Investigator, Special Investigations Unit (Meritain Health) CVS Health CorpInvestigator, Special Investigations Unit (Meritain Health)NJ$46,988–$122,400 / yearDemonstrated proficiency in Microsoft Office Suite (including Excel, specifically with pivot tables), database search tools, and use of the Intranet/Internet to research information. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Investigator, Special Investigations Unit (Aetna SIU) CVS Health CorpInvestigator, Special Investigations Unit (Aetna SIU)NJ$43,888–$93,574 / yearExperience with Microsoft Word, Excel, and Outlook products, open source database search tools, social media and internet research. Bachelor's Degree in Criminal Justice, Healthcare Management, Public Health, Biological Sciences, Data Analytics, or other related field preferred or equivalent experience.
Senior Investigator, Special Investigations Unit (Aetna SIU) CVS Health CorpSenior Investigator, Special Investigations Unit (Aetna SIU)NJ$46,988–$122,400 / yearAnticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $46,988.00 - $122,400.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations of fraud and abuse Required Qualifications 3 years working on health care fraud, waste, and abuse investigatory and audits required.
Private Investigator - Retired/Former Law Enforcement Lemieux & Associates LLCPrivate Investigator - Retired/Former Law EnforcementVineland, NJPart timeWe're actively seeking retired and former law enforcement professionals to join our Special Investigations Unit (SIU) as Investigators. Join a team where your background is respected, your voice is heard, and your work continues to make a difference.
SIU Investigator Allied UniversalSIU InvestigatorEdison, New Jersey$27–$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 .
SIU Investigator - NY Labor Law Allied UniversalSIU Investigator - NY Labor LawEdison, New Jersey$32–$40 / 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 .
CPC Investigator Horizon Healthcare ServicesCPC InvestigatorNewark, New JerseyThe Certified Professional Coder (CPC) is responsible for performing reviews, audits and coding oversight of medical records to ensure the appropriate CPT codes, diagnosis codes and modifiers according to Generally Accepted Medical Coding Guidelines, CPT-4; HCPCS; ICD-10 Guidelines; and, CMS Correct Coding. $70,500 - $94,395 This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.
CPC Investigator Blue Cross and Blue Shield AssociationCPC InvestigatorNewark, NJ$70,500–$94,395 / yearThe Certified Professional Coder (CPC) is responsible for performing reviews, audits and coding oversight of medical records to ensure the appropriate CPT codes, diagnosis codes and modifiers according to Generally Accepted Medical Coding Guidelines, CPT-4; HCPCS; ICD-10 Guidelines; and, CMS Correct Coding. The incumbent will also be responsible for handling low level investigative activities (external) related to claims, enrollment, accounting, receive and review suspected fraud and to complete cases with all information and analysis for resolution, as the manager and prior approved guidelines may direct.
Asset Protection Investigator (GME + eBay) Collectors Holdings, Inc.Asset Protection Investigator (GME + eBay)Jersey City, NJ$61,396–$99,678 / yearWork with the Head of Global Asset Protection to proactively identify gaps/areas of improvement with respect to digital security systems (access control, video surveillance, video storage) or physical processes that create exposure to theft. Excellent analytical skills and broad experience documenting investigations with the ability to think outside the box, handle multiple projects simultaneously, and build relationships with internal and external stakeholders.
AML Investigator I Valley National BancorpAML Investigator IMorristown, NJManage complex cases involving matters such as multiple relationship accounts, international wires involving Bank-designated high risk jurisdictions, and complex cash structuring schemes. Responsibilities include but are not limited to: Review and analyze alerts generated by the Bank's electronic monitoring software to make a determination as to whether activity warrants further review.
SIU Investigator Centene Corporation GroupSIU InvestigatorNJRemote$56,200–$101,000 / yearMinimum of five (5) years in healthcare field working in fraud, waste and abuse investigations and audits, (or) five years of insurance claims investigation experience or professional investigation experience with law enforcement agencies, (or) seven years of professional investigation experience involving economic or insurance related matters. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse.
Surveillance Investigator VRC InvestigationsSurveillance InvestigatorNewark, New JerseyVRC provides their investigators with necessary equipment and comparable pay, to include drive time, above normal commute mileage reimbursement, company paid licensing fees in most states and allowance for non-reimbursed business expenses. We currently have career opportunities for experienced, self-determined, and highly motivated SURVEILLANCE INVESTIGATORS that would like to join our team of professionals in our efforts to deter and combat insurance fraud.
Investigator Ethos Risk ServicesInvestigatorAtlantic City, NJPart timePrevious 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.
Entry-Level Investigator Ethos Risk ServicesEntry-Level InvestigatorJersey City, NJFull timeOur Full-Time Entry-Level Field Investigator position will help launch your career by providing you with an industry leading FULLY PAID Investigator Training Program - no prior experience necessary! Documentation: Finalize case file by submitting case reports and uploading video footage via personal laptop at the end of the day.
SIU Claims Investigator - Spanish Speaker Lemieux & Associates LLCSIU Claims Investigator - Spanish SpeakerVineland, NJ$25–$32 / hourPart timeOur leadership team brings over 25 years of field experience and is committed to fostering a professional, results-driven environment. Join Lemieux & Associates , a trusted leader in investigative services, and make an impact with your surveillance expertise.
Special Investigation Unit (SIU) Manager CVS Health CorpSpecial Investigation Unit (SIU) ManagerNJ$54,300–$159,120 / yearThe Certified Professional Coder (CPC) Manager will oversee a team of medical coders within the Special Investigations Unit (SIU) to ensure compliance with coding practices through comprehensive record reviews for medical, behavioral, transportation, and other healthcare providers. Ensure staff provide detailed written summaries of medical record review findings and ensure the team articulates findings effectively to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, and state regulators.
Special Agent U.S. Department of Homeland SecuritySpecial AgentNJ$48,854–$118,204 / yearOR Have at least 1 year of specialized experience equivalent to the GL-9 level (such as experience in or related to planning and conducting complex criminal investigations to determine violations of Federal laws and regulations; collecting and assembling facts to identify logical conclusions; gathering, analyzing, and evaluating evidence or data; conducting interviews and interrogations; making arrests; conducting searches and seizures; taking responsibility for own actions and those of team members to ensure the goals and deadlines for the team are met; partnering with or leveraging networks or relationships from outside the organization; experience managing complex projects including setting priorities and determining resource requirements). OR Have at least 1 year of specialized experience equivalent to the GL-7 level (such as experience applying law enforcement, protective, or investigative techniques in the performance of job duties; identifying problem areas and proposing and implementing solutions; taking responsibility for own actions and those of team members to ensure the goals and deadlines for the team are met; leading meetings or seminars on behalf of a professional or academic group; setting work priorities and allocating resources; partnering with other individuals from within and outside the organization).