UNKNOWN

FEED

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Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs. In this role, the Senior Investigator will conduct investigations that support healthcare program integrity initiatives by identifying potential fraud, waste, and abuse (FWA), analyzing complex information, and developing investigative findings.

Integrity Management Services, Inc.

Sr. Investigator (Full-time, Remote)

Workable

Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs. In this role, the Investigator will perform high level complex Medicare and Medicaid investigations and develop cases for future action, including referral to law enforcement, education, overpayment recovery and other administrative actions.

Investigator (Full-time, Remote)

Four years of recent (within last ten years) full-time investigative experience which included: 1.) conducting fact finding; 2.) collecting and preserving evidence according to the rules of evidence; 3.) examining records; 4.) locating and interviewing witnesses to verify or disprove claims of suspected law violations; 5.) and writing investigation reports sufficient for use at administrative hearings or in court. Working alongside attorneys, auditors, and other investigators, you will gather and analyze evidence, interview witnesses and suspects, collaborate with law enforcement partners, and help protect public resources and vulnerable Oregonians.

State of Oregon

*Investigator 3 - Civil Enforcement Division (Portland)

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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

Responsibilities: SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse. As the world’s leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies.

Peraton drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world’s leading mission capability integrator and transformative enterprise IT provider, we deliver trusted and highly differentiated national security solutions and technologies that keep people safe and secure. Peraton serves as a valued partner to essential government agencies across the intelligence, space, cyber, defense, civilian, health, and state and local markets. Every day, our employees do the can’t be done, solving the most daunting challenges facing our customers.

Peraton

Fraud Investigative Coordinator (SCA)

[AW]-iCims

The incumbent is responsible for conducting investigations of organizational or functional activities related to alleged fraud, waste and abuse perpetrated by providers, members, facilities, pharmacies, groups and/or employees of the organizations and Subsidiaries. The incumbent is also responsible for the field investigative work necessary to complete a review of a special project, potential fraud, waste and abuse case, conducting the initial investigations and coordinating the recovery/savings of money related to fraud, waste and abuse.

Highmark provides millions of people with the security of quality health insurance
Our history of helping families and companies with their health insurance needs dates to the 1930s, when our predecessor companies were established to help Pennsylvania's residents pay for health care.
Highmark was created in 1996 by the consolidation of two Pennsylvania licensees of the Blue Cross and Blue Shield Association — Pennsylvania Blue Shield (now Highmark Blue Shield) and Blue Cross of Western Pennsylvania (now Highmark Blue Cross Blue Shield). We are now one of the largest health insurers in the United States.
Highmark's officers and board of directors set the company's strategic direction and corporate policies. They are guided by our mission, vision and values.

Highmark Inc

Investigator

Senior Investigator

SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse. As the world's leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies.

Peraton Inc

Collaborates with internal business partners, compliance, legal, provider and payment integrity teams, and external agencies to coordinate investigative activities, support corrective actions, recoveries, and case resolution efforts. 2+ years Fraud, waste, and abuse investigations, healthcare investigations, claims audits, payment integrity, healthcare compliance, law enforcement investigations, or a related investigative field required.

Centene Management Company

SIU Investigator

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Investigator (Full-Time, Remote)

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Sr. Investigator (Full-Time, Remote)

This work unit conducts thorough investigations (including interviews of parties or witnesses, review of relevant documents and reports, and any other lawful investigative techniques); evidence collection, review, and preparation; prepares and presents both regulatory and criminal reports of investigation to statewide District Attorney's Offices, the State of Colorado Attorney General's Office and/or the FAMLI Division Hearings unit, seeking monetary or other relief authorized by the FAMLI Act or subsequent regulations, assessment of monetary amounts owed (fines & interest) and/or any other remedies approved by the Division. Work includes identifying suspects, interviewing witnesses, examining Complainant and Respondent records, verifying the authenticity of documents, collecting evidence, preparing affidavits for court orders for the production of records, writing comprehensive reports of investigations, and presenting the cases/investigations for prosecution/hearing.

HOUR

State of Colorado

Criminal Investigator III

Work with SIU Team (Clinical Reviewers, CPCs, Investigators, Analysts-including performing quality check on work, assisting in research, discuss to make appropriate coding determinations as needed). Healthcare Fraud Shield, a leader in healthcare fraud prevention and payment integrity solutions, is looking for a talented Coder or Clinical Coder/Fraud Investigator to join our team.

