insurance fraud investigator

Allied Universal Compliance and Investigations

<div><p>SIU Investigator - Tampa Bay Area</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 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.</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>
Florida applicants must either hold a C Private Investigators' License or independently complete the 40-hour course necessary to successfully apply for a CC Private Investigator's license (apprenticeship) before applying</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>
2026-1579822</div>

SIU Investigator - Tampa Bay Area

Marshall Investigative Group

<p></p><div><div><p>Marshall Investigative Group (MIG), the industry's leading investigative firm, seeks self-motivated individuals with experience in surveillance and mobile investigations to assist in researching insurance fraud claims involving monetary, bodily injury, theft, and property damage claims.</p><p></p><p><br>
We are currently hiring <b>Surveillance</b> <b>Agents </b>to conduct stationary/mobile surveillance across the country. Over the years, our current team of by-the-book agents have conducted thousands of successful insurance investigations. Innumerable hours of obtained video, capturing claimant activities from day-to-day errands, to construction, to sky diving, have been provided to our clients &ndash; saving millions of dollars on fraudulent claims.</p><p></p><p><br>
This is an excellent way for an individual to grow their experience in the surveillance and security fields. With over 15 years of experience, our highly trained investigators have conducted thousands of successful insurance claim investigations by obtaining innumerable hours of claim-disputing documentation, saving our clients millions of dollars on fraudulent claims.</p><p></p><p><b><br>
Qualifications</b></p><ul><li>
Must have a current, valid Driver's License</li><li>
Current Private Investigator (PI) License and mobile surveillance experience strongly preferred<ul><li>
Experience working at a licensed PI firm may be accepted instead of holding a Private Investigator License</li></ul></li><li><b>
Must have or be able to obtain Auto Insurance with 100/300/100 coverage limits before employment</b><ul><li>
$100k Maximum Bodily Injury per Person</li><li>
$300k Maximum Bodily Injury per Accident</li><li>
$100k Maximum Property Damage per Accident</li></ul></li><li>
Personal Computer with MS Word Required</li><li>
Personal Digital Surveillance Camera Required</li><li>
Proficiency in utilizing surveillance equipment, technology, and platforms</li><li>
A High School Diploma or equivalent is required</li><li>
Associate's or Bachelor's Degree in Criminal Justice, Security Management, or related field preferred</li><li>
Previous experience in mobile surveillance is highly desirable</li><li>
Traveling is required for Full-Time Employees</li><li>
Ability to work independently with minimal supervision</li><li>
Observing and conducting surveillance 8-10 hours per day</li><li>
Weekend work is required as needed for surveillance subjects</li><li>
Keen observational skillset with attention to detail, focusing on individuals for long periods of time</li><li>
Strong verbal and written communication skills with the ability to articulate findings and observations clearly and effectively</li><li>
Demonstrated integrity, professionalism, and discretion in handling confidential information and sensitive situations</li></ul><p></p><p><b><br>
General Duties</b></p><ul><li>
Follow established protocols and procedures for conducting surveillance operations in compliance with all legal and regulatory requirements</li><li>
Maintain a vigilant and discreet presence, avoiding detection, while observing subjects and their daily actions</li><li>
Document and report findings, incidents, and observations accurately and promptly</li><li>
Conduct mobile surveillance operations utilizing various monitoring equipment, including cameras and specialized devices</li><li>
Operate surveillance equipment and technology proficiently, troubleshooting technical issues as needed</li><li>
Maintain confidentiality and discretion regarding sensitive information obtained during the preparation for and during surveillance operations</li><li>
Prepare, review, and submit detailed reports of findings, incidents, and investigations within 48 hours</li><li>
Reports must be concise, grammatically correct, easy to follow, and include all supporting documentation within 48 hours of surveillance completion</li><li>
Participate in training programs and professional development activities to enhance surveillance skills and stay updated on industry best practices</li><li>
Perform other duties as assigned by management and support the organization's overall security and safety objectives</li></ul><p></p><p><br>
At the Marshall Investigative Group (MIG), our hourly rates, flexible day scheduling benefits, and expense/mileage reimbursements exceed the industry. All expenses are covered, including training, licensing, and testing fees. Comprehensive benefits are available for Full-Time agents. This position may require travel within your investigative region to accommodate full-time hours and client needs.</p><p></p><p><i><br>
Marshall Investigative Group is an equal opportunity employer that values diversity within our company culture. We do not discriminate based on race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.</i></p></div></div><p></p>

