healthcare fraud investigator

Devoted Health

<div></div><div><div>Job Description</div><div><i>
A bit about this role:</i></div><div></div><div>
Are you a highly analytical and experienced investigator with a passion for uncovering the truth and protecting vital healthcare resources? Our Special Investigations Unit (SIU) is looking for a skilled Investigator to join our dedicated team. In this crucial role, you'll be at the forefront of preventing, detecting, and responding to healthcare fraud, waste, and abuse (FWA), safeguarding our members and the integrity of the Medicare Fund. If you're driven by meticulous investigation, data-driven insights, and a commitment to justice, we encourage you to apply.</div><div></div><div><i>
Responsibilities and Impact will include:</i></div><div><br>
As an SIU Investigator, you'll be responsible for the full lifecycle of complex FWA investigations, acting as a subject matter expert and collaborating with various stakeholders. Your key responsibilities will include:</div><ul><li><div>
Lead Complex Investigations: Plan, organize, and execute specialized investigations into allegations of healthcare fraud, waste, and abuse. This includes handling intricate cases requiring advanced investigative knowledge and skills.</div></li><li><div>
Data-Driven Detection: Utilize advanced data mining and analysis techniques to identify aberrancies and outliers in claims, medical records, enrollment, and other healthcare transactions. You'll independently research FWA issues and employ cutting-edge investigative resources.</div></li><li><div>
Expert Guidance: Serve as a subject matter expert for other SIU Investigators, providing specialized knowledge and guidance to elevate team capabilities.</div></li><li><div>
Policy &amp; Strategy Development: Contribute to the development of robust policies and procedures related to FWA detection and investigation, as well as the annual SIU risk assessment and work plan.</div></li><li><div>
Thorough Documentation &amp; Reporting: Conduct comprehensive FWA investigations, ensuring complete and accurate case documentation and detailed investigative reports that adhere to SIU policies and standards.</div></li><li><div>
External Referrals &amp; Collaboration: Prepare comprehensive summary and detailed reports on investigative findings for referral to federal and state agencies, ensuring full compliance with regulatory requirements. You'll also actively participate in OIG Healthcare Fraud Workgroups.</div></li><li><div>
Stakeholder Engagement: Collaborate closely with internal stakeholders (e.g., FWA Monthly Workgroup, Market/Network, Credentialing Committee) to share updates on FWA schemes, coordinate recommendations, and facilitate fund recovery or other necessary actions.</div></li><li><div>
Provider Education: Conduct impactful provider education sessions as a direct response to investigation findings and audits.</div></li><li><div>
Liaison &amp; Point of Contact: Serve as a key point of contact for corporate and field inquiries regarding FWA, and participate in meetings with providers, business partners, regulatory agencies, and law enforcement.</div></li><li><div>
Training &amp; Development: Assist in developing and presenting engaging FWA training programs for internal and external audiences.</div></li></ul><div></div><div><i>
Required skills and experience:</i></div><ul><li><div>
Education: A Bachelor&rsquo;s Degree in Business, Criminal Justice, Healthcare, or a related field, or equivalent relevant work experience.</div></li><li><div>
Experience:</div></li></ul><ul><li><div>
Minimum of 3 years of dedicated experience in health insurance fraud investigation.</div></li><li><div>
Minimum of 5+ years experience as a detective or investigator for a law enforcement agency.</div></li><li><div>
