Registered Nurse - Nursing Home Surveyor/Complaint Investigator Greenlife Healthcare StaffingRegistered Nurse - Nursing Home Surveyor/Complaint InvestigatorNew York, NYWe are seeking a dedicated and experienced Registered Nurse - Nursing Home Surveyor/Complaint Investigator to join our team in New York City, NY (Bronx, Kings, Richmond, Manhattan, and Queens). This role is a temporary-to-permanent position that involves conducting surveys, complaint investigations, and surveillance activities at nursing homes to ensure compliance with Federal and State regulations.
NewLegal Investigative Analyst The Special Commissioner of Investigation for the NYC School DistrictLegal Investigative AnalystNew York, NY$63,732 / yearFull timeThe successful candidate will have strong analytic and exceptional writing skills, and will support agency attorneys including: legal research, reviewing and drafting agency documents, contract reviews, writing summaries, and preparing and finalizing SCI letters and reports to appropriate City agencies. is seeking a self-motivated candidate to serve as a Legal Investigative Support Analyst who will handle case sensitive data in a confidential manner.
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.
Welfare Fraud Investigator (Supervisor) Solano County CailforniaWelfare Fraud Investigator (Supervisor)Fairfield, CA$138,777.60–$168,688 / yearI understand that I must attach or submit copy of my degree or unofficial/official transcripts in Criminal Justice, Criminology, Law Enforcement, Police Science, or a closely related field by application review deadline in order to be considered for this position (unless you have a California Intermediate Post Certificate that can be substituted for the education requirement). Our investigators conduct thorough criminal and administrative investigations, verify eligibility information, recover public funds through overpayment collections and court-ordered restitution, and work closely with local, state, and federal partners to uphold the integrity of public assistance programs.
Senior Civil Health Care Fraud Investigator Contact Government Services LLCSenior Civil Health Care Fraud InvestigatorHarrisburg, PA$100,000–$200,000 / 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.
Healthcare Fraud Investigator Contact Government Services LLCHealthcare Fraud InvestigatorChicago, IL$85,000–$105,000 / yearCommunication skills, Ability to interact professionally and effectively with all levels of staff, including AUSAs, support staff, client agencies, debtors, debtor attorneys, and their staff, court personnel, business executives, witnesses, and the public. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently accurately and under pressure, and be enthusiastic about learning and applying knowledge to provide excellent litigation support to the client.
Fraud Investigator I Space Coast Credit UnionFraud Investigator IMelbourne, FL$28.13–$29.79 / hourThis role partners with law enforcement and internal teams, including Legal, Compliance, and Operations, to identify fraudulent activity, mitigate risk, and strengthen fraud detection and prevention processes. Stays current with fraud trends in the market by monitoring data from the Fraud Analysts and attending meetings/or conferences in order to prevent fraud losses to the organization and our membership.
SIU Clinical Healthcare Fraud Investigator III (ATL) The Intersect GroupSIU Clinical Healthcare Fraud Investigator III (ATL)Los Angeles, CARemote$45–$55 / hourThe SIU Clinical Healthcare Fraud Investigator III leads complex, high impact investigations into fraud, waste, and abuse across multiple healthcare service lines. The Intersect Group partners with mission focused healthcare organizations dedicated to improving access, quality, and equity of care for large and diverse member populations.
Fraud Investigator - Wage - Multiple Vacancies State of MaineFraud Investigator - Wage - Multiple VacanciesBangor, Maine$22.91–$31.97 / hourNo matter where you work across Maine state government, you find employees who embody our state motto-"Dirigo" or "I lead"-as they provide essential services to Mainers every day. A Baccalaureate Degree in Criminal Justice, Law, Business or Public Administration, or related field -AND- one year experience in criminal investigation, law enforcement, forensic accounting, auditing, or related field.
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.
