fraud investigator

Mechanics Bank

<div><div><div>Mechanics Bank is currently searching for a full time Sr. Fraud Investigator to join our team. This role will be working on-site at either our Irvine HQ or Roseville Executive Offices.</div><div><br>
The Sr. Fraud Investigator is responsible for conducting independent investigations into suspected or actual violations of financial regulations, including but not limited to Fraud, Anti-Money Laundering (AML), Bank Secrecy Act (BSA), Combating the Financing of Terrorism (CFT), Sanctions. This role requires a strong understanding of financial transactions, investigative techniques, and applicable laws and regulations. The Investigator will work closely with internal and external stakeholders, including law enforcement agencies, to identify, assess, and mitigate financial crime risks. The role involves conducting detailed investigations, reviewing transaction patterns, writing investigative reports and preparing suspicious activity reports (SARs). The role requires attention to detail, excellent analytical skills and observes the highest degree of confidentiality in the handling of information. The Investigator must thrive in a fast-paced, dynamic environment and demonstrate adaptability in responding to constantly evolving fraud schemes.</div></div><div></div><div>
What you will be doing:</div><ul><li><div>
Collect and analyze customer and financial transactions for potential fraudulent activity, money laundering, terrorist financing to identify patterns of suspicious activity.</div></li><li><div>
Apply critical thinking skills and experience in writing comprehensive investigation analysis to conclude whether or not to file a SAR. Maintain disciplines in consistently following current processes, procedures and policies ensuring compliance with applicable regulatory requirements regarding timely, accurate and thorough investigations are completed.</div></li><li><div>
Use of Bank systems, vendor applications and search engines to validate identities, research individual backgrounds and obtain information on transactional counterparties.</div></li><li><div>
Develop and maintain professional level communication with internal and external parties that recognizes acceptable business protocols.</div></li><li><div>
Interact with federal, state and local law enforcement agencies in receiving and providing critical investigative and case elements that can be used in prosecuting elements of a crime.</div></li><li><div>
Monitor and analyze emerging financial crime threats and trends.</div></li><li><div>
Maintain accurate and up-to-date knowledge of applicable laws and regulations.</div></li><li><div>
Travel required: 0-10%.</div></li></ul><div></div><div>
Who you are:</div><ul><li><div>
Bachelor's degree is preferred.</div></li><li><div>
Minimum 3 years of investigating and reporting financial crimes, particularly fraud is required.</div></li><li><div>
Minimum 2 years of experience using a fraud detection system is preferred.</div></li><li><div>
Investigative and research skills using various systems.</div></li><li><div>
Excellent written and verbal skills.</div></li><li><div>
Completes more complex investigations that are generally non-system generated (e.g., whistleblower, cyber-crime, elder financial abuse, identity theft, and internal, external and victim fraud).</div></li><li><div>
Ability to use multiple systems simultaneously to gather investigative data.</div></li><li><div>
Accurately completes all assigned investigations prior to the assigned and regulatory deadlines.</div></li><li><div>
Portrays strong investigative and analytical skills to identify patterns, trends, and potential red flags in transactions.</div></li><li><div>
Assesses the effectiveness of systems, processes and tools used to monitor risks and identify opportunities for improvement.</div></li><li><div>
Assists in investigating inquiries from peer BSA teams and all front line lines of business.</div></li><li><div>
Reviews customer accounts and analyzes transactions. This may include analyzing customer types, transaction patterns and account activity, and reviewing customer documentation, such as business licenses, articles of incorporation, or tax returns.</div></li><li><div>