Surveillance Agent

Plymouth Rock Assurance

<p></p><div><p>We are seeking a highly skilled and motivated candidate with specialized experience in <b>NJ provider/PIP initiatives</b> to join our team in order to assist with <b>Major Case Investigation</b>. The ideal candidate will have a strong background in identifying, investigating, and resolving complex cases of insurance fraud within the Personal Injury Protection (PIP) and healthcare provider space. Proficiency in investigative techniques, industry regulations, and PIP claim regulations is essential.</p>
<p>
</p><p>RESPONSIBILITIES</p>
<ul>
<li>Lead and conduct comprehensive investigations into major fraud cases, including healthcare fraud, staged accidents, exaggerated injuries, and fraudulent billing practices related to PIP claims.</li>
<li>Analyze and review claims data to identify red flags, trends, and patterns indicative of fraudulent activity, particularly focusing on NJ provider claims.</li>
<li>Collaborate with internal teams, external stakeholders, and law enforcement agencies to gather evidence and build cases.</li>
<li>Interview witnesses, claimants, and providers as part of the investigative process, documenting findings thoroughly.</li>
<li>Provide detailed reports and recommendations on cases for potential legal action or denial of claims.</li>
<li>Stay current with NJ PIP regulations, fraud detection techniques, and industry best practices.</li>
<li>Work closely with legal, compliance, and claims teams to ensure that investigative findings align with company policies and regulatory requirements.</li>
<li>Provide testimony and expert witness support in legal proceedings when necessary.</li>
</ul>
<p></p><p>QUALIFICATIONS</p>
<ul>
<li>Minimum of 5 years of experience in insurance fraud investigation, with a focus on <b>PIP claims</b> and <b>NJ provider networks</b>.</li>
<li>Proven expertise in the detection, investigation, and resolution of complex fraud cases in the insurance or healthcare industry.</li>
<li>Strong understanding of <b>New Jersey PIP laws</b>, regulations, and claims processing.</li>
<li>Proficiency in utilizing investigative tools, claims management software, and fraud detection systems.</li>
<li>Excellent written and verbal communication skills, with the ability to present complex findings clearly and effectively.</li>
<li>Ability to work independently, manage multiple investigations simultaneously, and meet deadlines.</li>
<li>Strong analytical and problem-solving skills.</li>
<li>Bachelor's degree or equivalent experience in criminal justice, insurance, or a related field.</li>
</ul>
<p></p><p>SALARY RANGE</p>
<p>
The pay range for this position is $70,000 to $103,500 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity.
</p><p></p><p>PERKS &amp; BENEFITS</p>
<ul>
<li>4 weeks accrued paid time off, 8 paid national holidays per year, and 2 floating holidays</li>
<li>Low cost and excellent coverage health insurance options that start on Day 1 (medical, dental, vision)</li>
<li>Annual 401(k) Employer Contribution</li>
<li>Free onsite gym and health center at our Woodbridge Location
</li><li>Resources to promote Professional Development (LinkedIn Learning and licensure assistance)
</li><li>Robust health and wellness program and fitness reimbursements</li>
<li>Various Paid Family leave options including Paid Parental Leave</li>
<li>Tuition Reimbursement
</li></ul><p></p><p>ABOUT THE COMPANY</p>
<p><i>
The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of &ldquo;A-/Excellent&rdquo;.</i></p></div>