Proven experience within Medicare and/or Medicaid programs, specifically with medical claim billing, reimbursement, audit, or provider contracting.</div></li><li><div>
Demonstrated experience with data analysis techniques.</div></li><li><div>
Experience with the Healthcare Fraud Shield platform is a significant plus.</div></li></ul><ul><li><div>
Exceptional Analytical Skills: Ability to interpret and dissect complex data sets, identifying patterns and anomalies indicative of FWA. Must have demonstrated experience with AI tools.</div></li><li><div>
Outstanding Communication: Excellent written and verbal communication skills are essential for clear report writing, compelling presentations, and effective stakeholder engagement.</div></li><li><div>
Integrity &amp; Detail-Oriented: A strong commitment to integrity and compliance, coupled with meticulous attention to detail in all aspects of investigations.</div></li><li><div>
Independent &amp; Collaborative: Proven ability to work independently, manage a diverse caseload of investigations, and thrive in a fast-paced environment, while also excelling in collaborative team settings.</div></li><li><div>
Strong Organizational Skills: Highly organized with the ability to manage multiple complex investigations simultaneously and effectively prioritize tasks.</div></li></ul><div></div><div><i>
Desired skills and experience:</i></div><ul><li><div>
Certified Fraud Examiner (CFE)</div></li><li><div>
Certified Professional Coder (CPC)</div></li></ul><div></div><div><br>
#LI-DS1<br>
#LI-Remote<br>
<br>
Salary range: $55,000 - $100,000 /year</div><div></div><div>
The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.</div><div></div><div>
Our Total Rewards package includes:</div><ul><li><div>
Employer sponsored health, dental and vision plan with low or no premium</div></li><li><div>
Generous paid time off</div></li><li><div>
$100 monthly mobile or internet stipend</div></li><li><div>
Stock options for all employees</div></li><li><div>
Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles</div></li><li><div>
Parental leave program</div></li><li><div>
401K program</div></li><li><div>
And more....</div></li></ul><div></div><ul><li><i>Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.</i></li></ul><div></div><div>
Healthcare equality is at the center of Devoted&rsquo;s mission to treat our members like family. We are committed to a diverse and vibrant workforce.</div><div></div><div>
At Devoted Health, we&rsquo;re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That&rsquo;s why we&rsquo;re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company &mdash; one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!</div><div></div><div>
Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted&rsquo;s Code of Conduct, our company values and the way we do business.</div><div></div><div>
As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.</div></div>
<br><p></p><div><div><div><div><div><div>We have been made aware of instances of fraudulent job postings and/or fraudulent recruiting activity by individuals purporting to represent Devoted Health. These fraudulent schemes often seek monetary contributions or payments from job seekers (such as for &ldquo;start up costs&rdquo; or &ldquo;equipment&rdquo;), or seek to collect sensitive personal information. These job postings and offers are NOT authorized by Devoted Health and Devoted is not responsible for fraudulent offers, personal information that you may have disclosed, or payments made to third parties purporting to represent Devoted. We have reported this matter and are cooperating with law enforcement agencies. Devoted Health will never ask for financial commitment or contribution from a candidate at any stage of the recruitment process.</div></div></div></div></div></div><div></div>