Ability to write comprehensive investigative analysis reviews that meets the requirements of the FFIEC&rsquo;s guidelines.</div></li><li><div>
Excellent written and verbal communication skills. Ability to read, analyze, and interpret general business periodicals, professional journals, or governmental regulations.</div></li><li><div>
Ability to calculate figures and amounts, interpret a variety of instructions furnished in written, oral, or schedule form.</div></li><li><div>
Assists with regulatory reporting (i.e., SAR filing and submission, Financial Elder Abuse, Identity Theft, etc.)</div></li><li><div>
Handles sensitive and confidential information with discretion, avoiding conflicts of interest, acting in an unbiased manner, and upholding professional integrity to maintain trust and credibility.</div></li><li><div>
Thorough understanding and remains informed of changes to BSA and OFAC regulations, including suspicious activity red flags. This includes attending training webinars, seminars, conferences and reading industry publications.</div></li><li><div>
Support the Sr. BSA Investigations Manager, Deputy BSA Officer and BSA Officer, as needed.</div></li><li><div>
Maintain a high degree of professionalism and confidentiality.</div></li><li><div>
Adhere to all company policies and procedures.</div></li><li><div>
Perform other duties assigned by management.</div></li></ul><div></div><div><div>
#LI-ML1</div></div><div></div><div>
Pay Range: $72,500.00 - $108,000.00 annually</div><div>
AIP/Bonus: up to 7.5%</div><div></div><div>
Our comprehensive employee benefits program is designed for you to live your best life at work, home, and everywhere in between. Employees working 25 hours or more per week are eligible for health benefits effective the first day of the month following or coinciding with their date of hire.<br>
Benefits package includes[1]:</div><div></div><ul><li><div>
Medical, prescription, dental, and vision coverage for employees and their eligible family members</div></li><li><div>
Employer paid Employee Assistance Program, Life Insurance, AD&amp;D, and Disability benefits</div></li><li><div>
Health Savings Account with employer contribution</div></li><li><div>
Healthcare and Dependent Care Flexible Spending Accounts and Commuter/Parking Benefit</div></li><li><div>
401(k) and Roth 401(k) with company contribution</div></li><li><div>
529 Education Savings plan, Tuition Reimbursement Program and Student Loan Assistance Program</div></li><li><div>
Supplemental Health plans, Voluntary Legal and Identity Theft Services</div></li><li><div>
11 paid holidays, paid Sick days (accrual of one hour for every 30 hours worked), up to 25 paid vacation days, and 16 hours of paid volunteer time throughout the calendar year</div></li><li><div>
Free personal checking and savings account; Discounted rates on primary residence loan with $0 origination fees (restrictions apply)</div></li></ul><div></div><div>
Final compensation package will be determined by the work experience, education, and/or skill level of the applicant along with internal equity and alignment with geographic market data.</div><div></div><ul><li><div>
Mechanics Bank is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, religion, national origin, age, genetic information, veteran status, or on the basis of disability, gender identity, sexual orientation or other bases prohibited by applicable law.</div></li><li><div>
Please view Equal Employment Opportunity Posters provided by OFCCP <div>here</div>.</div></li><li><div>
To learn more about Mechanics Bank&rsquo;s California privacy and security policies, including your right to a Notice At Collection as a California Resident, please visit</div><div><div>
California Privacy Policy for Prospective Employees | Mechanics Bank</div></div></li></ul><div></div><div>
[1] The benefits listed in this job posting reflect the Bank&rsquo;s most reasonable and genuinely expected benefits offered for this position.</div></div>

