compliance investigator

Special Citizens Futures Unlimited

<div>Job Description:

Salary: $60,000 - $65,000

Shift: Monday - Friday: 9am - 5pm

Location: Yonkers, NY

Job Overview

Join our team as a Quality Improvement Investigator and play a key role in driving quality, compliance, and continuous improvement across our organization. In this impactful position, you will lead incident investigations, collaborate with agency leadership, support regulatory compliance efforts, and contribute to initiatives that enhance services and outcomes for the individuals we support. This is an excellent opportunity for a detail-oriented professional who is passionate about problem solving, quality assurance, and making a meaningful difference in the community.

Responsibilities
<ul>
<li>Conduct, coordinate, and document incident investigations</li>
<li>Complete, organize, and submit incident packets and reports within regulatory time frames</li>
<li>Liaisons with all departments within the agency as needed</li>
<li>Participates in internal audits of each agency program, including visits, writing deficiency notes, conferencing with managers to review deficiencies, reviewing corrective actions and providing support for needed follow up</li>
<li>Safeguards the security and confidentiality of all documents and protected health information held by the Compliance Department in accordance with OPWDD and OMIG regulations.</li>
<li>Ensure treatment plans are in accordance with OPWDD regulations</li>
<li>Active participation within Committees as assigned by the Chief Compliance Officer</li>
<li>Comply with applicable federal and state legal requirements, standards, guidelines, all Special Citizens policies and procedures including the Agency&rsquo;s Quality Assurance Plan, Compliance Plan, Code of Business Conduct and Ethics, HIPPA, and program and billing documentation standards</li>
</ul>
Qualifications
<ul>
<li>GED/High School Diploma, bachelor&rsquo;s degree in human services or related field preferred</li>
<li>Knowledge of OPWDD and NYS Justice Center regulations</li>
<li>Progressive experience working with I/DD population</li>
<li>Demonstrated competency in written, verbal, organizational, computer, and computational skills, with knowledge of Microsoft Word, Outlook, Excel and EHR software</li>
<li>Must be detail oriented, self-driven and work both independently and as part of a team</li>
<li>Flexibility of work location with the ability to travel</li>
<li>Must have flexible working hours and be able to work outside normal business hours, as needed</li>
<li>Maintains professionalism and confidentiality at all times</li>
<li>AMAP, SCIP, CPR and First Aid certification and maintenance of same, as required</li>
<li>Experience working with OPWDDs incident management software (IRMA) preferred</li>
<li>Must have Incident Investigator certification or be able to complete course and pass certification exam within 3 months of hire.</li>
<li>Successful completion of criminal background history and fingerprint examination; a valid NYS driver&rsquo;s license to Agency standard</li>
<li>Excellent communications skills, both written and verbal</li>
<li><ul><li>Completion of other tasks as requested</li></ul></li>
</ul>
Special Citizens Futures Unlimited, Inc. provides equal employment opportunities (EEO)

Benefits:
<ul>
<li>403(b)</li>
<li>Dental insurance</li>
<li>Health insurance</li>
<li>Paid time off</li>
<li>Vision insurance</li>
</ul>
Application Question(s):
<ul>
<li>Do you have experience conducting incident investigations?</li>
<li>Are you familiar with OPWDD, Justice Center, or other regulatory requirements?</li>
</ul>
Education:
<ul><li>
High school or equivalent (Preferred)</li></ul>

Work Location: In person</div>

Quality Improvement Investigator

CVS Health

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.
This position can be work from home anywhere in the United States.
Position Summary
We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU), Self-Funded investigations team.
In this role, you will manage complex investigations into suspected and known acts of healthcare fraud, waste and abuse (FWA).
Key Responsibilities
<ul><li>Conduct high level, complex investigations of known or suspected acts of healthcare fraud, waste and abuse.
</li><li>Conduct Investigations to prevent payment of suspect or fraudulent claims submitted by insured's, providers, claimants, and customers.</li><li>
Research and prepare cases for clinical and legal review.</li><li>
Document all appropriate case activity in case tracking system.</li><li>
Prepare written case summaries and make referrals to State and Federal Agencies within the timeframes required by Law.
</li><li>Facilitate the recovery of company and customer money lost as a result of fraud, waste and abuse.
</li><li>Cooperate with federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud.
</li><li>Demonstrate high level of knowledge and expertise during interactions with internal and external partners.
</li><li>Provide trial testimony in support of criminal or civil proceedings.</li><li>
Give frequent presentations to internal and external customers regarding ongoing case investigations.</li><li>
Respond quickly and accurately to questions and leads from internal and external customers.</li><li>
Exercises independent judgment and uses available resources and technology to develop evidence in support of case investigations.
</li></ul>Required Qualifications<ul><li>
3-5 years investigative experience in the area of healthcare fraud, waste and abuse.</li><li>
Experience in in Microsoft Word, Excel, and Outlook products, open source database search tools, social media and internet research.
</li><li>Ability to travel approximately 10% of time for business purposes.</li></ul>
Preferred Qualifications<ul><li>
Certified Professional Coder (CPC), AHFI, CFE
</li><li>Knowledge of CVS/Aetna's policies and procedures</li><li>
Understanding of self-funded insurance plan operations</li><li>
Strong communication and customer service skills and the ability to effectively interact with Aetna's customers</li><li>
Resident of North Carolina</li></ul>
Education<ul><li>
Bachelor's degree preferred or equivalent work experience.</li></ul>
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$46,988.00 - $112,200.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. 
Additional details about available benefits are provided during the application process and on Benefits Moments. 
We anticipate the application window for this opening will close on: 07/27/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Senior Investigator, Special Investigations Unit (Aetna SIU)