SIU Investigator

PrimeWest Health

<p>Ready to be the ultimate fraud fighter? If you have a nose for the truth and a passion for protecting healthcare resources, PrimeWest Health needs your investigative expertise!<br/>As our SIU Investigator, you aren't just filing reports&mdash;you&rsquo;re the front line against fraud, waste, and abuse. You&rsquo;ll dive deep into Medicare and Medicaid business lines, turning raw data and initial allegations into rock-solid cases. From the first spark of suspicion to the final referral to law enforcement, you own the investigation.<br/>Why this role kicks it up a notch:<br/>The Lead Detective: You are the organization&rsquo;s primary resource for all things investigative.<br/>Total Case Ownership: You&rsquo;ll identify, develop, and resolve cases, managing everything from high-stakes evidence collection to complex data analysis.<br/>Collaborative Impact: You&rsquo;ll work side-by-side with internal teams, county partners, and external agencies to stop noncompliance in its tracks.<br/>Strategic Influence: Support the Corporate Compliance/HIPAA Privacy Officer by providing the subject matter expertise needed to keep our program integrity ironclad.<br/></p><p>Education &amp; Experience: Bachelor&rsquo;s degree in Business or a related field (preferred); equivalent experience in healthcare compliance, fraud investigation, auditing, or medical coding is also accepted.<br/></p><p>Experience: Proven background in healthcare investigations, medical record auditing, provider profiling, or program integrity&mdash;ideally within a health plan or regulatory agency.<br/>Technical Knowledge: Proficiency with CPT, HCPCS, and ICD-10 code sets.<br/>Tech Savvy: Strong Microsoft Office skills required; experience with claims processing or data systems is a major plus.<br/></p><p>Core Competencies<br/></p><p>Investigative Skills: Ability to independently research complex issues, analyze data, and manage multiple investigations simultaneously.<br/>Analytical Thinking: Strong problem-solving, negotiation, and conflict-resolution skills.<br/>Compliance Expertise: Ability to interpret and implement healthcare compliance guidelines and regulatory requirements.<br/>Communication: Excellent verbal and written skills to present complex findings clearly to diverse audiences.<br/>Professional Standards<br/>Attention to Detail: Exceptional organizational skills and a commitment to maintaining strict confidentiality.<br/>Judgment: Proven ability to exercise sound, independent judgment in sensitive situations.<br/>Work Ethic: Adaptable to evolving tasks, willing to learn new skills, and committed to meeting deadlines.<br/>Physical &amp; Travel Requirements<br/>Ability to work at a computer for extended periods, occasionally lift up to 20 lbs, and travel as needed.<br/></p><p>Why You&rsquo;ll Love Working Here:<br/></p><p>Comprehensive Benefits &ndash; Medical, dental, and vision coverage.<br/>Generous Paid Time Off &ndash; Vacation, sick, holidays, and personal days.<br/>Pension-Public Employee Retirement Association (PERA)<br/>Professional Growth &ndash; On-the-job training and development opportunities.<br/>Work-Life Balance &ndash; Regular business hours and a positive team culture.<br/>Onsite Fitness Center<br/></p><p>If you&rsquo;re a subject matter expert who loves solving puzzles and ensuring corrective actions stick, it&rsquo;s time to bring your skills to a team that values integrity as much as you do.<br/></p><p>Ready to protect the integrity of PrimeWest Health? Apply today!<br/></p>