Sr. Fraud Investigator

CGS Federal (Contact Government Services)

<div>
 Employment Type: Full-Time, Mid-Level
 <br/>
 <br/>
 Department: Litigation Support
 <br/>
 <br/>
 CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project in Nashville, TN. 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.
 <br/>
 <br/>
 CGS brings motivated, highly skilled, and creative people together to solve the government&rsquo;s most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities.
 <br/>
 <br/>
 Responsibilities will Include:
 <br/>
 <br/>
 <br/>
 <ul>
  <li>
   Review, sort, and analyze data using computer software programs such as Microsoft Excel
  </li>
  <li>
   Review financial records, complex legal and regulatory documents and summarize contents, and conduct research as needed. Preparing spreadsheets of financial transactions (e.g., check spreads, etc.)
  </li>
  <li>
   Develop HCF case referrals including, but not limited to:
  </li>
  <li>
   Ensure that HCF referrals meet agency and USAO standards for litigation
  </li>
  <li>
   Analyze data for evidence of fraud, waste and abuse
  </li>
  <li>
   Review and evaluate referrals to determine the need for additional information and evidence, and plan comprehensive approach to obtain this information and evidence
  </li>
  <li>
   Advise the HCF attorney(s) regarding the merits and weaknesses of HCF referrals based upon applicable law, evidence of liability and damages, and potential defenses, and recommend for or against commencement of judicial proceedings
  </li>
  <li>
   Assist the USAO develop new referrals by ensuring a good working relationship with client agencies and the public, and by assisting in HCF training for federal, state and local agencies, preparing informational literature, etc
  </li>
  <li>
   Assist conducting witness interviews and preparing written summaries
   <br/>
   <br/>
   <br/>
   <br/>
   <br/>
  </li>
 </ul>
 Qualifications:
 <br/>
 <br/>
 <br/>
 <ul>
  <li>
   Four (4) year undergraduate degree or higher in criminal justice, finance, project management, or other related field
  </li>
  <li>
   Minimum three (3) years of professional work experience in healthcare, fraud, or other related investigative field of work
  </li>
  <li>
   Proficiency in Microsoft Office applications including Outlook, Word, Excel, PowerPoint, etc
  </li>
  <li>
   Proficiency in analyzing data that would assist in providing specific case support to the Government in civil HCF matters (E.g., Medicare data, Medicaid data, outlier data)
  </li>
  <li>
   Communication 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. Communication requires tact and diplomacy
  </li>
  <li>
   U.S. Citizenship and ability to obtain adjudication for the requisite background investigation
  </li>
  <li>
   Experience and expertise in performing the requisite services in Section 3
  </li>
  <li>
   Must be a US Citizen
  </li>
  <li>
   Must be able to obtain a favorably adjudicated Public Trust Clearance
   <br/>
   <br/>
   <br/>
   <br/>
   <br/>
  </li>
 </ul>
 Preferred qualifications:
 <br/>
 <br/>
 <br/>
 <ul>
  <li>
   Relevant Healthcare Fraud experience including compliance, auditing duties, and other duties in Section 3
  </li>
  <li>
   Relevant experience working with a federal or state legal or law enforcement entity
   <br/>
   <br/>
   <br/>
   <br/>
   <br/>
  </li>
 </ul>
 #CJ
 <br/>
 <br/>
 We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
</div>


