UNKNOWN

FEED

Under immediate to general supervision, depending on the level in the series, assists in obtaining, preserving, and reporting admissible evidence for presentation in cases prosecuted by the District Attorneys Office; performs difficult criminal and civil investigations for the District Attorneys Office, Sheriffs Office, Municipal Police Agencies, and the Grand Jury; and performs related work as required. Some (I) to considerable (II) knowledge of the: substantive and procedural California Criminal, Civil, and Juvenile laws, and the modern techniques and practices of criminal investigation; laws of arrest, search and seizure, warrant and subpoena service, rules of evidence, and the admissibility of confessions and witnesses statements; functions and extent of authority of the District Attorneys Office; resources and techniques available in public and private criminal scientific laboratories and the latest medical-legal techniques in criminal investigation.

YEAR

County of Ventura

District Attorney Investigator I/II

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FULL_TIME

Work independently and collaboratively with internal stakeholders and external partners to evaluate and investigate suspicious insurance transactions (claims, underwriting, policy, etc.), collect evidence, support fraud detection programs, and communicate investigative findings to internal and external partners, regulators, and law enforcement. West Bend will comply with any applicable state and local laws regarding employee leave benefits, including, but not limited to providing time off pursuant to the Colorado Healthy Families and Workplaces Act for Colorado employees, in accordance with its plans and policies.

West Bend Insurance Company

Senior Investigator – Special Investigations Unit (Illinois, Indiana, and Michigan)

[AW]-iCims

OTHER

Serve as the primary liaison with state fraud bureaus, NICB, law enforcement, and prosecutors when cases present indicators of criminal activity or organized fraud schemes affecting commercial policyholders or business operations. Utilize advanced analytical reasoning to assess the extent and financial impact of suspected fraudulent activity, including complex commercial claim structures, multi‑party losses, and layered coverages.

Berkley

SIU Sr. Investigator

Partner directly with our Data Science and Product teams to test and refine predictive fraud models, feeding real-world case intelligence back into automated detection. We're looking for an experienced SIU Investigator to help protect honest policyholders and keep sophisticated fraud networks from gaming the system - while making sure legitimate claims move fast.

Lemonade Inc

SIU Investigator, Auto Claims

The 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.

At the Blue Cross and Blue Shield Association (BCBSA), we provide business strategy, technical support and consulting expertise to 36 Blue Cross and Blue Shield companies across the nation, employing more than 1,000 of the best strategic thinkers in the industry.  We are a Brand manager that sets quality control standards for the 36 independent companies that use the Blue Cross and Blue Shield Brands, and we serve as a trade association that represents these Blue companies. It is through our involvement that the Blues companies share a united vision and strategy while also benefiting from the local strength of all member companies.

Blue Cross and Blue Shield Association

CPC Investigator

We 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). We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals.

Greenlife Healthcare Staffing

Registered Nurse - Nursing Home Surveyor/Complaint Investigator

Workable

In terms of professional development, Everforth Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. This individual will play a critical role in ensuring accurate reimbursement, timely admissions, regulatory compliance, and uninterrupted patient care by validating insurance coverage and payer requirements across a variety of government and commercial health plans.

HOUR

StratAcuity Staffing Partners Inc

PT Home Health Insurance Verification Specialist/Investigator

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 Corporation

Corporate Investigator

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PART_TIME

We believe experienced investigators perform their best when they are equipped with the right tools, supported by proven systems, and given the autonomy to do what they do best—investigate. At Covert, we develop investigative professionals who are trusted to think critically, exercise sound judgment, and own their cases from assignment through completion.

Covert Special Investigations, Inc

Dallas Professional Investigator

Arizona Professional Investigator

A little about us: First Merchants is guided by a genuine philosophy of being a meaningful place to work and having a prosperous impact across all walks of life throughout the communities we serve, including consumers, businesses and other organizations. Utilizing the Case Management software, opens fraud cases, provides a clear and concise narrative of the event, updates the case, and assists the lead Investigator as needed.

First Merchants Corporation

Bank Protection Fraud Specialist I

Skills and attributes for success: Assists the client in the investigation and trial preparation phases by conducting medical claims data analysis, forensic investigations, financial damages, statistical sampling, and ability-to-pay analyses, which serve a significant role in determinations regarding investigations, prosecutions, settlements, and recovery in these matters, which can be voluminous and complex. Conducting financial investigations to assess the ability of individuals and organizations to satisfy settlements and judgments, including detailed analysis of assets, liabilities, debt covenants, borrowing capacity, earnings, financial ratios, aging schedules, tax considerations, and collectability.