Fraud Investigator City of FlintFraud InvestigatorFlint, MI$35.60–$39.47 / hourUnder general direction, performs advanced professional investigative work involving allegations of employee misconduct, fraud, abuse, theft, ethics violations, misuse of City assets, procurement irregularities, payroll fraud, workers compensation fraud, residency violations, conflicts of interest, and other violations of City policies, collective bargaining agreements, and applicable federal, state, and local laws. Do you have three (3) to five (5) years of progressively responsible professional experience conducting fraud investigations, administrative investigations, internal investigations, compliance investigations, internal auditing, human resources investigations, law enforcement investigations, or other closely related investigative work?
Healthcare Fraud Investigator at Integrity Advantage (Remote) HireAlignedHealthcare Fraud Investigator at Integrity Advantage (Remote)Remote, OREGONRemoteUtilize clients fraud detection solution to identify post-payment or pre-payment opportunities for investigation as well as other applications to perform data mining or track investigative results. Integrity Advantage is a small woman owned business serving health payers and other entities challenged with the detection, investigation and prevention of healthcare fraud, waste and abuse (FWA).
Clinical Fraud Investigator II Elevance HealthClinical Fraud Investigator IIAtlanta, GeorgiaWe are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. 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.
NewFraud Investigator I Global Credit UnionFraud Investigator IAnchorage, Alaska$69,557–$112,677 / yearFull timeConduct investigations into fraud claims related to online transactions, pre-authorized drafts, altered checks, forged endorsements, unauthorized third-party transfers, financial exploitation, identity theft, and additional fraudulent activities. Handle high-priority and high-risk cases, such as outgoing wires, recovering funds, consumer complaints, large transactions, and potential Bank Secrecy Act or SDN list violations.
Fraud Investigator Home BancShares IncFraud InvestigatorAmarillo, TXWhile performing the functions of this job, the employee is continuously required to sit, use hands to finger, handle, or feel, talk or hear; frequently required to reach with hands and arms, taste or smell; and occasionally required to stand, walk, stoop, kneel, crouch, or crawl. Ability to write reports, business correspondence, and policy/procedure manuals; ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Claims Fraud Investigator Zurich Insurance Group LtdClaims Fraud InvestigatorAZRemoteOur hybrid work model is thoughtfully designed around employee needs offering autonomy to complete focused work from a preferred location, while still supporting meaningful in-person collaboration when it adds value. Under general direction and within defined authority limits, this role is responsible for conducting insurance fraud investigations involving complex schemes, multi claim patterns, organized activity, and non medical major case work.
Fraud Investigator State of MaineFraud InvestigatorAugusta, 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 a number of programs, including MaineCare, Temporary Assistance for Needy Families (TANF), Food Supplement and Child Support.
Healthcare Fraud Investigator/Case Developer SGI Global, LLCHealthcare Fraud Investigator/Case DeveloperMuskogee, OKThe Investigator/Case Developer will support the Criminal Division's Healthcare Fraud and Abuse Control Program by conducting investigations involving healthcare fraud, fraud and abuse affecting federal healthcare programs, opioid diversion, and other criminal fraud matters within the jurisdiction of the USAO. SGI Global is seeking a Healthcare Fraud Investigator/Case Developer to provide investigative support services to the United States Attorney's Office (USAO) for the Eastern District of Oklahoma (EDOK).
Fraud Investigator II Suncoast Schools Federal Credit UnionFraud Investigator IITampa, FL$60,000–$80,000 / yearInvestigate cases of fraud including check fraud, new account fraud, debit and credit card fraud, teller transactions, check kiting, identity theft, elderly exploitation, and other suspicious activity. The key tasks include investigating cases of fraud by interviewing victims and suspects, obtaining and reviewing evidence, and determining facts from the information.
NewFraud Investigator, Marketplace Fraud Etsy IncFraud Investigator, Marketplace FraudBrooklyn, NY$91,000–$119,000 / yearAs an Etsy Inc. employee, whether a team member of Etsy or Depop, you will tackle unique, meaningful, and large-scale problems alongside passionate coworkers, all the while making a rewarding impact and Keeping Commerce Human. The role involves performing core enforcement reviews, conducting deep-dive fraud investigations, and analyzing fraud trends using data tools.