Healthcare Fraud Investigator

State of New Hampshire

<div><div><p><b>State of New Hampshire Job Posting
</b></p><p></p><p><b>Insurance Department
</b></p><p>Legal Division
</p><p>21 S Fruit Street, Suite 14, Concord, NH 03301<br>
</p><p></p><p><b>SENIOR INSURANCE FRAUD INVESTIGATOR
</b></p><p>Position #9U545<br>
<br>
</p><p>$69,255.00/annually - $96,385.00/annually<br>
<br>
</p><p></p><br>
<p><b>*See total compensation information at the bottom of announcement.<br>
</b></p></div><p></p><br>
<p>The State of New Hampshire, Insurance Department, Legal Division has a full-time vacancy for Senior Insurance Fraud Director.<br>
</p><p></p><br>
<p><b>SUMMARY:
</b></p>To investigate allegations of insurance-related criminal activity, participate in the collection and securing of evidence and prepare criminal cases for prosecution throughout the State of New Hampshire.<br>
<p></p><br>
<p><b>YOUR EXPERIENCE COUNTS </b>: Each additional year of approved formal education may be substituted for one year of required work experience and/or each additional year of approved work experience may be substituted for one year of required formal education.<br>
<br>
</p><p></p><br>
<p><b>PREFERRED QUALIFICATIONS:
</b></p><p>Education: Bachelor's degree from a recognized college or university with major study in business administration, insurance, statistics, accounting, criminal justice, law, finance, economics or a related field. Each additional year of approved formal education may be substituted for one year of required work experience.
</p><p></p><p>Experience: Five years of experience in law enforcement performing fraud investigations and/or undercover operations, or in the insurance industry performing statistical analysis, underwriting, claims adjudicating and accounting with specialization in the areas of health, life, disability, property and casualty insurance. Each additional year of approved work experience may be substituted for one year of required formal education.
</p><p></p><p>License/Certification: Must possess a valid driver's license and/or have access to transportation for use in statewide travel.
</p><p></p><p>Other Requirements: None
</p><p></p><p>Trainee Option: Candidates with an equivalent combination of 4+ years of relevant education and experience after completion of high school may be considered and hired in &lsquo;trainee status&rsquo; for this position.<br>
</p><p></p><br>
<p><b>RESPONSIBILITIES:
</b></p><p>Conduct criminal investigations of alleged insurance fraud or other insurance-related criminal activity including theft, forgery, and misapplication of property, to uncover violations of fiduciary responsibilities and perjury relating to all lines of insurance.<br>
</p><p></p><br>
<p>Examine and analyze complex insurance company, provider and Agent/Producer records, claims information and financial statements for potential fraud.<br>
</p><p></p><br>
<p>Complete field canvasses and utilize databases to locate witnesses and suspects developed throughout investigations in order to conduct interviews and/or interrogations.<br>
</p><p></p><br>
<p>Collect evidence by various means including search warrants, subpoenas, 1-party intercepts, and photography; ensure evidence is cataloged, properly packaged and sealed to protect from tampering, and securely stored.<br>
</p><p></p><br>
<p>Conduct and/or participate in undercover and sting operations at such places as medical providers&rsquo; offices, body shops and insurance agencies, and assist law enforcement agencies upon request.<br>
</p><p></p><br>
<p>Develop and implement criminal investigations and prosecution plans in conjunction with prosecuting attorneys, both state and federal, to achieve successful prosecutions for matters involving insurance-related crimes.<br>
</p><p></p><br>
<p>Provide testimony in both federal and state courts as an expert witness to summarize and give opinion on evidence and information.<br>
</p><p></p><br>
<p>Draft search warrant affidavits for court approval; collaborate with law enforcement agencies and assist in the execution of the search warrants.<br>
</p><p></p><br>
<p>Perform research and draft new legislation and regulations that directly affect the mission of the Fraud Unit in its duties to deter and combat insurance fraud.<br>
</p><p></p><br>
<p>Develop and present training programs to insurance carriers and law enforcement agencies, as well as the general public to help address fraud awareness.<br>
</p><p></p><br>
<p><b>DISCLAIMERS </b>:
</p><p>The supplemental job description lists the essential functions of the position and is not intended to include every job duty and responsibility specific to the position. An employee may be required to perform other related duties not listed on the supplemental job description provided that such duties are characteristic of that job title.
</p><p></p><p>When applicable, the work of an employee in trainee status in this position shall be overseen by a fully qualified individual. An employee in trainee status shall meet the minimum qualifications within the period of time specified on the SJD, not to exceed one year of being hired into this position.<br>
</p><p></p><br>
<p>For position-related questions, please contact Roni Karnis, Esq., General Counsel, at Roni.M.Karnis@ins.nh.gov.
</p><p></p><p>For application-related questions, please contact Katrina Gagne, Human Resources Technician, at Katrina.L.Gagne@ins.nh.gov.<br>
</p><p></p><br>
<p><b>*TOTAL COMPENSATION INFORMATION
</b></p><p>The State of NH total compensation package features an outstanding set of employee benefits, including:
</p><p>HMO or POS Medical and Prescription Drug Benefits:
</p><p></p><p>The actual value of State-paid health benefits and the amount of employee health benefit contributions may vary depending on the type of plan selected and the bargaining unit with which a position is associated.
</p><p><b>See this link for details on State-paid health benefits:
</b></p><p>https://www.das.nh.gov/hr/benefits.aspx<br>
<br>
</p><p>Value of State's share of Employee's Retirement: 12.87% of pay<br>
<br>
</p><p><b>Other Benefits:
</b></p><ul><li>Dental Plan at minimal cost for employees and their families ($500-$1800 value)
</li></ul><ul><li>Flexible Spending healthcare and childcare reimbursement accounts
</li></ul><ul><li>State defined benefit retirement plan and Deferred Compensation 457(b) plan
</li></ul><p></p><ul><li>Work/life balance flexible schedules, paid holidays and generous leave plan
</li></ul><ul><li>$50,000 state-paid life insurance plus additional low-cost group life insurance
</li></ul><ul><li>Incentive-based Wellness Program (ability to earn up to $500)
</li></ul><p>Total Compensation Statement Worksheet:
</p><p>https://www.das.nh.gov/jobsearch/compensation-calculator.aspx<br>
<br>
</p><p><b>Want the specifics? Explore the Benefits of State Employment on our website:
</b></p><p>https://www.das.nh.gov/hr/documents/BenefitBrochure.pdf<br>
<br>
</p><p>https://www.das.nh.gov/hr/index.aspx<br>
<br>
</p><p>EOE
</p><p></p><p>TDD Access: Relay NH 1-800-735-2964</p></div>