Sunrise Research Institute

About 3Sync Research3Sync Research is a growing clinical research organization dedicated to advancing medicine through high-quality clinical trials. We partner with leading pharmaceutical companies, CROs, physicians, and healthcare professionals to bring innovative treatment options to diverse patient populations.Our office conducts outpatient clinical research across multiple therapeutic areas, including primary care, pediatrics, asthma/allergy, diabetes, endocrinology, infectious disease, vaccines, and other adult and pediatric studies. We are looking for a strong, experienced provider who is comfortable working directly with patients and supporting clinical trial oversight.Position OverviewWe are seeking a bilingual APRN / Nurse Practitioner to join our clinical research team as a Clinical Trial Sub-Investigator. This is an excellent opportunity for an experienced provider who is detail-oriented, and comfortable working with both adults and children.In this role, you will work closely with the Principal Investigator, site directors, operations leadership, recruitment team, clinical research coordinators, sponsors, CROs, and regulatory teams to support the safe and compliant conduct of clinical trials. The Sub-Investigator will conduct patient screening, eligibility review, physical exams, safety assessments, protocol compliance, clinical documentation, enrollment support, participant retention, and contribute to overall site performance.Key ResponsibilitiesAssist the Principal Investigator in the oversight and execution of clinical trialsConduct patient screening, enrollment, and ongoing study visit assessmentsPerform physical exams and clinical evaluations for adult and pediatric participantsReview medical history, medications, labs, vitals, inclusion/exclusion criteria, and study eligibilityMonitor participant safety throughout the studyIdentify, assess, document, and report adverse events and clinical concernsPerform or assist with blood draws, vital signs, and other protocol-required proceduresReview informed consent forms, source documents, lab reports, CRFs, and study records for accuracy and completenessSupport protocol compliance, data collection, and audit readinessCommunicate professionally with participants, parents/guardians, study staff, sponsors, CROs, and regulatory teamsSupervise and support clinical research staff when neededCollaborate closely with site directors, operations leadership, recruitment teams, coordinators, and the Principal Investigator to support successful study outcomes, strong enrollment, participant retention, protocol compliance, and overall site performanceServe as a team player within a fast-paced clinical research environment, helping ensure smooth communication between clinical, operational, and recruitment staffEnsure study activities are conducted in compliance with FDA regulations, ICH-GCP guidelines, HIPAA, protocol requirements, and site SOPsRequirementsActive and unrestricted License/Certification- Florida APRN / Nurse Practitioner License requiredMinimum of 5+ years of experience as an APRN / Nurse Practitioner(Bilingual English/Spanish )Must be comfortable working with both adult and pediatric patientsStrong clinical assessment, documentation, and decision-making skillsExperience with patient evaluation, medical history review, medication review, labs, and clinical proceduresPhlebotomy or blood sampling experience preferredFamiliarity with medical terminology, clinical documentation, and outpatient patient careAbility to work independently while collaborating with the Principal Investigator and research teamStrong attention to detail and ability to work in a fast-paced clinical environmentProfessional, dependable, organized, proactive, and team-orientedGCP certification preferred; training can be provided if neededAvailability to work occasional weekends as needed based on study requirementsPreferred ExperienceFamily MedicinePrimary CarePediatricsInternal MedicineUrgent CareAllergy / AsthmaEndocrinologyDiabetes CareInfectious DiseaseVaccinesClinical ResearchClinical Trial Sub-Investigator experienceIdeal CandidateThe ideal candidate is an experienced, bilingual provider who is comfortable making clinical assessments, asking the right questions, identifying safety concerns, and working with a wide range of patients. We are looking for someone who is confident in their clinical judgment, reliable, personable, and able to take ownership of patient evaluations in a research setting.This person should also be a strong team player who works well with site directors, operations leadership, recruitment teams, coordinators, and the Principal Investigator to help drive successful study outcomes, strong enrollment, participant retention, protocol compliance, and overall site performance.Why Join 3Sync ResearchOpportunity to work on innovative clinical trials and emerging treatmentsAdult and pediatric patient populationGrowing research organization with expanding study opportunitiesCollaborative team environmentExposure to multiple therapeutic areasFlexible schedule availableMeaningful role in supporting patient safety and advancing clinical researchBenefits:Health insuranceDental insuranceVision insurancePaid time offPay: $88,117.74 - $106,120.29 per yearBenefits:<ul><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Work Location: In person