Civil Health Care Fraud (HCF) Investigator. Crossroads Talent SolutionsCivil Health Care Fraud (HCF) Investigator.Macon, GAFor more than a decade, we have supported critical operations for partners including the U.S. Army, U.S. Air Force, U.S. Navy, U.S. Marine Corps, National Guard, Defense Health Agency (DHA), National Oceanic and Atmospheric Administration (NOAA), Small Business Administration (SBA), U.S. Citizenship and Immigration Services (USCIS), U.S. Attorney's Office (USAO), and the U.S. Department of Agriculture (USDA). Founded in 2014, Crossroads Talent Solutions, LLC is a veteran-led SBA 8(a) and Service-Disabled Veteran-Owned Small Business headquartered in Maryland, delivering trusted program management, administrative, and mission support services to federal agencies nationwide.
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.
Payments Fraud Investigator Stripe IncPayments Fraud InvestigatorCACommunicate regular updates during team and organization-wide business reviews, summarize outcomes of complex investigations for executives, and deliver clear case determinations to users and partner financial institutions. Lead root cause analyses to identify gaps in current systems, policies and strategies, and determine enhancements and process improvements to address emerging fraud risks through collaboration with key stakeholders.
Financial Fraud Investigator - Corporate Security - Vice-President Morgan StanleyFinancial Fraud Investigator - Corporate Security - Vice-PresidentPurchase, NYWhat you'll do in the role: Ensure appropriate actions are taken to mitigate potential losses to clients and Morgan Stanley (e.g., restricting accounts to prevent further fraudulent activity, coordinating the reissue of credit/debit cards, closing accounts, advising account officers and their clients, and investigating cryptocurrency fraud). We are seeking a Corporate Security, Financial Fraud Investigator to conduct time-sensitive, professional, and comprehensive investigations into allegations and business-unit escalations involving wire transfers, debit/credit cards, checks, ACH, Cryptocurrency, and other suspected fraud that may adversely affect the financial integrity of Morgan Stanley and its clients.
Fraud Investigator City of Portsmouth VAFraud InvestigatorPortsmouth, VA$53,765.84–$69,216.92 / yearInvestigates referrals to determine withheld, altered or misrepresented information; receives and logs referrals from multiple sources; contacts employers, schools and other sources; interviews clients; prepares and forwards findings affecting ongoing and pending eligibility to prevent incorrect program payments; calculates incorrect program payments and obtains repayment agreements; and prepares and forwards findings on non-IPVs to workers supervisor. Requires the ability to analyze, reconcile and prepare reports, budget expenditures, work orders, time cards, incident reports, billing invoices and other required documentation using prescribed formats and conforming to all rules of punctuation, grammar, diction and style.
Regional Fraud Investigator Burke & Herbert BankRegional Fraud InvestigatorAlexandria, VA$27–$37 / hourInvestigate and manage external fraud investigations, such as check fraud, new account fraud, elder exploitation, wire fraud, online take over and other, ensuring cases are handled timely, and documented accurately with a concise case summary, following existing procedures. This position is responsible for conducting comprehensive external fraud investigations on check fraud, wire fraud, account take over, identity theft, new account fraud, elderly exploitation, and other types of fraud, to detect and prevent fraud losses to the bank and the customer.
Fraud Investigator I United Community BankFraud Investigator IGreenville, South CarolinaRemote$38,769–$57,876 / yearFull timeOverview: The Fraud Investigator I plays a key role in protecting the bank and its customers from financial loss by investigating fraud claims and suspicious activity across deposit, payment, card, and digital banking channels. Working in a fast-paced environment, the Fraud Investigator I partners with customers and internal teams to resolve fraud cases, maintain regulatory compliance, and identify emerging fraud trends and recovery opportunities.