SENIOR INSURANCE FRAUD INVESTIGATOR

Prime Therapeutics

<div><div>At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.</div><div>
Job Posting Title</div><div></div>
SIU Investigator - Remote<div>
Job Description</div><div></div><div><div><div><div>
The Special Investigations Unit (SIU) Investigator is responsible for conducting standard investigations of potential pharmacy, member, and/or prescriber fraud, waste and abuse (FWA). This position conducts claims data mining, fraud analysis and auditing/monitoring activities and proactively identifies improvement opportunities in investigation procedures and FWA prevention efforts ensure proper identification of potential FWA. The SIU Investigator prepares investigative reports for leadership, remediation actions, recovery efforts, internal committees and/or referral to state and federal law enforcement agencies.</div><div></div><div>
Responsibilities</div><ul><li><div>
Develop investigative plans, documents and justification to support investigations; evaluate impact of changing circumstances or newly discovered evidence to a previously developed investigation plan; proactively communicate plans, progress and changes to department leadership and other internal or external stakeholder</div></li><li><div>
Obtain and review factual and reliable evidence to support investigative outcomes; evidence reviews may include invoice documentation, entity interviews, background checks, pharmacy documentation, licensing information, proof of delivery and payment level information</div></li><li><div>
Evaluate reports of potential fraud in SIU and make recommendations on next steps; ensure investigative action aligns to department policy and practice; provide recommendations to audit operations and/or SIU regarding enhancements or required changes to process</div></li><li><div>
Adhere to evidentiary requirements in compliance with federal, state and local laws pertaining to investigations and fair claims handling practices; evaluate risk to determine how best to proceed with investigations based on the allegations, quality metrics and other performance indicators required per SIU procedures</div></li><li><div>
Recommend referrals to client SIUs, regulatory agencies, and/or law enforcement; recommend retention of experts or private investigators, surveillance or other expenditures to support investigations</div></li><li><div>
Other duties as assigned</div></li></ul><div></div><div>
Minimum Qualifications</div><ul><li><div>
Bachelor's degree in Criminal Justice, Healthcare or related area of study or the equivalent combination of education and relevant work experience; HS diploma or GED is required</div></li><li><div>
2 years of work experience in investigation, audit, healthcare or legal</div></li></ul><div></div><div>
Must be eligible to work in the United States without the need for work visa or residency sponsorship</div><div></div><div>
Additional Qualifications</div><ul><li><div>
Change agile with a willingness and ability to adjust direction based upon changing priorities and business need while working with a high degree of autonomy</div></li><li><div>
Ability to think critically, problem solve and use appropriate judgement to make decisions and provide risk advice to internal and external partners while anticipating the broad impact of decisions</div></li><li><div>
Ability to establish trust, respect and credibility and form effective working relationships with individuals at all levels of an organization; collaborate effectively cross-functionally and with clients, law enforcement and other key stakeholders</div></li><li><div>
Ability to distill complex concepts or situations into concise and compelling communications</div></li><li><div>
Knowledge and understanding of pharmacy and medical claims processing environment</div></li></ul><div></div><div>
Preferred Qualifications</div><ul><li><div>
Certified Fraud Examiner (CFE) or Accredited Health Care Fraud Investigator (AHFI)</div></li><li><div>
National Pharmacy Technician Certification through PTCB or ExCPT (CPhT)</div></li><li><div>
Licensed Practical Nurse (LPN) or Registered Nurse (RN)</div></li><li><div>
Experience working with RxClaims and/or JUDI</div></li><li><div>
Previous audit and investigation experience</div></li><li><div>
Pharmacy background within retail, mail order, hospital, or compounding setting</div></li><li><div>
Data mining experience</div></li><li><div>
Excel experience</div></li></ul></div></div></div><div></div><div>
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures</div><div></div><div>
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.</div><div></div>
Potential pay for this position ranges from $59,000.00 - $94,000.00 based on experience and skills.<div></div><div><i><br>
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to </i><i>race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.</i></div><div></div><div><i>
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.</i></div><div></div><div><i>
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.</i></div><div></div><div>
Positions will be posted for a minimum of five consecutive workdays.</div></div>