Office of the Minnesota Attorney General

JOB
<br><b>Who May Apply:</b> Open to all qualified applicantsDate Posted: 3/16/2026Closing Date: 3/30/2026LA5 Salary Range: $27.30 - $40.71 / hourly; $57,002 - $85,002 / annuallyLA6 Salary Range: $30.65 - $45.50 / hourly; $63,997 - $95,004 / annuallyLA7 Salary Range: $35.92 - $57.95 / hourly; $75,000 - $120,999 / annually Job SummaryThe Office of Attorney General Keith Ellison has a clear mission: we help Minnesotans afford their lives and live with dignity, safety, and respect. We are a dynamic group of dedicated professionals who choose public service as a calling, and we are actively and intentionally committed to supporting an internal culture that affirms that calling. The Office is one of Minnesota’s largest public law offices and as of 2025, has been recognized as a Star Tribune Top Workplace Minnesota for five years in a row and Top Workplace USA for four years in a row. The Office’s Medicaid Fraud Division is currently seeking an Investigator with the skills and drive to uncover, investigate, and stop fraudulent claims made to taxpayer-funded public health insurance programs. This Investigator makes a difference in the lives of vulnerable people and contributes to the economic well-being of Minnesotans and our state. Investigators conduct criminal investigations into health care providers suspected of defrauding the Minnesota Medicaid program. The investigator reviews complaints against public health care providers; evaluates and analyzes claims data, medical records, and financial records; conducts research and surveillance; interviews victims, witnesses, and targets of investigations; participates in the execution of search warrants; drafts reports summarizing investigative findings; and works with attorneys to prepare cases for prosecution. Investigators are required to testify about their findings at criminal jury trials. This position is eligible for a hybrid work environment (combination of in-office work and telework). Minimum QualificationsBachelor’s degree in criminal justice, accounting, healthcare administration, or a related field OR 4 years of demonstrable similar experienceAbility to perform assigned job responsibilities with a high level of professionalismProven ability to show excellent judgement, character, and work ethicIntermediate or advanced proficiency in Microsoft OfficeFamiliarity with legal procedures, rules of evidence, and/or investigative proceduresDemonstrated skill in: Research and writingCritical thinkingCommunication To be considered at the Legal Assistant 6 level (LA6), candidates must have at least 5 years of directly related experience. To be considered at the Legal Assistant 7 level (LA7), candidates must have at least 10 years of directly related experience. Preferred QualificationsFluency in Spanish, Hmong, Somali, or other relevant language for MinnesotaEducation or experience in one of the following fields: Accounting or finance; economics or statistics; criminal justice, law enforcement, or investigations; healthcare or nursing How to ApplyInterested applicants must apply online through the State of Minnesota Careers website, which is the State’s official application and hiring site. The deadline for applications is Monday, March 30, 2026.Go to www.mn.gov/careers;Apply for posting number 92851Direct Link If you have any questions about the application process, please contact Theresa Pinger at theresa.pinger@ag.state.mn.us or (651) 300-7162. Why Work For Us Working together to improve the state we love. What do Minnesota's State employees have in common? A sense of purpose in their workConnection with their coworkers and communitiesOpportunities for personal and professional growthBenefits As an employee, you'll have access to one of the most affordable health insurance plans in Minnesota, along with other benefits to help you and your family be well.Your benefits may include: Paid vacation and sick leave 12 paid holidays each year Low-cost medical, dental, vision, and prescription drug plans Fertility care, including IVFDiabetes careDental and orthodontic care for adults and children 6 weeks paid leave for parents of newborn or newly adopted childrenPension plan that provides income when you retire (after working at least three years)Employer paid life insurance to provide support for your family in the event of deathShort-term and long-term disability insurance that can provide income if you are unable to work due to illness or injuryTax-free expense accounts for health, dental, and dependent care Resources that provide support and promote physical, emotional, social, and financial well-beingSupport to help you reach your career goals: Training, classes, and professional developmentFederal Public Service Loan Forgiveness Program (Some positions may qualify; for more information, visit the Federal Student Aid website at studentaid.gov)Employee Assistance Program (EAP) for work/life support: A voluntary confidential program that helps employees and their families with life challenges that may impact overall health, personal well-being, or job performanceCommon sources of stress can be addressed through the EAP: mental health, relationship challenges (personal and work), grief and loss, finances, and legal issuesDaily Living/Convenience Services: Chore services, home repair, trip planning, child/elder carePrograms, resources and benefits eligibility varies based on type of employment, agency, funding availability, union/collective bargaining agreement, location, and length of service with the State of Minnesota.An Equal Opportunity EmployerMinnesota state agencies are equal opportunity, affirmative action, and veteran-friendly employers. State agencies are committed to creating a workforce that reflects the diversity of the state and strongly encourages persons of color and Indigenous communities, members of the LGBTQIA2S+ community, individuals with disabilities, women, and veterans to apply. The varied experiences and perspectives of employees strengthen the work we do together and our ability to best serve Minnesotans. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, national origin, sex (including pregnancy, childbirth, and disabilities related to pregnancy or childbirth), gender identity, gender expression, marital status, familial status, age, sexual orientation, status regarding public assistance, disability, veteran status or activity in a local Human Rights Commission or any other characteristic protected by law. Minnesota state agencies make reasonable accommodations to their employees and applicants with disabilities. If you have a disability and need assistance in searching or applying for jobs with the State of Minnesota, call the Careers Help Desk at (651) 259-3637 or email careers@state.mn.us and let us know the support you need.

