UNKNOWN

FEED

Fraud 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.

Military, Veterans and Diverse Job Seekers

SIU Investigator

ea_via_bold

This role is an extension of our Special Investigations Unit (SIU) that sits within Legal-you will spend your days investigating suspected fraud against Clover''s Medicare Advantage business and ensuring that those investigations are coordinated, well-documented, and supported by the right legal advice from the Legal department. Collaborate Across Functions: Work with Clover''s clinical, compliance, claims, payment integrity, provider relations, revenue operations, and SIU teams to gather information, validate findings, and translate investigative outcomes into operational improvements, provider education, and member impact.

YEAR

Clover Health Investments Corp

Director, Fraud Investigations

HOUR

By applying for this job, you agree to receive AI-generated calls, text messages, and/or emails from Mitchell Martin Inc and its affiliates and contracted partners at various frequency through traditional and automated methods. The role requires strong analytical skills and expertise in investigative techniques, utilizing various data analysis tools.

<div>
<div>
<h3>OUR FOCUS IS GROWTH</h3>
</div>
</div>
<div>
<div>
<p>It’s not just about filling job openings.  It’s about enabling growth and inspiring success.  That’s what we do.</p>
<p>Mitchell Martin is one of the nation’s largest staffing companies, with offices throughout the US as well as in India and the Philippines.  We help drive success for both people and companies by helping them achieve positive growth.   We do this by building strong relationships and developing a deep understanding of the people we work with, in order to facilitate the best matches for both sides of the equation.    </p>
</div>
</div>

Mitchell Martin

Special Investigation Unit Investigator III

jobdiva

Acquire 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.

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>


Allied Universal

SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. The role conducts routine and focused provider and member audits and monitoring events, supports the coordination of external audits, and contributes to the Annual Program Integrity Workplan and the Medicare D-SNP Program Integrity framework.

San Francisco Health Plan

Investigator, Program Integrity

clearcompany

Drawing on expertise in corporate law, commercial law, employment law, ethics and compliance, and intellectual property, the LCO offers strategic legal counsel that is informed by a clear understanding of the company's business objectives and knowledge of the laws and regulations relevant to the business worldwide. To ensure a fair and consistent evaluation, the use of AI, recording tools or other technologies to generate, suggest or provide responses during interviews-whether virtual or in person-is not permitted unless explicitly approved in advance as part of a reasonable accommodation or invited by the interviewer.

KLA Corp

Corporate Investigator

Working knowledge of local, state and federal laws and regulations pertaining to health insurance, investigations and legal processes (commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, etc.). In some states, 5 years of experience working in a fraud, waste and abuse (FWA)/special investigations unit (SIU)/fraud investigations role may be required (dependent on state/contractual requirements).

Molina Healthcare Inc

Investigator, Special Investigative Unit Coding (Remote)

Must be able to work in a law enforcement environment that includes the presence of firearms; Must qualify and carry a firearm; A valid California driver license is required; Must be 21 years of age; Must be able to work both indoors and outdoors, depending on the situation in which investigator is involved, at any given time; There is a reasonable expectation of contact with dangerous suspects; Frequent sitting, standing, walking, and carrying is required; and. Incumbents may work alone, with a team, or as a lead criminal investigator assigned to conduct investigations of criminal enterprises and profiteering and assist in the prosecution of cases involving these groups in both State and Federal courts; and conduct investigations involving a broad range of felony violations, both State and Federal judicial systems.

State Of California

INVESTIGATOR

FULL_TIME

Position Summary: The Analyst I, Fraud Operations is responsible for identifying, investigating and evaluating all aspects of Fraud and financial crime related risks and controls, assisting with regulatory compliance analysis and research for Technology Credit Union (Tech CU). Assists with reviewing and conducting analysis on regulatory and legal changes affecting financial institutions in fraudulent activity to determine applicability and impact to Tech CU.

Technology Credit Union

Fraud Operations Analyst I

[AW]-iCims

Excellent interpersonal (i.e. verbal and written communications) and problem solving skills and ability to work collaboratively with diverse groups, including all levels of University personnel, including management and faculty, and to facilitate agreement on issues and corrective actions. Maintains and ensures accurate and appropriate documentation of assessments, triage, case assignments, dispositions, including closed cases that require corrective action by management on EthicsPoint and i-Group databases.