SIU Investigator - Remote

Allied Universal Compliance and Investigations

<div><p>Major Case Unit Investigator</p><h2 class="jobSectionHeader"><b>
Overview</b></h2><p>
Company Overview:
</p><p>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're ready to grow with the best, explore a career with us and make a difference.</p><h2 class="jobSectionHeader"><b>
Job Description</b></h2><p>
Allied Universal&reg; is hiring a <b>Major Case Unit Investigator.</b> This position is responsible for completing insurance fraud investigations and quality control of the final investigative product by providing a high level of technical expertise being delivered to our clients. The position requires the candidate to develop professional relationships with supported customers at the adjuster and management level.The perfect candidate for this role will have an in-depth understanding of suspect and non-suspect claims investigations and will be able to communicate effectively with claims staff.</p><p><br>
</p><p><b>hourly rate of pay $35 - $40 / hr</b></p><br>
<p></p><p><b>RESPONSIBILITIES:</b>
</p><ul><li>Use <b>specialized services</b> 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>Prioritize assignments, conduct necessary field interviews, and exercise independent judgment, initiative and decision making when developing and following investigative leads.</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 contract.</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>Coordinate with local, state, and federal law enforcement and prosecutors, Department of Insurances, NICB, and other carrier SIU's.</li></ul><p><b>
QUALIFICATIONS (MUST HAVE):</b>
</p><ul><li>Must possess one or more of the following (education):<ul><li>
Bachelor's degree OR</li>
<li>High School diploma or higher with a minimum of five (5) years of complex criminal investigative experience conducting fraud/economic related analysis</li></ul></li><li><ul><li><ul><li>
Criminal investigator</li>
<li>Detective</li>
<li>Special agent in a full-time capacity</li></ul></li></ul></li></ul><ul><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>Ability to type 40+ words per minute with minimum error</li></ul><p><b>
PREFERRED QUALIFICATIONS (NICE TO HAVE):</b>
</p><ul><li>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>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 Financial Crime Investigator (CFCI)</li></ul></li></ul><p><b>
BENEFITS:</b>
</p><ul><li>Medical, dental, vision, basic life, AD&amp;D, and disability insurance</li>
<li>Enrollment in our company's 401(k)plan, subject to eligibility requirements</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 for full time positions. Unused vacation is only paid out where required by law.</li></ul><h2 class="jobSectionHeader"><b>
Closing</b></h2><p>
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
</p><p>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.</p><p><br>
</p><h2 class="jobSectionHeader"><b>Requisition ID</b></h2><br>
2026-1536795</div>

Major Case Unit Investigator

CNO Financial Group, Inc.

