NewClinical Fraud Investigator II Elevance HealthClinical Fraud Investigator IIAtlanta, GeorgiaRequires an Associate Degree in Nursing and/or current certification as a Certified Professional Coder (AAPC or AHIMA) and minimum of 4 years related experience, including minimum of 1 year experience in a Clinical Fraud and Abuse Investigation area; or any combination of education and experience, which would provide an equivalent background. Locations: This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance.
Fraud Investigator II (2026-51896) University of MassachusettsFraud Investigator II (2026-51896)Worcester, MAAll Academic Accounting & Finance Administrative Professional Administrative Support Advancement Basic Science Biotechnology Clinical Research Environmental Health & Safety Executive Faculty Healthcare Human Resources Information Technology Interns Library Maintenance and Facilities Management Nursing Office Assistant Other Post Doc Professional Technician I Public Safety Research Residents Retail & Dining Services Staff Assistant Staff Associate Volunteer. All Bedford Boston Brockton Brockton Canton Charlestown Danvers Devens Fall River Fitchburg Holyoke Jamaica Plain Jamaica Plan Lincoln Mattapan North Hampton North Quincy Pocasset Shrewsbury Springfield Taunton Tewksbury Waltham Westborough Westfield Woburn Worcester Wrentham.
Senior Fraud and Abuse Investigator/CPC/CFI/CFS/CHC/CFE/AHFI - Remote Sentara Healthcare IncSenior Fraud and Abuse Investigator/CPC/CFI/CFS/CHC/CFE/AHFI - RemoteVARemote$25.60–$42.67 / hourExperience utilizing data analytics to identify high-risk providers and claims for pre-payment review within a healthcare payer, SIU, Program Integrity, or Payment Integrity environment is strongly preferred. Experience conducting pre-pay investigations, provider risk assessments, data mining, fraud, waste and abuse (FWA) analysis, and proactive identification of billing anomalies and emerging provider trends.
Welfare Fraud Investigator (Entry/Journey) DOQ Solano County CailforniaWelfare Fraud Investigator (Entry/Journey) DOQFairfield, CA$97,136–$138,902.40 / yearThe Welfare Fraud Investigator (Journey) will conduct routine and complex investigations, regarding public assistance eligibility, theft, and fraud, as well as other investigations such as threats against department employees and theft of and damage to public property; prepares cases substantiated for administrative and/or formal legal action; testifies in both judicial and non-judicial proceedings; and performs related duties as required. Note: Incumbents hold peace officer powers pursuant to Section 830.35 of the California Penal Code, however, this is not considered an active law enforcement classification for such personnel administrative matters as retirement, industrial or workers compensation.
NewSUPERVISING FRAUD INVESTIGATOR II, DEPARTMENT OF HEALTH CARE SERVICES State Of CaliforniaSUPERVISING FRAUD INVESTIGATOR II, DEPARTMENT OF HEALTH CARE SERVICESOrange County, CA$9,840–$13,459 / yearAbout this Role: Under the general direction of the Senior Special Agent, the Supervising Fraud Investigator II, organizes, and coordinates the work of multiple offices statewide to conduct targeted preliminary and full criminal and administrative investigations of fraud, waste or abuse by DHCS program beneficiaries and providers, respectively. Our success is made possible by the hard work of more than 4,800 DHCS team members and through collaboration with the federal government and other state agencies, counties, and partners for the care of low-income families, children, pregnant women, older adults, and persons with disabilities.
NewFraud Investigator State of MaineFraud InvestigatorPortland, Maine$22.91–$31.97 / hourThe Department provides health and social services to approximately a third of the State's population, including children, families, older Mainers, and individuals with disabilities, mental illness, and substance use disorders. The Office for Family Independence (OFI) is responsible for administration of eligibility determination for several programs, including MaineCare, Temporary Assistance for Needy Families (TANF), Food Supplement and Child Support.
Senior Fraud, Waste and Abuse (FWA) Investigator PacificSource Health PlansSenior Fraud, Waste and Abuse (FWA) InvestigatorPortland, OR$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.
Fraud Investigator II UMass Chan Medical SchoolFraud Investigator IIWestborough, MAGENERAL SUMMARY OF POSITION: Under the general direction of the Associate Director, or designee, the Fraud Investigator II serves a crucial role in combating fraud, waste and abuse ("FWA") within the Medicaid program. 5-7 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.
Investigator - Medicaid Fraud Control Unit Missouri Attorney GeneralInvestigator - Medicaid Fraud Control UnitJefferson City, MO$51,000–$55,000 / yearFull timeThe Investigator's primary duties include conducting interviews, obtaining and analyzing Medicaid claims, reviewing healthcare provider documentation, preparing detailed investigative reports and exhibits, maintaining investigative case files, testifying in court, interfacing with other law enforcement and government agencies, collecting and analyzing evidence, conducting interviews, preparing reports and exhibits to include testimony in courts, and collecting evidence for possible use in civil or criminal proceedings. The MFCU utilizes a team-based approach to uncover abuse and neglect of Medicaid recipients and complex financial fraud committed by healthcare providers, including hospitals, nursing homes, pharmacies, physicians, dentists, nurses, and other Medicaid providers.