UCSF Medical Center

Investigations Coordinator/Investigator

KLA Corporation

Manage the life-cycle of the investigation: Receive initial referral from internal or external source of a matter to be investigated; review the referral for necessity and completeness; log and track the investigation; collaborate with the CSO on investigative steps needed when necessary; recommend and execute courses of action to move investigations to resolution to include conducting off-site and telephonic interviews; determine whether forwarding the investigation results to a law enforcement or prosecutorial agency is appropriate and, if so, provide the agency with a thorough, organized, well-documented, and clearly-explained information packet. The SI will support the Security Program and the Chief Security Officer (CSO) of corporate security by developing and operating a comprehensive program for the prevention, detection, investigation, litigation and prosecution of fraud and theft across all functional and geographic units.

Security Investigator

Performs sophisticated analyses of large-scale hard-copy and electronic data, such as health care claims data, financial transaction data, accounting records, or bank records to develop investigative leads and to determine their potential relevance to the allegations at issue. Skills and attributes for success: The investigator will generate new investigations, and to continue with ongoing investigation and civil actions involving fraud in areas such as healthcare, contracting, and grants, as well as other fraud and abuse of federal public funds and programs.

CONTACT GOVERNMENT SERVICES

Affirmative Civil Enforcement (Ace) Investigator

In California, the pay range for this position is $131,100 - $189,800
In New York, the pay range for this position is $131,100 - $189,800
At Adobe, for sales roles starting salaries are expressed as total target compensation (TTC = base + commission), and short-term incentives are in the form of sales commission plans. Adobe’s industry-leading offerings including Adobe Acrobat Studio, Adobe Express, Adobe Firefly, Creative Cloud, Adobe Experience Platform, Adobe Experience Manager, and GenStudio enable people and businesses to turn ideas into impact, powered by AI and driven by human ingenuity.

Adobe is the global leader in digital marketing and digital media solutions. Our tools and services enable our customers to create groundbreaking digital content, deploy it across media and devices, measure and optimize it over time, and achieve greater business success. We help our customers make, manage, measure and monetize their digital content across every channel and screen.  </p>  <h2>Digital media</h2><p> Adobe helps creative professionals, publishers, developers, and businesses create, publish, promote, and monetize their content anywhere.</p> <h2>Digital marketing</h2><p> Our digital marketing solutions combine content and data, personalization, experience management, and social capabilities so businesses can move faster from data to insights to action. </p>

Adobe

Threat Intelligence / Reverse Engineering Investigator

Establishes and verifies relationships among all facts and evidence obtained or presented to confirm the authenticity of documents, corroborate witness statements, and otherwise build proof necessary to successful case resolution. Establishes and/or verifies relationships among all facts and evidence obtained or presented to confirm the authenticity of documents, corroborate witness statements, and otherwise build proof necessary for successful litigation.

Financial Investigator

Senior Financial Investigator

Experience with Microsoft Word, Excel, and Outlook products, open source database search tools, social media and internet research. Conducts high level, complex analysis of Dental Providers and Practices to effectively pursue the prevention, investigation and prosecution of Fraud, Waste and Abuse.

<p>CVS Health offers a world of promising job opportunities across a diverse range of careers in everything from corporate and pharmacy roles to retails positions. No matter where you work at CVS Health, your unique skills, talents and abilities are welcome and valued. We recognize and reward greatness and want our employees to know their work is making a difference in the lives of millions. Join us today. Together we can continue making innovative, high-quality health and pharmacy services safe, affordable and accessible – for all. </p>

CVS Health Corp

Senior Investigator, Special Investigations Unit (Aetna SIU)

Let us know you're interested in a future opportunity by joining our Talent Community on jobs.genpt.com or create an account to set up email alerts as new job postings become available that meet your interest! This role focuses on protecting company assets by conducting thorough investigations, gathering evidence, and preparing detailed case packets for internal review or legal action.