<div><p><b>Salary Range</b> : $60,900 - $91,300 Annual</p>
<p><b>Job Details</b></p>
<p>The stated pay range is based on a national-average location. Actual salary is determined by factors including relevant work experience, skills and location. This position is bonus eligible. Candidates and associates may be asked to travel to corporate offices for interviews, training and/or meetings. Work cannot be performed from outside of the United States.</p>
<p>CNO Financial Group is hiring a Bilingual Investigator, Corporate Investigations and Support to investigate suspicious, unlawful, and/or fraudulent activity directed at policyholder and enterprise assets.</p>
<p>This is your opportunity to consult with business partners to provide training and guidance on suspicious insurance transactions. You&rsquo;ll be able to utilize your attention to detail and inquisitiveness to analyze information provided during investigations.</p>
<p><b>As a Bilingual Investigator, Corporate Investigations and Support, your responsibilities will include:</b></p>
<ul><li>Meet department and individual goals while adhering to all state and federal regulations, company ethics and integrity standards.</li>
<li>Reviews, assesses, and analyzes suspected fraudulent activity including insurance claims, underwriting, personnel, and other sensitive company-wide matters.</li>
<li>Plans, reviews, assesses, and prioritizes referrals to the CI&amp;S group.</li>
<li>Develops investigative action plans for moderately sized and/or moderately complex to complex cases. Also works with and supports other team members on complex / large scope cases as a secondary or additional investigator.</li>
<li>Investigates multiple types of cases, including internal fraud, employee misconduct, claims fraud, agent related fraud and moderately complex to complex cases with multiple insureds.</li>
<li>Assists Departments of Insurance and law enforcement agencies with investigations of fraud and agent misconduct on moderately sized and moderately complex cases.</li>
<li>Consults with business partners, Departments of Insurance, Law Enforcement, and other agencies to provide training and guidance, and investigates and reports fraud as required.</li>
<li>May coordinate with field representatives and outside agencies as needed.</li>
<li>Writes investigative reports and communicates risks and trends from fraudulent activities.</li>
<li>Documents investigation details in the CI&amp;S Case Management system.</li>
<li>Empowered to make decisions that supplement the case review.</li>
<li>Make outbound calls and conduct interviews with impacted parties during the case review.</li>
</ul><p><b>The Bilingual Investigator, Corporate Investigations and Support position is well-suited for someone with:</b></p>
<ul><li>Good knowledge and understanding of insurance investigations, criminal justice, and/or law enforcement principles and practices.</li>
<li>Analyze, interpret, and evaluate relevant information to resolve a variety of suspicious, sensitive, and moderately complex to complex investigations.</li>
<li>Compares alternative courses of action and develops/recommends tactical plans to execute a strategy.</li>
<li>Influences others and maintains productive working relationships with internal and external partners.</li>
<li>Persuasively communicate in one-on-one, small group, and large group settings.</li>
<li>Uses sounds judgement and prior experiences to make sounds decisions when investigating complex issues with multiple stakeholders.</li>
<li>Must be honest and ethical and exert a high level of integrity and confidentiality.</li>
<li>Customer focused; willingness to communicate with customers (internal and external).</li>
<li>Highly organized and able to handle multiple priorities simultaneously.</li>
<li>Efficient in navigating CNO systems for research and analysis.</li>
</ul><p><b>What you&rsquo;ll need:</b></p>
<ul><li>Bachelor's degree or equivalent experience.</li>
<li>2-5 years of industry experience with securities, life and/or health insurance.</li>
<li>Good knowledge of Microsoft Office suite.</li>
<li>Ability to make recommendations, decisions, and identify when escalation is needed.</li>
