Fraud Investigator II University of Massachusetts Medical SchoolFraud Investigator IIWestborough, Massachusetts5-7 years of related experience in fraud examination, healthcare, business, finance or related field; with at least 2 years of experience conducting data mining in the healthcare insurance industry and claims related experience. The Investigator II collaborates with the Associate Director on more complex case reviews as needed, in addition to performing activities related to data mining, data analysis and recoveries.
Investigator Highmark IncInvestigatorPAThe incumbent is responsible for conducting investigations of organizational or functional activities related to alleged fraud, waste and abuse perpetrated by providers, members, facilities, pharmacies, groups and/or employees of the organizations and Subsidiaries. The incumbent is also responsible for the field investigative work necessary to complete a review of a special project, potential fraud, waste and abuse case, conducting the initial investigations and coordinating the recovery/savings of money related to fraud, waste and abuse.
Special Investigation Unit Investigator III L.A. Care Health PlanSpecial Investigation Unit Investigator IIILos Angeles, CAThe Special Investigation Unit Investigator III performs in-depth evaluation of potential fraud & abuse cases and develops complex investigations that involve high dollar amounts, sensitive issues, or that otherwise meet criteria for fraud, waste & abuse. claims history, provider files) to determine provider billing patterns and detect potential fraudulent or abusive billing practices or vulnerabilities in Medi-Cal/Medicare policies and initiates appropriate action.
Director, Claims Litigation Dollar Tree ManagementDirector, Claims LitigationChesapeake, VirginiaThe Claims Director partners with internal and external stakeholders to identify, measure and manage claims, including development and implementation of risk control and mitigation solutions within business operations. Conduct analysis of claims data to facilitate decisions on liability claims program structure, staffing, program adjustments for maximum results, and use of additional resources to augment TPA capabilities.
Senior Claims Examiner Coaction Specialty Insurance GroupSenior Claims ExaminerMorristown, New JerseyMay be designated as claims contact for key accounts and programs in which case the Examiner will perform various account or program management tasks including: Preparing for and attending claim reviews. The type of claims handled by the team include bodily injury arising out of commercial slip and fall, ceiling collapses, bed bug, dog bites, and other premises liability losses.
Fraud Investigator AMOCO Federal Credit UnionFraud InvestigatorTexas City, TexasThe Fraud Investigator assists AMOCO in achieving its mission of "serving the financial needs of our members" by investigating and documenting potential fraud and suspicious activities across various types of transactions. The goal of every interaction is to create member loyalty and to serve and satisfy the financial needs of our members and employees at every touchpoint in the member service chain.
Investigator Attorney Jacoby and MeyersInvestigator AttorneyLos Angeles, CASpecializing in all types of accident claims, including automobile, motorcycle, bicycle, Uber/Lyft, or trucking accidents, slip and falls, dog bites, construction accidents and other wrongful conduct, the attorneys at Jacoby & Meyers have recovered over a billion dollars for their clients' personal injury and wrongful death claims caused by the negligence of a third party. The position will require traveling and driving to locations and may require being available outside of business hours and on some weekends, depending on investigation and as needed to meet and speak with clients.
NewFire Investigator EFI Global IncFire InvestigatorMetairie, LAOver 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. Mental: Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
NewFraud Investigator APG Federal Credit UnionFraud InvestigatorEdgewood, Maryland$61,800–$99,000 / yearCollaborate with Internal and External Partners (10%) : Work closely with business units, law enforcement agencies, financial institutions, merchants, insurance providers, and industry partners to investigate cases, recover losses, support prosecution efforts when appropriate, and facilitate recovery opportunities. Detect and Prevent Fraud Losses (20%) : Analyze alerts, reports, surveillance footage, call recordings, wire requests, fraud detection tools, and transactional activity to identify risks and take timely action to prevent or minimize losses.
NewInvestigator (4899-31) The Hamilton County Prosecutor's OfficeInvestigator (4899-31)Cincinnati, Ohiointerviews witnesses and suspects; collects and analyzes information; collects and secures evidence; performs research and file searches; provides surveillance, uses cover identity, etc.); receives, screens and records information from informants, citizens, law enforcement personnel, and others; communicates with the public and governmental or law enforcement agencies; testifies in court as needed. Maintains and operates an office computer, utilizing database-oriented inquiry system to produce word processing documents and reports; develops, maintains and completes detailed records and reports (e.g.
Compliance Investigator Montana GovernmentCompliance InvestigatorHelena, MTA degree in business, public administration, criminal justice, legal studies, labor relations, human resources, accounting, or a related field may supplement relevant professional experience but is not a substitute for demonstrated skills and competencies in the areas noted above. Support data tracking and reporting: Assists in tracking caseload activity, workload trends, and case outcomes and contributes to reporting that supports program oversight, operational planning, and continuous improvement.
Investigator State of Rhode IslandInvestigatorProvidence, RI$73,601–$83,096 / yearThe MFCU is responsible for investigating and prosecuting (a) fraud by healthcare providers in the Rhode Island Medicaid program; (b) fraud in the administration of the Rhode Island Medicaid program; (c) the abuse, neglect, mistreatment of individuals who live in Rhode Island's skilled nursing facilities and board and care facilities; and (d) to investigate and prosecute cases of abuse, neglect or mistreatment in "noninstitutional" settings where the abuse, neglect or mistreatment involves a Medicaid recipient. The Rhode Island Office of the Attorney General is seeking a highly motivated investigator to join the Medicaid Fraud Control and Patient Abuse Unit (MFCU) to investigate complex criminal and civil enforcement actions related to allegations of fraud against the state Medicaid program and allegations of abuse and neglect of residents of long-term care facilities.