Today Genuine Parts Company (GPC) is a service organization engaged in the distribution of:

• Automotive Replacement Parts

• Industrial Replacement Parts and Materials

• Business Products

The Company has a distribution network of over 3,100 operations located throughout the United States, Canada, Mexico, the Caribbean, Australia, New Zealand, China, and Southeast Asia. In addition, the Company expanded its global network into Europe with its 2017 acquisition of Alliance Automotive Group.

Genuine Parts Co

Asset Protection Investigator (French and English)

VRC 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.

VRC Investigations

Surveillance Investigator

Investigate complex child sexual exploitation operations to understand how abuse manifests on Meta's platforms and the wider information ecosystem Lead a portfolio of investigative research to include identifying abuse trends, understanding adversarial behavior, and designing forward-looking enforcement strategies to mitigate harm Proactively hunt for threats and undetected abuse by leveraging internal data sets, open-source intelligence, and third-party private intelligence Analyze qualitative and quantitative data to advance investigations, quantify trends and support findings with clear, concise evidence Apply analytical rigor to investigations, analysis, and programs while looking for strategic improvement opportunities This role involves exposure to graphic and/or objectionable content including but not limited to graphic images, videos and writings, offensive or derogatory language, and other potential objectionable material, i.e. child exploitation, graphic violence, self-injury, animal abuse, and other content which may be considered offensive or disturbing5+ years work experience performing security investigations in government, intelligence, cyber security, journalism and/or private sector organizations Subject matter expertise or prior work experience in child safety based laws or policies (i.e intelligence, law enforcement, legal analysis, or NGO) Experience with open source investigation techniques and familiarity with a variety of internet research tools Experience leveraging SQL, OSINT, and network security concepts in an investigative context Experience developing multi-source, evidence-based findings and communicating them to diverse audiences Proficient in SQL Experience working or managing projects that have enterprise-wide impact and/or multi-organization cross functional stakeholders Experience adhering to and implementing responsible, ethical AI practices (e.g., risk assessment, bias mitigation, quality and accuracy reviews) Experience working with a team spanning multiple locations/time zones Demonstrated ongoing AI skill development (e.g., prompt/context engineering, agent orchestration) and staying current with emerging AI technologies MS or equivalent experience in Computer Science, Information Systems, Intelligence Studies, Cybersecurity or related field Demonstrated ability to integrate AI tools to optimize/redesign workflows and drive measurable impact (e.g., efficiency gains, quality improvements) Experience prioritizing and managing threat investigations with competing deadlines and stakeholder needs Experience conducting large scale data analysis and utilizing big data tools such as Jupyter Notebook, Maltego, Palantir, etcMeta builds technologies that help people connect, find communities, and grow businesses. The candidate will have experience independently identifying and pursuing investigative leads, and delivering measurable outcomes aligned with team goals and will be able to extract, assimilate, and correlate a wide variety of data in order to surface, analyze, and disrupt threat actors across multiple spaces.

Brand Manager Jobs in Rogers, AR

SIU Investigator Military, Veterans and Diverse Job Seekers

Director, Fraud Investigations Clover Health Investments Corp

Special Investigation Unit Investigator III Mitchell Martin

SIU Investigator Allied Universal

Investigator, Program Integrity San Francisco Health Plan

Corporate Investigator KLA Corp

Investigator, Special Investigative Unit Coding (Remote) Molina Healthcare Inc

INVESTIGATOR State Of California

Fraud Operations Analyst I Technology Credit Union

Investigations Coordinator/Investigator UCSF Medical Center

Corporate Investigator KLA Corporation

Security Investigator Military, Veterans and Diverse Job Seekers

Affirmative Civil Enforcement (Ace) Investigator CONTACT GOVERNMENT SERVICES

Threat Intelligence / Reverse Engineering Investigator Adobe

Financial Investigator CONTACT GOVERNMENT SERVICES

Senior Financial Investigator CONTACT GOVERNMENT SERVICES

Senior Investigator, Special Investigations Unit (Aetna SIU) CVS Health Corp

Asset Protection Investigator (French and English) Genuine Parts Co

Surveillance Investigator VRC Investigations

Security Analyst Investigator Meta Platforms Inc

Similar Job Searches

See More Jobs

Stand out to leading employers.