NewProgram Integrity Investigator (Healthcare Fraud Waste & Abuse) TriWest Healthcare AllianceProgram Integrity Investigator (Healthcare Fraud Waste & Abuse)Omaha, NERemoteFull 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).
Fraud Investigator - Midvale, UT (In Office) Zions Bancorporation NAFraud Investigator - Midvale, UT (In Office)Midvale, UTRelevant Professional Certification: Association of Certified Anti-Money Laundering Specialists (ACAMS), Associate of Certified Fraud Examiners (ACFE) or Association of Certified Financial Crime Specialists (ACFCS) is a plus. Zions Bancorporation is one of the nation's premier financial services companies operating as a collection of great banks under local brands and management teams in high-growth western markets.
NewExternal Fraud Investigator U.S. BancorpExternal Fraud InvestigatorBrookfield, WI$66,640–$78,400 / yearIn addition, certain positions may also be subject to the requirements of FINRA, NMLS registration, Reg Z, Reg G, OFAC, the NFA, the FCPA, the Bank Secrecy Act, the SAFE Act, and/or federal guidelines applicable to an agreement, such as those related to ethics, safety, or operational procedures. Partners with their assigned Line of Business, other Risk/Compliance/Audit (RCA) professionals, and RCA Managers to, depending on their function, create, implement, maintain, review or oversee an effective risk management framework.
Corporate Fraud Investigator Glacier BankCorporate Fraud InvestigatorHelena, MTThis role involves handling cases related to electronic banking fraud (including Zelle), new account abuse, deposit fraud, check forgery, elder abuse, debit and credit card fraud, suspected money laundering, check kiting, identity theft, internal fraud, loan fraud, and other complex schemes. WA Applicants ONLY range:Spokane $32.65 to $48.97 an hourWenatchee $33.10 to $49.66 an hourDescription- Conduct routine investigations into suspected fraud including identity theft, account abuse, check fraud, elder abuse, debit/credit card fraud, loan fraud, electronic banking fraud (e.g., Zelle), internal fraud, loan fraud, and others.
Senior Fraud, Waste and Abuse (FWA) Investigator PacificSourceSenior Fraud, Waste and Abuse (FWA) InvestigatorPortland, Oregon$65,296.83–$111,004.62 / yearIndependently plan, conduct, and manage prompt, thorough onsite and desk-top investigations of health care claims, Thoroughly document investigative findings and actions to create comprehensive case files in accordance with established policies and procedures. Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Compensation Disclaimer .
Senior Fraud, Waste And Abuse (Fwa) Investigator PacificSourceSenior Fraud, Waste And Abuse (Fwa) InvestigatorBoise, ID$65,296.83–$111,004.62 / yearEssential Responsibilities: Independently plan, conduct, and manage prompt, thorough onsite and desk-top investigations of health care claims, Thoroughly document investigative findings and actions to create comprehensive case files in accordance with established policies and procedures. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork.
NewInsurance Claims Investigator Data Surveys IncInsurance Claims InvestigatorHowell, MIhas been leading the private insurance investigative industry for over 50 years, servicing the self-insured, defense attorneys and all major insurance carriers defending against fraudulent claims. Insurance Claims Investigators at Data Surveys, Inc. are required to utilize their own personal vehicles for any necessary road travel throughout the week.
NewSurveillance / Claims / SIU Investigator Allied Universal® Compliance and InvestigationsSurveillance / Claims / SIU InvestigatorBristol, TNAcquire 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.
SIU / Claims Investigator - Central / South VA Allied UniversalSIU / Claims Investigator - Central / South VACharlottesville, Virginia$25–$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 .
Western VA SIU / Claims Investigator - Part Time Allied UniversalWestern VA SIU / Claims Investigator - Part TimeLynchburg, Virginia$27–$36 / 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 .
SIU / Claims Investigator - Northern VA / DC Area Allied UniversalSIU / Claims Investigator - Northern VA / DC AreaFredericksburg, Virginia$25–$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 .
NewSurveillance / Claims / SIU Investigator Allied UniversalSurveillance / Claims / SIU InvestigatorKnoxville, TennesseeFull timeAcquire 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 .
Surveillance / Claims Investigator Allied UniversalSurveillance / Claims InvestigatorFargo, NDClaim Investigators validate the facts of loss for Insurance claims through scene Investigations, claimant and witness Interviews, document retrieval and data Interpretation. Associate's degree in Criminal Justice with a minimum of four (4) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims.
Surveillance / Claims Investigator - Part Time Allied UniversalSurveillance / Claims Investigator - Part TimeHonolulu, HI$22–$26 / hourSurveillance / Claims Investigators validate the facts of loss for Insurance claims through scene Investigations, claimant and witness Interviews, document retrieval and data Interpretation. Associate's degree in Criminal Justice with a minimum of four (4) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims.
Investigator - Surveillance / Claims / SIU Allied UniversalInvestigator - Surveillance / Claims / SIUKnoxville, TNAcquire 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.
SIU Investigator KemperSIU InvestigatorDallas, TexasFraud Claims Law Specialist (FCLS) or Fraud Claims Law Associate (FCLA) designations and Certified Insurance Fraud Investigator (CIFI) or Certified Fraud Examiner (CFE) designations are preferred. Investigates files by using appropriate field, computer and telephone investigative techniques and provides appropriate documentation of actions in a thorough timely manner.
Retail Claims Investigator Rebel Convenience StoresRetail Claims InvestigatorUpland, CAWe’re looking for a detail-oriented Claims Investigator to support the fair, accurate, and timely resolution of general liability, property damage, and Injury claims across our convenience store and fuel station locations. If you have a background in investigations and enjoy uncovering facts, assessing risk, and supporting sound outcomes, then this may just be the role for you!
Healthcare Claims Investigator - San Juan, PR UnitedHealth Group Inc.Healthcare Claims Investigator - San Juan, PRSan Juan, PRThe work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
Claims SIU Investigator Turo IncClaims SIU InvestigatorArizona, AZ$70,000–$80,000 / yearThe Claims Special Investigations Unit (SIU) Investigator investigates potentially fraudulent, suspicious, or misrepresented claims to reduce financial loss and protect the integrity of Turo's marketplace. Whether you're flying in from afar or looking for a car down the street, searching for a rugged truck or something smooth and swanky, Turo puts you in the driver's seat of an extraordinary selection of cars shared by local hosts.
SIU Investigator Allied UniversalSIU InvestigatorAtlanta, GeorgiaAcquire 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 .