Sr Fraud, Waste and Abuse Investigator (Investigator Sr) CalOptimaSr Fraud, Waste and Abuse Investigator (Investigator Sr)Orange, CA$72,096–$115,353 / yearWe are hoping you will join us as a Sr Fraud, Waste and Abuse Investigator (Investigator Sr) and help shape the future of healthcare where you'll be an integral part of our OOC - Fraud & Waste team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.
Welfare Fraud Investigator County of RiversideWelfare Fraud InvestigatorRiverside, CAFull timeAbility to: Conduct a variety of welfare fraud and departmental investigations; obtain information and evidence by observation, record examination, interviews and use of electronic and electronic data processing equipment; analyze and evaluate the statements of witnesses or suspected violators and draw logical conclusions; secure and present information and evidence in both verbal and written form; identify, detain and arrest suspects in accordance with sworn peace officer status; deal with citizens and public officials under conditions requiring tact; establish and maintain effective working relationships with the members of the public and other law enforcement personnel; communicate clearly and effectively with diverse populations. Knowledge of: Diverse interviewing techniques; research methods and techniques; investigative techniques and procedures; the principles of identification, preservation and presentation of evidence; the legal rights of citizens; policies and procedures regarding the safety and security of juveniles; ongoing and new rules of evidence and court procedures; methods of collaborative problem solving; ongoing and new state and local laws and regulations governing sworn peace officer legal authority; commercial and property laws and credit transactions; legal procedures; the methods of financial record keeping.
Senior Fraud Investigator - Financial Products Snapcommerce Holdings Inc.Senior Fraud Investigator - Financial ProductsNYThis includes supporting risks such as identity fraud, first-party abuse, payment fraud, dispute abuse, account misuse, and negative balance exposure, while improving operational processes, strengthening controls, and helping build a secure, seamless, and scalable financial products platform that drives long-term growth and customer trust. We focus on improving the quality of transactions, reducing fraud and financial losses, ensuring regulatory compliance, and building scalable systems that support a seamless and trustworthy customer experience across travel, financial products, earnings and emerging product lines.
Fraud Investigator TikTok IncFraud InvestigatorSan Jose, CACollaborate with various levels of the organization internally, including senior management, Employment Relations, Ethics, Legal Counsel, and DPO as well as with various external organization legal counsel, and law enforcement in fraud and other financial mismanagement cases. Significant experience conducting financial crime investigations, including analyzing large datasets to identify trends and typologies related to financial fraud, money laundering, bribery, and corruption within a large organization.
NewRisk Investigator - Third Party/ATO Fraud Mercury Technologies IncRisk Investigator - Third Party/ATO FraudSan Francisco, CA$121,700–$152,100 / yearAs a member of our Account Fraud team, you''ll investigate escalated account takeover cases, assess account security, coordinate containment and recovery efforts, and communicate directly with customers through some of their most stressful moments. In this role, you''ll help protect our customers by investigating suspected account compromise, responding quickly to high-risk security incidents, and serving as the primary point of contact for customers during critical account recovery events.
NewFraud Investigator, Marketplace Fraud EtsyFraud Investigator, Marketplace FraudBrooklyn, New YorkAs an Etsy Inc. employee , whether a team member of Etsy or Depop, you will tackle unique, meaningful, and large-scale problems alongside passionate coworkers, all the while making a rewarding impact and Keeping Commerce Human. The role involves performing core enforcement reviews, conducting deep-dive fraud investigations, and analyzing fraud trends using data tools.
Fraud Investigator Hilltop Holdings IncFraud InvestigatorDallas, TXPlainsCapital Bank ranks sixth among the largest banks headquartered in Texas by deposits and has a statewide presence with approximately 55 locations in markets such as Austin, the Coastal Bend, Dallas, Fort Worth, Houston, Lubbock, the Rio Grande Valley, and San Antonio. PlainsCapital Bank conducts both commercial and consumer banking, providing a full suite of commercial banking products and services to fit any business model and convenient services, personal attention, and account features to help simplify managing personal finances.