Investigator – Medicaid Fraud Division

Centene

<div><p>You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you&rsquo;ll have access to competitive benefits including a fresh perspective on workplace flexibility.<br>
</p><p><b>Please note: candidate must reside within state of Kentucky</b></p><p><b>
Position Purpose: </b>Position acts as a subject matter expert in the field of Compliance and/or Special Investigations Unit (SIU) investigations. Provides direction and guidance to staff who investigate and remediate compliance and fraud, waste, and abuse related matters; while maintaining an investigative workload of moderate to high complexity. Assists manager on monitoring team caseload and report on metrics.</p><ul><li>
Provides guidance to team members who investigate and remediate compliance and fraud, waste, and abuse related matters</li><li>
Assists manager on monitoring team caseload and report on metrics</li><li>
Identifies training needs and develop training aids and step actions</li><li>
Provides training and mentoring to team on casework and other SIU activities</li><li>
Evaluates and assesses allegations to determine those criteria, including federal and state regulations, Centers for Medicare &amp; Medicaid Services (&ldquo;CMS&rdquo;) guidelines, and internal policies, procedures, and standards that are alleged to have been violated</li><li>
Conducts and documents interviews investigatory purposes</li><li>
Reviews investigative interviews prepared by junior investigators</li><li>
Manages caseloads of moderate to high complexity, develops investigative plans for multiple investigations, prioritizing and managing through execution</li><li>
Thoroughly documents actions, organizes, and reviews case files</li><li>
Consults with management, in-house counsel, and/or senior leadership to resolve difficult or complex issues</li><li>
Identifies risks and recommends and communicates remedial actions to mitigate future potential risks</li><li>
Performs follow up to ensure remedial and disciplinary measures are implemented appropriately and timely</li><li>
Prepares clear and concise investigative plans and reports</li><li>
Provides support and guidance to junior investigative staff</li><li>
Identifies trends and aberrant activity to generate proactive leads for investigations and analyzes data to detect potentially fraudulent activity</li><li>
Attends, actively participates in, and/or leads meetings with various business area managers</li><li>
Communicates directly with Federal or State regulators</li><li>
Prepares cases for referral to management, government agencies, and law enforcement</li><li>
Develops and maintains strong working relationships with associates and regulators</li><li>
Testifies in criminal and civil matters</li><li>
Supports the development and maintenance of Corporate Compliance policies and procedures and workflows</li><li>
Participates in and lead special projects as needed</li><li>
Perform other duties as assigned</li><li>
Complies with all policies and standards</li></ul><p><b>
Education/Experience:</b></p><ul><li>
Bachelor's Degree in related field; or Associate's degree with 6 years related experience; or High School Diploma/GED with 7 years related experience required</li><li>
Master's Degree preferred</li><li>
5+ years Healthcare fraud-related investigations with audit and risk analysis. required</li><li>
1+ years Managed care or working with health insurance company required</li><li>
In-depth knowledge of government programs, the managed care industry, Medicare, Medicate laws and requirements, federal, state, civil and criminal statutes required</li><li>
Reading, analyzing and interpreting State and Federal laws, rules and regulations. Knowledge of community, state and federal laws and resources required</li><li>
Knowledge and understanding of managed care claims processing systems and medical claims coding preferred preferred</li></ul><p><b><br>
Licenses/Certifications:</b><br>
Accredited Health Care Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), Certified Pharmacy Technician, or other industry related certification preferred</p>
Pay Range: $70,100.00 - $126,200.00 per year<p>
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.</p><p>
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.</p><p><br>
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act</p></div>

Lead SIU Investigator

<div><p>You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you&rsquo;ll have access to competitive benefits including a fresh perspective on workplace flexibility.<br>
</p><p><b>Position Purpose: </b>Investigate allegations of potential healthcare fraud and abuse activity as part of our pharmacy investigations team. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse.</p><ul><li>
Conduct investigations of potential waste, abuse, and fraud</li><li>
Document activity on each case and refer issues to the appropriate party</li><li>
Perform data mining and analysis to detect aberrancies and outliers in claims</li><li>
Develop new queries and reports to detect potential waste, abuse, and fraud</li><li>
Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions</li><li>
Assist with complex allegations of healthcare fraud</li><li>
Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies</li><li>
Complete various special projects and audits</li><li>
Performs other duties as assigned.</li><li>
Complies with all policies and standards.</li></ul><p><b>
Education/Experience:</b></p><ul><li>
Bachelor's Degree Business, Criminal Justice, Healthcare, or related field, or equivalent experience required</li><li>
1+ years Medical/pharmacy claim investigation, medical/pharmacy claim audit, medical/pharmacy claim analysis, or fraud investigation required</li></ul>
Pay Range: $56,200.00 - $101,000.00 per year<p>
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.</p><p>
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.</p><p><br>
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act</p></div>