Claims Representative, SIU

Velocity Agent

<p><b>Job Overview</b><br/>Join our dynamic Loss Prevention team as a Surveillance Investigator Trainee, where you'll embark on an exciting journey to develop essential skills in security and investigative techniques. This paid trainee position offers a unique opportunity to learn the fundamentals of surveillance, data collection, report writing, and fraud prevention within a fast-paced retail environment. As a key player in safeguarding assets and deterring theft, you'll gain hands-on experience in law enforcement principles and security operations, setting the foundation for a rewarding career in loss prevention and investigations.</p><p><b>Duties</b></p><ul><li>Assist with surveillance activities by monitoring CCTV footage and conducting visual inspections to identify suspicious behavior or potential theft.</li><li>Support data collection efforts by gathering evidence, documenting incidents, and maintaining detailed records of observations.</li><li>Contribute to report writing by documenting findings accurately and clearly for internal investigations or legal proceedings.</li><li>Participate in research initiatives aimed at understanding theft patterns, fraud schemes, and security vulnerabilities.</li><li>Collaborate with team members to conduct research on fraud prevention strategies and improve security protocols.</li><li>Learn to recognize signs of fraudulent activity and assist in implementing preventative measures.</li><li>Support law enforcement liaison activities by providing accurate information during investigations or incident reports.</li></ul><p><b>Qualifications</b></p><ul><li>Strong interest in law enforcement, security, or investigative work with a proactive attitude.</li><li>Excellent report writing skills with attention to detail and clarity.</li><li>Ability to collect and organize data efficiently for analysis and documentation purposes.</li><li>Basic knowledge of surveillance techniques and familiarity with CCTV systems is preferred.</li><li>Demonstrated research skills with the ability to analyze patterns and identify risks.</li><li>Understanding of fraud prevention and detection methods is a plus.</li><li>Prior experience or training in security or law enforcement is advantageous but not required; training will be provided. This paid Surveillance Investigator Trainee position is designed for motivated individuals eager to develop their expertise in loss prevention while making a tangible impact on safety and security within our organization. Join us to build your career in a vibrant environment that values your growth, dedication, and commitment to excellence!</li></ul><p>Pay: From $25.00 per hour</p><p>Benefits:</p><ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Employee discount</li><li>Fuel card</li><li>Health insurance</li><li>Life insurance</li><li>Paid training</li><li>Referral program</li><li>Retirement plan</li><li>Vision insurance</li></ul><p>Work Location: In person</p>

Surveillance Investigator Trainee (Loss Prevention)

Ethos Risk Services

<div><p><b>ABOUT US:</b></p><p>
Ethos Risk Services is a leading insurance claims investigation and medical management company, specializing in surveillance and fraud detection. At the forefront, we provide accurate data and actionable insights that translate into better decision-making for our clients.</p><p></p><p><b><br>
JOB SUMMARY:</b></p><p>
Our dynamic Ethos team is seeking a<b> Special Unit Investigations (SIU) Field Investigator</b> to conduct field investigations, gather and analyze evidence, and produce detailed reports that support claims decisions. You'll work both independently and collaboratively, often traveling to accident scenes, interviewing witnesses, and uploading documentation into our claims system.</p><p></p><p><b><br>
KEY RESPONSIBILITIES:</b></p><ul><li><b>
Scene Investigations:</b> Conduct thorough on-site investigations of accidents and property losses.</li><li><b>
Interviews &amp; Statements:</b> Conduct in-person interviews and obtain accurate, detailed statements from all parties involved.</li><li><b>
Online Research:</b> Gather case information through digital sources and background checks.</li><li><b>
Report Writing:</b> Draft thorough, detailed investigative reports summarizing findings and observations.</li><li><b>
Case Documentation:</b> Conduct in-person interviews and obtain accurate, detailed statements from all parties involved, and retrieve relevant documents to support investigative findings.</li><li><b>
Case Management:</b> Track case progress, time, and expenses accurately within Ethos systems.</li><li><b>
Fraud Detection:</b> Recognize compensability issues, misrepresentation, and other red flags in claims.</li><li><b>
Client Communication:</b> Maintain professional contact with clients and claim handlers throughout the investigation process.</li></ul><p><b><br>
QUALIFICATIONS:</b></p><p><b>
Education:</b> Associate's or Bachelor's degree in Criminal Justice or a related field preferred.</p><p><b>
Experience:</b></p><ul><li>
Minimum of 2 years of SIU experience with an investigative firm or insurance carrier, working across various lines of business such as liability, auto, and property.</li><li>
Former military or law enforcement background preferred.</li></ul><p><b>
Licenses/Certifications:</b></p><ul><li>
Active Private Investigator license or willingness to obtain one (where required by state).</li><li>
Active driver's license and valid auto insurance.</li></ul><p><b>
Other Requirements:</b></p><ul><li>
A well-maintained and reliable vehicle for exclusive use.</li><li>
SIU equipment, including a recorder and a high-quality digital camera.</li><li>
A reliable laptop, cell phone, and internet service are needed for communication and administrative tasks.</li></ul><p><b><br>
WORKING CONDITIONS:</b></p><ul><li>
While we aim to keep assignments within a 2-hour drive of your residence, occasional further travel and overnight stays (covered by the company) may be required.</li><li>
Occasional weekend work may be required to align with case demands and or/client requests.</li></ul><p><br>
Ethos Risk Services is an equal opportunity employer that does not discriminate on the basis of religious creed, sex, national origin, race, veteran status, disability, age, marital status, color or sexual orientation or any other characteristic.</p></div>