</ul><p><b>What will set you apart:</b></p>
<ul><li>Fluent in both English &amp; Spanish</li>
<li>Candidate location in Central or Eastern US time zone is preferred OR willingness to work Central or Eastern time zone business hours</li>
<li>CFE, CPA, CIFI or AHFI</li>
<li>Related Work Experience: 5+ years of industry experience with securities, life and/or health insurance</li>
</ul><p>The Company offers the following benefits for this position, subject to applicable eligibility requirements:</p>
<ul><li>medical insurance</li>
<li>dental insurance</li>
<li>vision insurance</li>
<li>401(k) retirement plan with company match</li>
<li>short-term &amp; long-term disability insurance</li>
<li>Paid time-off and corporate holidays,</li>
<li>paid parental leave</li>
<li>company paid life insurance</li></ul><br>
<p></p>
<p>CNO embraces flexibility and encourages you to work where you&rsquo;re most productive. Associates who live within a 60-mile radius of a corporate office (Carmel, Chicago, and Orlando) have access to come into that office.</p>
<p>Associates who live outside of a 60-mile radius of a corporate office (Carmel, Chicago, or Orlando) may perform this role full-time work from home (WFH) from any US based location, as long as you are willing to work central or eastern time zone hours.</p>
<p>All associates may be asked to travel to varying corporate offices periodically. Work cannot be performed from outside of the United States.</p>
<p>CNO provides life and health insurance, annuities, financial services, and workforce benefits solutions through our family of brands and supported by our associates and agents. Our customers work hard to save for the future, and we help protect their health, income and retirement needs with 3.2 million policies and more than $35 billion in total assets. Our 3,400 associates, 8,600 exclusive agents and independent partner agents guide individuals, families and businesses through a lifetime of financial decisions.</p>
<p>We are financially strong and well positioned for continued growth, and we are grounded in our core values of People Focused, Integrity, Customer Driven, and Excellence. We have offices in more than 260 communities in the U.S., including our headquarters in Carmel, Indiana, and corporate offices in , Chicago, Orlando and Milwaukee.</p>
<p>At CNO Financial Group, we&rsquo;re always looking forward&mdash;to the security and stability we help create for our insurance brands&rsquo; customers, and the growth we create within our own company. We're looking for ambitious people who want to do more. We'll provide you with opportunities to grow your skills through challenging professional experiences.</p>
<p>If you're looking for a culture that encourages development, helps you reach your potential, and rewards you for your contribution, then CNO Financial Group is right for you. For more information, visit CNOinc.com.</p>
<p>We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, sex, gender, gender expression, sexual orientation, age, marital status, veteran status, or disability status. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.</p>
<p><b>Compensation</b></p>
<p>Pay Range: $60,900.00 - $91,300.00 Annual</p>
<p>We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, sex, gender, gender expression, sexual orientation, age, marital status, veteran status, or disability status. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.</p>
<p><b>ReqID</b> : JR170084</p>
<p><b>Job Type</b> : Full time</p>
<p><b>Additional Locations</b> : Pasadena, CA; Houston, TX; Riverside, CA; Fresno, CA; Modesto, CA; Miami, FL; Dallas, TX;</p></div><p></p>

Bilingual Investigator, Corporate Investigations & Support

Search 1328+ Fraud investigator jobs near you this March. New roles added regularly across leading industries. Apply today.

1328 fraud investigator jobs Near Me

Sr. Fraud Investigator

Healthcare Fraud Investigator

Healthcare Fraud Investigator

SENIOR INSURANCE FRAUD INVESTIGATOR

SIU Investigator - Remote

Major Case Unit Investigator

Bilingual Investigator, Corporate Investigations & Support