Healthcare Fraud Shield

Work with SIU Team (Clinical Reviewers, CPCs, Investigators, Analysts-including performing quality check on work, assisting in research, discuss to make appropriate coding determinations as needed). Healthcare Fraud Shield, a leader in healthcare fraud prevention and payment integrity solutions, is looking for a talented Clinical Coder/Fraud Investigator to join our team.

SIU Clinical Investigator

PinpointHQ

Position requires advanced knowledge of dental terminology and dental procedure codes; knowledge of common data mining tools, such as Audit Command Language (ACL), SQL Developer and IBM’s Fraud and Abuse Management System (FAMS); strong verbal and written communication skills; strong organizational and analytical skills; ability to manage multiple assignments with competing deadlines; and the ability to resolve complex problems using independent judgment. Position requires a bachelor's degree in accounting, business administration, finance, healthcare administration, information technology, or a related field and three years of experience auditing, utilizing analytical tools and software, dental claims billing or review, or as a dental hygienist.

Delta Dental Plan of Michigan

Special Investigations Unit Investigator

Preferred 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.

Cotiviti Holdings Inc. (Inactive)

Senior Investigator Lead Validation (Healthcare FWA)

Education/Certification: An Associate Degree in Human Services Technology, Social Services Associate, Paralegal Technology, Criminal Justice, Business Administration, Secretarial Science or closely related curriculum and two years of experience as an Income Maintenance Caseworker or Investigator; or, graduation from high school and three years of experience as an Income Maintenance Caseworker or Income Maintenance Investigator; or graduation from high school and two years of investigative experience in credit, legal, or law enforcement work plus eighteen months of experience as an Income Maintenance Caseworker or Income Maintenance Investigator; or an equivalent combination of training and experience. Where the cause of the error indicates a potential for client fraud the employees are responsible for investigating the case to include seeking information from the client, clients employers, income maintenance caseworker referring the case and any other related sources of information.

Harnett County, North Carolina

Income Maintenance Investigator II- Part Time

Public safety employees such as commissioned law enforcement officers hired by the New Orleans Police Department (NOPD), firefighters hired by the New Orleans Fire Department (NOFD), emergency medical technicians hired by the New Orleans Emergency Medical Services (NOEMS) and the recruits for these positions hired by these departments are excluded from this provision. VETERANS PREFERENCE: On original entrance examinations, veterans (as defined in Article X, Section 10(2) of the Constitution of the State of Louisiana), disabled veterans, certain spouses and parents of veterans shall receive additional credit if claimed as provided on the Veterans Preference claim form which can be obtained in this office.

City of New Orleans

CRIMINAL INVESTIGATOR IV (INSPECTOR GENERAL) (CLASS CODE 0710)

For 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.

Fraud Investigator Jobs in the United States

Sr. Investigator (Full-time, Remote) Integrity Management Services, Inc.

Investigator (Full-time, Remote) Integrity Management Services, Inc.

*Investigator 3 - Civil Enforcement Division (Portland) State of Oregon

INVESTIGATOR State Of California

Fraud Investigative Coordinator (SCA) Peraton

Investigator Highmark Inc

Senior Investigator Highmark Inc

Fraud Investigative Coordinator (SCA) Peraton Inc

SIU Investigator Centene Management Company

Investigator (Full-Time, Remote) Integrity Management Services, Inc.

Sr. Investigator (Full-Time, Remote) Integrity Management Services, Inc.

Criminal Investigator III State of Colorado

SIU Investigator Healthcare Fraud Shield

SIU Clinical Investigator Healthcare Fraud Shield

Special Investigations Unit Investigator Delta Dental Plan of Michigan

Senior Investigator Lead Validation (Healthcare FWA) Cotiviti Holdings Inc. (Inactive)

Income Maintenance Investigator II- Part Time Harnett County, North Carolina

CRIMINAL INVESTIGATOR IV (INSPECTOR GENERAL) (CLASS CODE 0710) City of New Orleans

Senior Financial Analyst/Investigator Contact Government Services LLC

Senior Financial Analyst/Investigator CONTACT GOVERNMENT SERVICES

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