Bilingual APRN / Nurse Practitioner

Allied Universal Compliance and Investigations

<div>Major Case Unit Investigator<h2 class="jobSectionHeader">
Overview</h2><div> 
Company Overview:
</div><div>Advance Your Career in Insurance Claims with Allied Universal&reg; Compliance and Investigation Services. Allied Universal&reg; Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you&rsquo;re ready to grow with the best, explore a career with us and make a difference.</div><h2 class="jobSectionHeader"> 
Job Description</h2> 
Allied Universal&reg; is hiring a Major Case Unit Investigator (MCU). MCU staff investigate claims with red flags that suggest fraudulent behavior In relation to an Insurance claim. The Investigator must use their extensive knowledge of Insurance policies and the components of fraud to determine If claims warrant reporting to the appropriate state agency for prosecution.
RESPONSIBILITIES:<ul><li>
Use specialized services to identify new and emerging fraud trends and provide an enhanced focus on complex claims, high-risk claim exposures, such as organized crime-rings, Complex Financial Fraud Schemes, medical provider treatment fraud, medical provider billing fraud, Corporate Investigations, Case File Reviews, Anti-Fraud Consulting, and Criminal Conspiracies involving the insurance industry.</li><li>
Conduct complex Investigations across all lines of business in the insurance industry which may involve serious injuries, extensive damages, large scale or multi-party construction defect matters or complicated coverage issues.</li><li>
Analyze and interpret complex and voluminous evidence and convey highly technical information effectively to others.</li><li>
Prepare and submit detailed investigative reports as necessary and make investigative recommendations in accordance with all applicable fraud statutes, case law, and the policy contracts</li><li>
Assist clients as a subject matter expert/ expert witness, coordinate and attend Examinations Under Oath, and attend legal proceedings as required.</li><li>
Utilize the most advanced investigative techniques in the industry to include Analytics; Link Analysis; and Advanced Database and Social Media Analysis to assess suspected fraudulent claims or provider activity and create business intelligence reports that advance fraud identification and prevention efforts.</li><li>
Coordinate with local, state, and federal law enforcement and prosecutors, Department of Insurances, NICB, other carrier SIU&rsquo;s</li><li>
Independently develop a strategic plan to achieve assignment objectives, ensuring thorough documentation and effective communication with clients and their Special Investigation Unit Supervisor</li></ul>
QUALIFICATIONS (MUST HAVE):<ul><li>
Must possess one or more of the following:<ul><li>
Bachelor&rsquo;s degree in Criminal Justice or a related field</li></ul></li><li>
A minimum of five years of complex criminal investigative experience as a criminal investigator, detective, and/or special agent in a full-time capacity, conducting fraud/economic related analysis. OR five (5) years of experience as a special investigator conducting insurance claim analysis and investigations with a carrier, third-party administrator and/or vendor contracted special investigations unit, plus one year conducting complex investigations.</li><li>
</li><li>Ability to be properly licensed as a Private Investigator as required by the state where you reside</li><li>
Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course</li><li>
Proficient understanding and application of anti-fraud laws, insurance regulations, and compliance standards within their home state and designated regional area.</li><li>
Proficient in utilizing laptop computers and cell phones.</li><li>
Ability to type 40+ words per minute with minimum error</li></ul>
PREFERRED QUALIFICATIONS (NICE TO HAVE):<ul><li>
One or more of the following professional industry certifications:<ul><li>
Certified Fraud Investigator (CFE)</li><li>
Certified Insurance Fraud Investigator (CIFI)</li><li>
Fraud Claim Law Associate (FCLA)</li><li>
Fraud Claim Law Specialist (FCLS)</li></ul></li></ul><div>
BENEFITS:</div><ul><li>
Medical, dental, vision, basic life, AD&amp;D, retirement plan and disability insurance</li><li>
Seven paid holidays annually, sick days available where required by law</li><li>
Vacation time offered at an initial accrual rate of 3.08 hours biweekly; unused vacation is only paid out where required by law</li></ul><h2 class="jobSectionHeader"> 
Closing</h2><div> 
Allied Universal&reg; is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: www.aus.com
</div><div>If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: www.aus.com/offices.</div><h2 class="jobSectionHeader"> 
Requisition ID</h2> 
2026-1612324</div>