NYC Human Resources Administration

<p></p><div><div><div><div><div><div><h1 class="jobSectionHeader"><b>SENIOR INVESTIGATOR
</b></h1></div><div><div><div><div><ul><li>HRA/DEPT OF SOCIAL SERVICES
</li></ul></div></div><div><div>Posted On: 03/19/2026
</div></div><div><div><ul><li>Full-Time
</li></ul></div></div><div><div><div>Location
</div><div>MANHATTAN</div>
</div></div></div><div><div><div><ul><li>Exam May Be Required
</li></ul></div></div><div><div><div><div>Department
</div><div>Office Of Investigation-NM</div>
</div></div></div><p></p><div><div><div>Salary Range:</div>
<div>$59,359.00 &ndash; $68,263.00</div>
</div></div></div></div><div><div><p><b>Save</b></p>
</div></div></div></div></div></div><div><div><div><h2 class="jobSectionHeader"><b>Job Description</b></h2></div>
<div><div><div>APPLICANTS MUST BE PERMANENT IN THE FRAUD INVESTIGATOR CIVIL SERVICE TITLE
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The DSS Accountability Office (DSS-AO) is responsible for protecting the integrity of social services programs administered by the New York City Department of Social Services (DSS) and ensuring that DSS complies with all statutory, regulatory, and contractual standards.<br>
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Within AO, exists the Bureau of Fraud Investigations (BFI). They are mandated to conduct investigations of individuals and organized groups allegedly attempting or committing fraudulent acts against the social service programs administered by HRA/DSS. BFI has many sub-units. One is such units is the Investigation Division.<br>
<br>
The Investigation Division (ID) oversees and investigates several mandated NYS projects such as the Massachusetts Border Match, 1099 Match and the Bank Match, along with other internally generated projects. In addition, the division plays an active role in the timely investigation and resolution of BFI&rsquo;s quarterly PARIS Match and assists with the field visits for the Prison Match. ID continues to have an ongoing investigative partnership with the Office of Welfare Inspector General (OWIG) and New York City Housing Authority Inspector General (NYCHA IG).
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<br>
BFI is recruiting for one (1) Fraud Investigator II to function as a Senior Investigator, who will:
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<ul><li>Conduct complex investigations into allegations of fraud, waste, and/or abuse of social services benefits administered by HRA and the City of New York. Cases are received from unit supervisors and are generated from data mining, anonymous sources, and other match reports.</li></ul><br>
<ul><li>Perform fieldwork activity including interviews with clients, witnesses, and participants who are under investigation to verify documents and records and gather evidence to build solid cases against persons committing fraud. Conduct collateral interviews with employers, landlords, and other witnesses to secure information. Interact with other law enforcement agencies at Federal, State, and local levels as part of the investigative process.</li></ul><br>
<ul><li>Access numerous resources, such as the Welfare Management System (WMS), LexisNexis, HRA Viewer, ACRIS, ACCIS, and Data Warehouse to conduct research and obtain vital information relevant to the investigation.</li></ul><br>
<ul><li>Write detailed case notes and annotated reports summarizing chronological events and developments. Resolve allegations of fraud by making eligibility determinations or recommendations for continued assistance, case closings, or reduced assistance.</li></ul><br>
<ul><li>Perform extensive fieldwork activity including interviews, undercover operations, surveillance and interrogations.</li></ul><br>
<ul><li>Meet with Supervisor to discuss activities, concerns, and findings in investigations.</li></ul><br>
<ul><li>Liaise between HRA, AO/IREA, and local law enforcements. Represent and testify on behalf of HRA in court and at Fair Hearings.</li></ul><br>
<ul><li>Assist in the training of new investigative staff. May provide coverage for Supervisor on a rotating basis.</li></ul><br>
<ul><li>Perform other duties as needed.<br>
</li></ul><br>
<br>
Hours/Schedule: 9-5 Monday - Friday<br>
<br>
FRAUD INVESTIGATOR - 31113</div><p><b><br>
Minimum Qualifications</b></p><p><br>
1. A four-year high school diploma or its educational equivalent and three years of satisfactory, full-time experience, acquired within the United States in one or a combination of the following:
<br>
a . performing investigations involving criminal and/or fraudulent activities; or
<br>
b. evaluating credit histories; or
<br>
c. searching for assets; and/or
<br>
d. researching, compiling and/or locating evidence or information in order to build a case or uncover activities of a criminal, corrupt, unlawful or unethical nature involving public or private funds; or
<br>