Special Investigations Unit (SIU) - Field Investigator

Old National Bank

<div>Overview:
<div>
Old National Bank has been serving clients and communities since 1834. With over $70 billion in total assets, we are a regional powerhouse deeply rooted in the communities we serve. As a trusted partner, we thrive on helping our clients achieve their goals and dreams, and we are committed to social responsibility and investing in our communities through volunteering and charitable giving.</div><div></div><div><i><br>
We continually seek highly motivated and talented individuals as our people are critical to our success. In return, we offer competitive compensation with our salary and incentive program, in addition to medical, dental, and vision insurance. 401K, continuing education opportunities and an employee assistance program are also included in our benefit suite. Old National also offers a variety of </i><i>Impact Network Groups</i><i> led by team members who are passionate about driving engagement, creating awareness of diverse backgrounds and experiences, and building inclusion across the organization. We offer a unique opportunity to join a growing, community and client-focused company that is firmly rooted in its core values.</i></div>
Responsibilities:
<p><b>
Position</b><b> </b><b>Summary</b></p><p>
Old National Bank has an outstanding opportunity in its dynamic Risk Management Department for a Fraud Investigator. The Fraud Investigator at Old National Bank will be responsible for investigating assigned cases relating to deposit account fraud, loan fraud, theft, embezzlement, and other suspicious activity. The Fraud Investigator will support the activities of the corporation&rsquo;s operating units and branch locations as a consultative resource responding to questions and inquiries. Further, the Fraud Investigator will perform research and verify the accuracy of information regarding cases or future prevention measures. This position will comply with all state and federal rules, regulations and laws while utilizing sound judgment and the highest degree of confidentiality.</p><div><b>
Salary Range</b></div><div>
The salary range for this position is $51,700.00/Yr. - $101,500.00/Yr.. The base salary indicated for this position reflects the compensation range applicable to all levels of the role across the United States. Actual salary offers within this range may vary based on a number of factors, including the specific responsibilities of the position, the candidate&rsquo;s relevant skills and professional experience, educational qualifications, and geographic location.</div><div></div><p><b><br>
Key Accountabilities</b></p><div><b>
Key Accountability 1:</b><b> </b>Research and investigate suspicious activity and cases.</div><br>
<div></div><ul><li>
Utilizing a variety of reports, review and investigate suspicious activity.</li><li>
Investigate assigned cases at various risk levels as an expert analyst and interviewer.</li></ul><div></div><p><b><br>
Key Accountability</b><b> </b><b>2:</b><b> </b>Comply with all state and federal rules, regulations and laws.</p><ul><li>
Ensure that all investigations are handled in an efficient and timely manner to meet all regulatory guidelines and requirements.</li><li>
Represent the corporation to local, state, and federal law enforcement agencies as needed.</li><li>
Maintain a role in the preparation of Suspicious Activity Reports and provide supporting documentation with the filing requirements of FinCEN.</li></ul><div></div><p><b><br>
Key Accountability 3:</b> Serve as a consultative resource for the bank&rsquo;s banking center locations and corporate operating units.</p><ul><li>
Serve as the point of contact and educational resource for fraud related questions and inquiries.</li></ul><div></div><p><b><br>
Key Competencies for Position</b></p><p><b>
Strategy in Action &ndash;</b> <i>Build your strategic mindset capability</i><i>.</i></p><ul><li>
Breaks down larger goals into smaller achievable goals and communicates how they are contributing to the broader goal.</li><li>
Actively seeks to understand factors and trends that may influence role. Anticipates risk and develop contingency plans to manage risks.</li><li>
Identified opportunities for improvement and seeks insights from other sources to generate potential solutions. Aligns activities to meet individual, team and organizational goals.</li></ul><div></div><p><b><br>