Contact Government Services LLC

Fraud Auditor

CONTACT GOVERNMENT SERVICES

Bachelor Degree in Criminal Justice, Business, Health Care Administration, Human Resources with 3 years’ work experience involving researching and investigating inquiries OR 7 years’ work experience involving researching and investigating inquiries. At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work.

HCSC

Compliance Investigator

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Provides exceptional customer service by maintaining contact with business partners, customers and external resources throughout the life of each investigation, including liaison network with claim, legal, underwriting partners, public officials, law enforcement officers and others to obtain assistance in conducting investigations. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

The Travelers Companies

SIU Investigator

REQUIREMENTS: Previous 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.

Ethos Risk Services LLC

Investigator

apply investigating principles and techniques, including the criminal rules of evidence and search and seizure laws; make sound observations, remember facts, and give testimony based thereon; gather, analyze, and evaluate facts and data; prepare clear and concise reports; qualify to use firearms; scrutinize behavior of individuals and situations; understand the psychology of human behavior; and maintain professionalism and deal effectively with the public, office staff, and representatives of governmental and non-governmental agencies. Knowledge of: Investigational methods and techniques; the rules of evidence and laws of arrest; apprehension and arrest techniques; legal system, court procedures, legal instruments, and legal terminology; the jurisdiction and functions of the various law enforcement and governmental agencies and departments; interviewing methods and interrogation techniques; characteristics of human behavior and basic elements of criminal behavior; report writing; and the geographic, economic, social, and racial composition of the community.

County of Hawaii

Investigator V - SR-24

JOB SUMMARY: Our dynamic Ethos team is seeking a Special Unit Investigations (SIU) Field Investigator to conduct field investigations, gather and analyze evidence, and produce detailed reports that support claims decisions. Case Documentation: Conduct in-person interviews and obtain accurate, detailed statements from all parties involved, and retrieve relevant documents to support investigative findings.

Special Investigations Unit (SIU) - Field Investigator

Knowledge of applicable state and federal regulations and laws, including Regulation Z, Regulation B, the Fair Housing Act, the Home Mortgage Disclosure Act, the Real Estate Settlement Procedures Act, the Fair Credit Reporting Act, the Bank Secrecy Act in conjunction with the USA PATRIOT Act, Anti-Money Laundering requirements, the Customer Identification Program, the Right to Financial Privacy Act, and the Community Reinvestment Act. Intermediate mathematical skills, including calculating interest and percentages, balancing accounts, performing calculations using whole numbers, common fractions, and decimals, locating routine mathematical errors, and computing rates, ratios, and percentages.

Banc of California

FIU Investigator I

Investigates actual and suspected law violations, including cases of a difficult and complex nature; gathers, preserves, analyzes, and reports evidence; conducts field investigations and searches crime scenes; interviews and interrogates complainants, suspects, witnesses, and other persons to obtain information; recommends to attorneys the filing of criminal complaints; writes reports, and assists attorneys in the preparation of cases for trial; investigates the personal background of complainants, suspects, and witnesses; testifies in court regarding evidence and investigations; arrests suspected criminals. May be assigned periodically as Bureau Officer of the Day; may be assigned to investigate police officer-involved incidents, consumer and insurance fraud, hazardous materials violations, child abduction and criminal/grand jury investigations involving public officials; may be assigned to drug and other law enforcement multi-agency task forces, criminal intelligence and organized crime, and other specialized units within the Bureau of Investigation.

Fraud Investigator Jobs in the United States

District Attorney Investigator I/II County of Ventura

Senior Investigator – Special Investigations Unit (Illinois, Indiana, and Michigan) West Bend Insurance Company

SIU Sr. Investigator Berkley

SIU Investigator, Auto Claims Lemonade Inc

CPC Investigator Blue Cross and Blue Shield Association

Registered Nurse - Nursing Home Surveyor/Complaint Investigator Greenlife Healthcare Staffing

PT Home Health Insurance Verification Specialist/Investigator StratAcuity Staffing Partners Inc

Corporate Investigator KLA Corporation

Dallas Professional Investigator Covert Special Investigations, Inc

Arizona Professional Investigator Covert Special Investigations, Inc

Bank Protection Fraud Specialist I First Merchants Corporation

Fraud Auditor Contact Government Services LLC

Fraud Auditor CONTACT GOVERNMENT SERVICES

Compliance Investigator HCSC

SIU Investigator The Travelers Companies

Investigator Ethos Risk Services LLC

Investigator V - SR-24 County of Hawaii

Special Investigations Unit (SIU) - Field Investigator Ethos Risk Services LLC

FIU Investigator I Banc of California

Senior District Attorney Investigator A/B (COR) Military, Veterans and Diverse Job Seekers

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