Fraud Investigator-Security Specialist, FISU Central Bancshares, IncFraud Investigator-Security Specialist, FISULexington, KYESSENTIAL JOB DUTIES AND RESPONSIBILITIES: Supervisory duties to include interviewing and selection, training and development, delegating responsibilities, monitoring work flow, ensuring quality control, helping employees establish goals and objectives, monitoring and tracking employee performance, completing officer performance appraisals, coaching and counseling, sales management and ensuring compliance to bank and trust department policies and procedures. EDUCATION/EXPERIENCE REQUIRED: Bachelor's degree and five+ years' experience with specific emphasis on investigations (including conducting enhanced due diligence on individuals and entities that are the subject of an investigation) related to AML/CFT, BSA or Fraud at a financial institution, regulatory agency or law enforcement agency; or equivalent combination of education and experience.
SIU Fraud Investigator Mass General BrighamSIU Fraud InvestigatorSomerville, MassachusettsPerforms case research to include the review, interpretation, and application of payment policies, medical policies, provider manuals, benefits documents, national or local coverage determinations, and other applicable clinical practice parameters, regulations, or guidance pertaining to the submission of claims to health insurance plans. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
Cleveland - BWC Fraud Investigator - PN: 20066769 Highland County Joint Township District HospitalCleveland - BWC Fraud Investigator - PN: 20066769Cleveland, OHFor applicant support and additional information about employment with the State of Ohio, return to Careers. Ohio.
Fraud Investigator Intern Berkshire BankFraud Investigator InternBoston, MA$18–$24.91 / hourThis internship provides exposure to fraud prevention, financial crimes investigations, regulatory compliance and banking operations while developing analytical, investigative and communication skills. Purpose/Objective: The Fraud Investigator Intern supports the Financial Intelligence Unit (FIU), by assisting with the investigation and documentation of suspected fraudulent activity.
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.
Fraud Investigator I United Community Banks IncFraud Investigator IGreenville, SCRemote$38,769–$57,876 / yearWorking in a fast-paced environment, the Fraud Investigator I partners with customers and internal teams to resolve fraud cases, maintain regulatory compliance, and identify emerging fraud trends and recovery opportunities. The Fraud Investigator I plays a key role in protecting the bank and its customers from financial loss by investigating fraud claims and suspicious activity across deposit, payment, card, and digital banking channels.
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.
Fraud Investigator Synovus Financial CorpFraud InvestigatorBirmingham, ALPrepares and submits case narratives for Suspicious Activity Reports (SAR) to the AML/BSA department for review and FinCEN filing, ensuring narrative and SAR form are completed accurately and within procedural and regulatory deadlines while maintaining detailed records of narratives to provide supporting documentation for audits and regulatory reviews. Required Knowledge, Skills, & Abilities: Knowledge of applicable federal and state laws related to financial crimes including the Uniform Commercial Code (UCC), Regulation E, Regulation CC, and the Law Enforcement Criminal Code.
Fraud Investigator Berkshire BankFraud InvestigatorBoston, MA$52,000–$90,498 / yearPurpose/Objective: As a member of the Financial Intelligence Unit's Fraud Investigations Team, the incumbent is responsible for handling all aspects of the fraud investigation process - including incident intake, advising on best practices for remediation, case management, and completion of regulatory reports. Key Accountabilities: Investigate fraud referrals/incidents and perform necessary research; efficiently arriving at sound risk-based conclusions in order to minimize fraud losses.
Senior Health Care Fraud Investigator Part-Time The Gilchrist Law Firm PASenior Health Care Fraud Investigator Part-TimeBirmingham, ALProduces a variety of written documents utilizing varied and advanced word processing software functions, working from handwritten draft, edited copy, or electronic files created by another staff member. This includes understanding the local rules in order to know the procedures when to file pleadings conventionally, via Case Management/Electronic Case Files (CM/ECF) and/or when to file ex parte pleadings on sealed cases.