Compelling Communication &ndash;</b><b> </b><i>Openly and effectively</i><i> </i><i>communicates</i><i> </i><i>with others.</i></p><ul><li>
Effectively and transparently shares information and ideas with others.</li><li>
Tailors the delivery of communication in a way that engages the audience and that is easy to understand and retain.</li><li>
Unites others towards common goal.</li><li>
Asks for others' opinions and ideas and listens actively to gain their support when clarifying expectations, agreeing on a solution and checking for satisfaction.</li></ul><div></div><div><b><br>
Makes Decisions &amp; Solves Problems &ndash;</b><b> </b><i>Seeks deeper understanding and takes action</i><i>.</i></div><br>
<div></div><ul><li>
Takes ownership of the problem while collaborating with others on a resolution with an appropriate level of urgency.</li><li>
Collaborates and seeks to understands the root causes of problems.</li><li>
Evaluates the implications of new information or events and recommends solutions using decisions that are sound based on what is known at the time.</li><li>
Takes action that is consistent with available facts, constraints and probable consequences.</li></ul><div></div><p><b><br>
Delights Clients &ndash;</b><b> </b><i>Continuously</i><i> </i><i>seeks</i><i> </i><i>and applies knowledge leading to a best-in-class client experience.</i></p><ul><li>
Passionately serves internal/external clients with excellence.</li><li>
Maintains a growth mindset staying current with developments and trends in areas of expertise influencing client satisfaction both internally and externally.</li><li>
Understands data, metrics and/or financial information, and how they tie to client satisfaction and business outcomes related to position, client and/or team.</li><li>
Nurtures client relationships by listening, prioritizing, and acting responsibly to meet client needs, mitigate risk and add shareholder value.</li></ul><div></div><p><b><br>
Q</b><b>ualifications and Education Requirements</b></p><ul><li>
Bachelor&rsquo;s degree in business, accounting or law enforcement or equivalent experience.</li><li>
Years of experience will determine the level of the position. Minimum of 3 years in financial institution fraud investigation, financial crimes law enforcement or other related fields or be a subject matter expert in retail banking, lending, wealth management, operations or technology.</li><li>
Strong to advanced investigative, analytic and decision-making skills</li><li>
Problem solving skills with the ability to define problems and propose solutions.</li><li>
Must have strong interpersonal skills, business writing skills and expertise as well as verbal communication skills.</li><li>
Strong time management skills and ability to complete multiple projects simultaneously.</li></ul><div></div><p><b><br>
Key Measures of Success/Key Deliverables:</b></p><ul><li>
Works independently and follows procedures and job aids.</li><li>
Maintains an error ratio of 85% or better after six months in the position for all cases.</li><li>
Sets priorities for daily work related to escalations and case work, completing cases timely according to procedures.</li><li>
Communicates effectively with internal and external customers in a timely manner.</li></ul><div></div><div><b><br>
Old National is proud to be an equal opportunity employer focused on fostering an inclusive workplace and committed to hiring a workforce comprised of diverse backgrounds, cultures and thinking styles.</b></div><div></div><div><br>
As such, all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, status as a qualified individual with disability, sexual orientation, gender identity or any other characteristic protected by law.</div><div></div><div><i><br>
We do not accept resumes from external staffing agencies or independent recruiters for any of our openings unless we have an agreement signed by the Director of Talent Acquisition, SVP, to fill a specific position.</i></div><div></div><p><b><i><br>
Our culture is firmly rooted in our core values.</i></b></p><p><b><i>
We are optimistic. We are collaborative. We are inclusive. We are agile. We are ethical.</i></b></p><p><b><i>
We are Old National Bank. Join our team!</i></b></p></div>