Fraud Investigator - Medicare Peraton IncFraud Investigator - MedicareRemote$66,000–$106,000 / yearInvestigators are expected to research and understand the relevant offenses being investigated; conduct efficient and effective investigations concerning those alleged offenses and detect or verify suspected violations; obtain information and evidence by observation, record examination, and interview. What you''ll do: The position is expected to perform high level complex investigations of medical professional service providers and develop cases for future action, including referral to law enforcement, education, over payment recovery and other administrative actions.
Investigator (AG) State of Rhode IslandInvestigator (AG)Providence, RI$73,601–$83,096 / yearThe MFCU is responsible for investigating and prosecuting (a) fraud by healthcare providers in the Rhode Island Medicaid program; (b) fraud in the administration of the Rhode Island Medicaid program; (c) the abuse, neglect, mistreatment of individuals who live in Rhode Island's skilled nursing facilities and board and care facilities; and (d) to investigate and prosecute cases of abuse, neglect or mistreatment in "noninstitutional" settings where the abuse, neglect or mistreatment involves a Medicaid recipient. The Rhode Island Office of the Attorney General is seeking a highly motivated investigator to join the Medicaid Fraud Control and Patient Abuse Unit (MFCU) to investigate complex criminal and civil enforcement actions related to allegations of fraud against the state Medicaid program and allegations of abuse and neglect of residents of long-term care facilities.
Senior Support Investigator (NYHELP Program) Vacancy (Family and Community Services) Oneida County New YorkSenior Support Investigator (NYHELP Program) Vacancy (Family and Community Services)Utica, NYEither: (A) Successful completion of sixty (60) semester credit hours at a regionally accredited or NYS registered college or university, of which at least thirty (30) credit hours were completed in social work, sociology, psychology, business management or criminal j ustice, AND two (2) years of experience in social service -type programs examining, investigating, or evaluating claims and/or complaints for assistance, veterans, or unemployment benefits or a similar social service -type program operating under established criteria for eligibility; OR. (B) Successful completion of thirty (30) credit hours at a regionally accredited or New York State registered college or university, of which at least fifteen (15) credit hours were completed in social work, sociology, psychology, business management or crimin al justice, AND three (3) years of experience in social service -type programs examining, investigating, or evaluating claims and/or complaints for assistance, veterans, or unemployment benefits or a similar social service -type program operating under estab lished criteria for eligibility.
Senior Compliance Analyst and SIU Investigator Community Health GroupSenior Compliance Analyst and SIU InvestigatorChula Vista, CARegulatory Compliance: Ensure all investigations adhere to California Department of Insurance regulations, Centers for Medicare & Medicaid (CMS), Department of Health Care Services (DHCS), and Department of Managed Health Care (DMHC) and other statutory requirements. Under the direction of the CO, timely and comprehensively coordinate, monitor, and perform duties related to CHG's FWA Program, including investigations, CAPs, education and training, and FWA Program development and risk management.
Senior Financial Analyst/Investigator CONTACT GOVERNMENT SERVICESSenior Financial Analyst/InvestigatorHarrisburg, PA$80,000–$140,000 / yearFor 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. Here at CGS we value honesty through hard work and self-awareness, professionalism in all we do, and to deliver the best quality to our consumers mending those relations for years to come.
A/P Area Investigator D1 Vallarta Supermarkets IncA/P Area Investigator D1Santa Clarita, CA$22.50–$26 / hourResponsible to utilize data available through CCTV systems, exception report system, or NCR reports to develop cases on possible dishonest acts pertaining to, transactions left suspended, canceled transactions, refunds, voided transactions and sweet hearting. We may collect your name, driver's license or state identification card number, passport number or other government identification number (including U.S. work authorization number), Social Security information, residence/postal address, email address(es), phone number(s), and other contact information during the application and recruitment process.
Field Investigator - Region 11 Texas Health and Human Services CommissionField Investigator - Region 11Edinburg, TX$4,263.16–$5,521.16The position prepares and presents training; reviews and/or develops investigative techniques; assists with development of policies and procedures for conducting investigations; recommends improvements, changes, or modifications to BPI processes to increase efficiency and effectiveness of division activities and promote program integrity; and performs other related duties as assigned. BPI Field Investigators conduct highly complex administrative and criminal investigations involving recipients of HHS programmatic services, such as Medicaid; the Children's Health Insurance Program (CHIP); the Supplemental Nutrition Assistance Program (SNAP); Temporary Assistance for Needy Families (TANF); and the Women, Infants, and Children's (WIC) program.
Senior Financial Analyst/Investigator Contact Government Services LLCSenior Financial Analyst/InvestigatorHarrisburg, PA$80,000–$140,000 / yearFor 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. Here at CGS we value honesty through hard work and self-awareness, professionalism in all we do, and to deliver the best quality to our consumers mending those relations for years to come.