Fraud Investigator EagleBankFraud InvestigatorSilver Spring, Maryland$69,844–$108,847 / yearFull timeRequires direct and productive interaction with the Fraud Investigations Manager, BSA/AML, clients, and other fraud personnel within financial services organizations entities, and federal/local/state law enforcement agencies. Responsibilities: The Fraud Investigator develops and conducts fraud investigations, monitors and dispositions fraud alerts, and mitigates financial losses through asset recovery for EagleBank Corp.
Certified Healthcare Fraud Analyst Codoxo.Certified Healthcare Fraud AnalystCodoxo is the premier provider of artificial intelligence-driven solutions and services that help healthcare companies and agencies proactively detect and reduce risks from fraud, waste, and abuse and ensure payment integrity. Key Responsibilities: Evaluate claims data in accordance with federal regulations, state-specific policies, or commercial guidance to identify potential fraud, waste, and abuse [FWA], claim processing errors, or improper payments.
Criminal Investigator - Medicaid Fraud Division Law, Department ofCriminal Investigator - Medicaid Fraud DivisionAtlanta, GeorgiaEnters data into databases and analyzes the data for evidence.-Assists in conducting source and expenditure analyses and cash flow analyses of suspects in health care fraud investigations and patient abuse investigations.-Assists in searching public records, governmental databases, and commercial databases for evidence of health care fraud and patient abuse allegations.-Assists the appropriate parties in identifying potential assets subject to seizure due to health care provider fraud.-Assists the appropriate parties in organizing, analyzing, and processing items of evidence and other documentation for investigation and prosecutorial purposes in health care fraud and patient abuse investigations.-Utilizes computers and the appropriate software to conduct health care fraud and patient abuse investigations.-Demonstrates a basic knowledge of computer software in creating databases, spreadsheets, graphs, and presentations.-Demonstrates the appropriate computer skills to conduct health care fraud investigations.-Prepares appropriate reports in a timely, thorough, and accurate manner.-Prepares thorough and accurate reports documenting interviews of witnesses and suspects in a timely manner.-Prepares thorough and accurate reports documenting the execution of search warrants and the seizure of evidence in a timely manner.-Prepares thorough and accurate reports documenting the analyses of financial databases and conclusions of the analyses in a timely manner.·Prepares thorough and accurate reports documenting public record and database searches and conclusions from the searches in a timely manner.-Prepares thorough and accurate case reports for all investigative activities in a timely manner.-Distributes copies of reports to the appropriate parties in a timely manner. -Positions require current proof of POST Certification.-Responds to assignments and requests for assistance in health care fraud and patient abuse investigations in a timely manner.-Responds to assignments and requests for assistance by reviewing documentation, conducting interviews, and gathering intelligence information for health care fraud investigations and patient abuse investigations.-Participates in the planning and gathering of information for investigations involving health care fraud and patient abuse investigations.-Assists in executing and planning on-site search warrants to obtain evidence of health care fraud and patient abuse.-Assists in the identification and seizure of health care fraud evidence during the execution of on-site search warrants.-Will be issued a firearm and/or less lethal equipment (e.g.
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.
NewSpecial Investigations Unit (SIU) Elder and Vulnerable Adult Financial Exploitation (EVAFE) Fraud Investigator U.S. BankSpecial Investigations Unit (SIU) Elder and Vulnerable Adult Financial Exploitation (EVAFE) Fraud InvestigatorTempe, Arizona$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. Proven experience working in cross-functional teams to address cases holistically, fostering effective partnerships with law enforcement officials, social service agencies, and legal professionals.
NewSpecial Investigations Unit (Siu) Elder And Vulnerable Adult Financial Exploitation (Evafe) Fraud Investigator US BankSpecial Investigations Unit (Siu) Elder And Vulnerable Adult Financial Exploitation (Evafe) Fraud InvestigatorColumbus, OH$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. Proven experience working in cross-functional teams to address cases holistically, fostering effective partnerships with law enforcement officials, social service agencies, and legal professionals.
Certified Healthcare Fraud Analyst CodoxoCertified Healthcare Fraud AnalystYour City, Your StateCodoxo is the premier provider of artificial intelligence-driven solutions and services that help healthcare companies and agencies proactively detect and reduce risks from fraud, waste, and abuse and ensure payment integrity. Evaluate claims data in accordance with federal regulations, state-specific policies, or commercial guidance to identify potential fraud, waste, and abuse [FWA], claim processing errors, or improper payments.
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.
Senior Investigator Lead Validation (Healthcare FWA) Cotiviti Holdings Inc. (Inactive)Senior Investigator Lead Validation (Healthcare FWA)Remote$70,000–$90,000 / yearPreferred certifications: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Specialist (CFS), Certified Fraud Examiner (CFE), Certified Forensic Interviewer (CFI), or. Leverages claims data, dashboards, and predictive models to identify providers exhibiting atypical billing patterns or potential fraud, waste, and abuse.
Senior Investigator Pre Pay (Healthcare FWA) Cotiviti Holdings Inc. (Inactive)Senior Investigator Pre Pay (Healthcare FWA)Remote$70,000–$90,000 / yearPreferred certifications: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Specialist (CFS), Certified Fraud Examiner (CFE), Certified Forensic Interviewer (CFI), or. Leverages claims data, dashboards, and predictive models to identify providers exhibiting atypical billing patterns or potential fraud, waste, and abuse.