Major Case Unit Investigator

<div>SIU Investigator<h2 class="jobSectionHeader">
Overview</h2><div> 
Company Overview:
</div><div>Advance Your Career in Insurance Claims with Allied Universal&reg; Compliance and Investigation Services. Allied Universal&reg; Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you&rsquo;re ready to grow with the best, explore a career with us and make a difference.</div><h2 class="jobSectionHeader"> 
Job Description</h2><div> 
Allied Universal&reg; is hiring a Special Investigations Unit (SIU) Investigator. Special Investigations Unit (SIU) Specialists investigate claims with red flags that suggest fraudulent behavior In relation to an Insurance claim. The SIU Specialist must use their extensive knowledge of Insurance policies and the components of fraud to determine If claims warrant reporting to the appropriate state agency for prosecution.</div><div>
</div><ul><li>Must possess a valid driver's license with at least one year of driving experience
</li><li>Candidate must reside in state listed in job posting
</li><li>Pay Rate: $27 - $32 / hr
</li></ul><div></div><div>RESPONSIBILITIES:</div><ul><li>
Independently investigate suspected fraudulent insurance claims for a variety of coverage to include workers&rsquo; compensation, general liability, property and casualty and disability</li><li>
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</li><li>
Create and maintain detailed documentation for investigations, file reviews, audits, training tasks, consulting projects, and other assignments as directed</li><li>
Produce professional and expert reports, memos, and letters that are clear, concise, and grammatically correct</li><li>
Run appropriate database indices if necessary and verify the accuracy of results found</li><li>
Independently develop a strategic plan to achieve assignment objectives, ensuring thorough documentation and effective communication with clients and their Special Investigation Unit Supervisor</li></ul><div>
QUALIFICATIONS (MUST HAVE):</div><ul><li>
Must possess one or more of the following:</li><li><ul><li>
Bachelor&rsquo;s degree in Criminal Justice</li><li>
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</li></ul></li><li>
Ability to be properly licensed as a Private Investigator as required by the state where work Is completed</li><li>
Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course</li><li>
Minimum of five (5) years of demonstrated experience conducting complex insurance investigations or adjusting complex insurance claims</li><li>
Proficient understanding and application of anti-fraud laws, insurance regulations, and compliance standards within their home state and designated regional area.</li><li>
Proficient in utilizing laptop computers and cell phones.</li><li>
Special Investigative Unit (SIU) Compliance knowledge</li><li>
Ability to type 40+ words per minute with minimum error</li><li>
Flexibility to work varied and irregular hours and days including weekends and holidays</li></ul><div>
PREFERRED QUALIFICATIONS (NICE TO HAVE):</div><ul><li>
Military experience</li><li>
Law enforcement</li><li>
Insurance administration experience</li><li>
Familiarity with California SIU regulations</li><li>
One or more of the following professional industry certifications:</li><li><ul><li>
Certified Fraud Investigator (CFE)</li><li>
Certified Insurance Fraud Investigator (CIFI)</li><li>
Fraud Claim Law Associate (FCLA)</li><li>
Fraud Claim Law Specialist (FCLS)</li><li>
Certified Protection Professional (CPP)</li><li>
Associate in Claims (AIC)</li><li>
Chartered Property Casualty Underwriter (CPCU)</li></ul></li></ul><div>
BENEFITS:</div><ul><li>
Medical, dental, vision, basic life, AD&amp;D, retirement plan and disability insurance</li><li>
Seven paid holidays annually, sick days available where required by law</li><li>
Vacation time offered at an initial accrual rate of 3.08 hours biweekly; unused vacation is only paid out where required by law</li></ul><h2 class="jobSectionHeader"> 
Closing</h2><div> 
Allied Universal&reg; is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: www.aus.com
</div><div>If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: www.aus.com/offices.</div><h2 class="jobSectionHeader"> 
Requisition ID</h2> 
2026-1609926</div>

SIU Investigator

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6468 compliance investigator jobs Near Me

Quality Improvement Investigator

Senior Investigator, Special Investigations Unit (Aetna SIU)

Senior Investigator, Special Investigations Unit (Aetna SIU)

Senior Investigator, Special Investigations Unit (Aetna SIU)

Bilingual APRN / Nurse Practitioner

Major Case Unit Investigator

SIU Investigator