AGO Senior Investigator/Analyst | Medicaid Fraud & Abuse Division | Seattle State of WashingtonAGO Senior Investigator/Analyst | Medicaid Fraud & Abuse Division | SeattleSeattle, WA$6,870–$9,246The incumbent develops sources of information relating to Medicaid fraud and abuse and neglect in residential facilities; executes search warrants; collects, preserves and handles evidence in accordance with established rules of evidence; conducts surveillance; conducts criminal and civil interviews; prepares written reports, affidavits and other investigative documents; serves as a subject matter expert in civil and criminal healthcare fraud investigations. With the goal of employee health and wellness, we also offer: Flexible schedules and part-time/hybrid telework options; A Wellness Program, an Infants in the Workplace Program, and the Employee Assistance Program, which provides counseling, webinar, and other cost-free support resources; Numerous employee-driven affinity groups to foster community and connection, including Bereavement, Elder Care, Parenting, POC, LGBTQ+, Veterans and more.
Manager I, Global Fraud Investigator & Case Manager - (Global Remote) Catholic Relief ServicesManager I, Global Fraud Investigator & Case Manager - (Global Remote)CARemoteIn collaboration with relevant Country Program, Regional Office, and Global Department personnel, either directly and/or through guidance, oversee and/or execute the assessment and investigation of fraud allegations for assigned cases. Ensure all steps throughout the investigation cycle (including credibility assessment, planning, fieldwork, reporting, remediation, and follow-up) are completed in accordance with the CRS Allegation Management Policy & Procedure and in compliance with applicable laws and donor regulations.
SIU Fraud Investigator Brigham and Women's HospitalSIU Fraud InvestigatorSomerville, MA$79,560–$115,720.80 / yearPerforms case research to include the review, interpretation, and application of payment policies, medical policies, provider manuals, benefits documents, national or local coverage determinations, and other applicable clinical practice parameters, regulations, or guidance pertaining to the submission of claims to health insurance plans. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
Lead Risk Investigator, Fraud Tilt FinanceLead Risk Investigator, FraudThis is an advanced individual-contributor role: you won’t manage people, but you’ll operate as the senior-most investigative authority on the team, running project-scale investigations, setting the bar other investigators calibrate against, and representing Risk Operations’ fraud findings directly to leadership. Lead project investigations: Own the investigation of Tilt’s most complex fraud events end to end — coordinated fraud rings, systemic attack patterns, and cross-product schemes — from initial signal through root-cause analysis, account remediation, and a leadership-ready readout.
Senior Fraud and Waste Investigator, Medicaid Humana IncSenior Fraud and Waste Investigator, MedicaidILRemote$71,100–$97,800 / yearThe Senior Fraud and Waste Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Make decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction.
Welfare Fraud Investigator County of Riverside, CaliforniaWelfare Fraud InvestigatorRiverside, CA$72,189.49–$124,212.73 / yearAbility to: Conduct a variety of welfare fraud and departmental investigations; obtain information and evidence by observation, record examination, interviews and use of electronic and electronic data processing equipment; analyze and evaluate the statements of witnesses or suspected violators and draw logical conclusions; secure and present information and evidence in both verbal and written form; identify, detain and arrest suspects in accordance with sworn peace officer status; deal with citizens and public officials under conditions requiring tact; establish and maintain effective working relationships with the members of the public and other law enforcement personnel; communicate clearly and effectively with diverse populations. Knowledge of: Diverse interviewing techniques; research methods and techniques; investigative techniques and procedures; the principles of identification, preservation and presentation of evidence; the legal rights of citizens; policies and procedures regarding the safety and security of juveniles; ongoing and new rules of evidence and court procedures; methods of collaborative problem solving; ongoing and new state and local laws and regulations governing sworn peace officer legal authority; commercial and property laws and credit transactions; legal procedures; the methods of financial record keeping.