2. An associate degree or 60 semester credits from an accredited college or university, including or supplemented by 12 semester credits from an accredited college or university in criminal justice, forensic auditing, forensic science, police science, criminology, criminal justice administration and planning, and/or law or a related field and one year of satisfactory, full-time experience as an investigator as described in &ldquo;1&rdquo; above; or
<br>
3. A baccalaureate degree from an accredited college or university; or
<br>
4. Education and/or experience equivalent to &ldquo;1&rdquo;, &ldquo;2&rdquo; or &ldquo;3&rdquo; above. Undergraduate college credit can be substituted for experience on the basis of 10 semester credits from an accredited college or university, for three months of full-time experience. However, all candidates must have at least a four-year high school diploma or its educational equivalent.
<br>
<br>
Clerical experience in an organization which investigates criminal or fraudulent activities is not acceptable.</p><p><b><br>
55a Program</b></p><br>
This position is also open to qualified persons with a disability who are eligible for the 55-a Program. Please indicate at the top of your resume and cover letter that you would like to be considered for the position through the 55-a Program.<br>
<p><b>
Public Service Loan Forgiveness</b></p><br>
As a prospective employee of the City of New York, you may be eligible for federal loan forgiveness programs and state repayment assistance programs. For more information, please visit the U.S. Department of Education&rsquo;s website at https://studentaid.gov/pslf/.<br>
<p><b>
Residency Requirement</b></p><br>
New York City residency is generally required within 90 days of appointment. However, City Employees in certain titles who have worked for the City for 2 continuous years may also be eligible to reside in Nassau, Suffolk, Putnam, Westchester, Rockland, or Orange County. To determine if the residency requirement applies to you, please discuss with the agency representative at the time of interview.<br>
<p><b>
Additional Information</b></p><div></div><p><br>
The City of New York is an inclusive equal opportunity employer committed to recruiting and retaining a diverse workforce and providing a work environment that is free from discrimination and harassment based upon any legally protected status or protected characteristic, including but not limited to an individual's sex, race, color, ethnicity, national origin, age, religion, disability, sexual orientation, veteran status, gender identity, or pregnancy.</p></div>
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</b></p><p><b>Save</b></p>
</div></div></div></div><div><div><div><div><div><div><div>Job ID
</div><div>774503</div>
</div></div><div><div><div><div>Posted until
</div><div>05/17/2026</div>
</div></div></div><div><div><div><div>Title code
</div><div>31113</div>
</div></div></div><div><div><div><div>Civil service title
</div><div>FRAUD INVESTIGATOR</div>
</div></div></div><div><div><div><div>Title classification
</div><div>Competitive-1</div>
</div></div></div><div><div><div><div>Business title
</div><div>SENIOR INVESTIGATOR</div>
</div></div></div></div><div><div><div><ul><li><div>Experience Level: </div>Experienced (Non-Manager)
</li></ul></div></div><div><div><div><div>Job level
</div><div>02</div>
</div></div></div><div><div><div><div>Number of positions
</div><div>1</div>
</div></div></div><div><div><div><div>Work location
</div><div>375 Pearl Street</div>
</div></div></div><div><div><ul><li><div>Category: </div>Social Services
</li></ul></div></div></div></div></div></div><div><div><div><div><div>SENIOR INVESTIGATOR</div></div></div></div></div></div><p></p>

SENIOR INVESTIGATOR

Allied Universal Compliance and Investigations

<div><p>SIU / Surveillance 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 SIU / Surveillance Investigator. SIU / Surveillance Specialists investigate claims with red flags that suggest fraudulent behavior In relation to an Insurance claim. The SIU / Surveillance 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.</p><p><br>
</p><ul><li><b>Must possess a valid driver's license with at least one year of driving experience</b></li><li><b>
Candidate must reside in state listed in job posting</b></li><li><b>
Pay Rate: $30 - $36 / hr</b></li></ul><br>
<p></p>
<p><b>RESPONSIBILITIES:</b>
</p><ul><li>Independently investigate suspected fraudulent insurance claims for a variety of coverage to include workers' 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><p><b>
QUALIFICATIONS (MUST HAVE):</b>
</p><ul><li>Must possess one or more of the following:</li><li><ul><li>
Bachelor'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><p><b>
PREFERRED QUALIFICATIONS (NICE TO HAVE):</b>
</p><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><p><b>
BENEFITS:</b>
</p><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"><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><h2 class="jobSectionHeader"><b>
Requisition ID</b></h2><br>
2026-1553408</div>

SIU / Surveillance Investigator

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