Fraud Investigator II

Hennepin County

<div><div><div><h2 class="jobSectionHeader"><b>Description</b></h2></div>
<p></p><div><div>Hennepin Health is seeking a Senior Investigator for the Special Investigations Unit (SIU). This Senior Investigator will be responsible for managing a comprehensive program to combat suspected fraud, waste, and abuse (FWA) and leading FWA investigations from triage to conclusion.</div><p><br>
Current Hennepin County employees who refer a candidate hired into an open competitive position may be eligible for a <b>$500 </b>referral bonus. For more information visit employee referral program.</p><br>
Find us <b>here</b> at upcoming career fairs!<div></div><div><b><br>
Location and hours:</b></div>
This position is hybrid and will be performed both on-site at the Health Services Building at 525 Portland Avenue, Minneapolis, MN 55415 (this location is accessible by public transportation and light rail) and remote as job duties require. Work hours will be Monday through Friday, 8 a.m. - 4:30 p.m. with Wednesday and Thursday being onsite. While this position is designated as hybrid, based on current requirements hires must reside in or relocate to Minnesota or Wisconsin. New Employee Orientation (NEO) for all new benefit-earning employees is in-person in downtown Minneapolis. Details about NEO will be provided upon hire.<br>
<br>
<b>About the position type:</b><br>
This is a full-time, benefit-earning position.<br>
This position is internally classified as an Administrative Assistant, Senior.<br>
Click here to view the job classification specification.<br>
<div><b>
In this position, you will:</b></div><ul><li>
Lead research and identify potential areas of fraud, waste, and abuse (FWA) and request data to facilitate investigations, including the creation and utilization of analytic reports.</li><li>
Manage investigations from identification and triage until completion, making recommendations on final disposition of cases.</li><li>
Work with other department of Hennepin Health to effectuate case dispositions (e.g., implement payment suspensions, make policy updates, provider outreach, etc.).</li><li>
Collaborate with the investigation departments of our vendors, and other partners in the county, state, and federal government.</li><li>
Create regular reports for Hennepin Health&rsquo;s Board and regulators.</li><li>
Perform as the subject matter expert on areas related to FWA.</li><li>
Manage existing policy and procedure documents related to FWA investigations.</li></ul><b>
Need to have:</b><ul><li>
One of the following:<ul><li>
Bachelor's degree or higher in public administration, business administration, criminal justice, health care administration, or other field appropriate to the position <b>and</b> four or more years of experience in general administrative work relating to the management of departmental/organizational operations or in a specialty area appropriate to the position.</li><li>
Eight years or more of general administrative work related to the management of departmental/organizational operations or in a specialty area appropriate to the position.</li></ul></li></ul><div><b><br>
Nice to have:</b></div><ul><li>
Certified Fraud Examiner (CFE) credential or Accredited Health Care Fraud Investigator (AHFI) designation.</li><li>
Experience working with:<ul><li>
Medicaid, MinnesotaCare, Medicare, or other publicly funded health programs.</li><li>
Healthcare fraud investigations.</li><li>
Claims or claims processing, including knowledge of medical terminology, costs, enrollment, and group data.</li><li>
A managed care organization.</li><li>
Microsoft Office Suite (Excel, Word, OneNote, Teams, Outlook), Google Sheets, and industry claims platforms (e.g. Facets).</li></ul></li><li>
Knowledge of state and federal laws and regulations pertaining to health insurance and/or government programs, including Medicare and/or Medicaid.</li><li>
Ability to:<ul><li>
Request, use, and analyze data to perform investigations.</li><li>
Have excellent verbal and written communication skills.</li></ul></li></ul><br>
<b>
About the department:</b><br>
Hennepin Health provides health care coverage to Hennepin County residents who are enrolled in a Minnesota Health Care Program. Hennepin Health is a nonprofit, state-certified health maintenance organization that contracts with the Minnesota Department of Human Services. We envision being a leader in partnering with our members and communities to improve health, by integrating health care and service to enhance the health and well-being of our members and the community.<br>
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<b>About Hennepin County:</b><br>
Hennepin is the largest county government organization in Minnesota. Our employees work every day to improve the health, safety and quality of life for our residents and communities. All of our jobs align with our mission to serve residents through transformative services that eliminate disparities, eliminate inequities, and create opportunity for all and our vision of a community where all people are healthy, all people are valued, and all people thrive.<br>
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Our employees receive a combination of competitive benefits and positive workplace culture not found at other organizations. This includes meaningful work that impacts our community, competitive pay, work-life balance, a variety of benefits and opportunities to grow. Learn more at The Bridge (login as Guest).<br>
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Hennepin County envisions an organization where our commitment to diversity and the elimination of disparities is fundamental in providing excellent service to our community.<br>
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Your future. Made here.<br>
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This posting may be used to fill current and future vacancies.<br>
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<b>Watch this </b><b>video</b><b> for application best practices and tips.</b><br>
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This position will have access to systems or other documentation that contains HIPAA data.<br>
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Invitations to interview will be based upon an assessment of education and experience. Final candidates may be required to complete a background check.<br>
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<b>If you have any questions, please contact:</b><br>
Kristin Checco<br>
Kristin.Checco@hennepin.us</div></div></div><p></p>

Senior Investigator - Special Investigations Unit (SIU)

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