Business

Wealth Management

equestftpin

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="37" data-aria-level="1">Pay Rate: $20 - $22 / 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><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="38" data-aria-level="1">Private Investigator’s license required prior to applying<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><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="39" 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> 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:
2026-1593426

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>

Investigator Jobs in Lancaster, OH

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Investigator Jobs in Lancaster, OH

Special Investigator-Health Insurance Fraud (Ohio residency required) AmeriHealth Caritas

Wealth Management Executive Office Sr Investigator JPMorgan Chase Bank, N.A.

Surveillance Investigator Allied Universal

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