senior investigator

CVS Health

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

Senior Investigator, Special Investigations Unit (Aetna SIU)

Ethos

<div>
 
 About Us
 
 
 
 Ethos Risk Services is a leading insurance claims investigation and medical management company, specializing in surveillance and fraud detection. At the forefront of, we provide accurate data and actionable insights that translate into better decision-making for our clients. To learn more, visit: https://ethosrisk.com/about-us/
 
 
 
 Job Summary
 
 
 
 Have you ever thought about becoming a Private Investigator? Are you ready to kick-start your career in a rapidly growing industry? Want to get paid to learn how to investigate fraud and conduct covert surveillance in the real world? Our
 
 Full-Time Entry-Level Field Investigator
 
 position will help launch your career by providing you with an industry
 
 leading FULLY PAID Investigator Training Program - no prior experience necessary!
 
 
 
 
 Key Responsibilities
 
 
 
 <ul>
 <li>
 Case Preparation: Conduct preliminary investigations using social media and analyzing database research.
 </li>
 <li>
 Field Surveillance: Perform covert surveillance from your vehicle by tracking and capturing high-quality video evidence of surveillance targets.
 </li>
 <li>
 Report Writing: Draft detailed and court-ready investigative reports summarizing activity and key findings.
 </li>
 <li>
 Documentation: Finalize case files by submitting case reports and uploading video footage via personal laptop at the end of the day.
 </li>
 <li>
 Communication: Work closely with field supervisor, receiving regular guidance and mentorship.
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Driver's License: Active driver's license that is not currently suspended or revoked.
 </li>
 <li>
 Personal Vehicle: A well-maintained vehicle that is always reliable (preferably with tinted windows). Proof of auto insurance coverage is required.
 </li>
 <li>
 Travel Expectations: While we aim to keep assignments within a reasonable drive of your residence, occasional further travel and overnight stays (covered by the company) may be required.
 </li>
 <li>
 Technology: A reliable laptop, cell phone, and internet service are needed for communication and administrative tasks.
 </li>
 <li>
 Required Skills: Strong computer &amp; internet proficiency. Excellent communication, verbal &amp; writing skills.
 
 
 </li>
 </ul>
 
 What We Offer
 
 
 
 <ul>
 <li>
 Paid Investigator Training Program: Fully paid training program led by industry experts with ongoing development and support. Initial training will be held via virtual classroom then transition into on-the-job training.
 </li>
 <li>
 Paid Licensing: We pay for all your licensing fees! Our licensing team will guide you through the process of acquiring all investigator licensing to ensure a smooth process.
 </li>
 <li>
 Surveillance Equipment: We will provide you with necessary surveillance equipment. After a year of employment, it is yours to keep!
 </li>
 <li>
 Pay Increases &amp; Milage Reimbursement: There are several performance milestones within your training &amp; first year of employment that will reward you with pay increases. Additionally, we offer a mileage reimbursement program.
 </li>
 <li>
 Health Insurance/Retirement: Medical, Dental Vision, Life/Disability Insurance + 401k
 
 
 </li>
 </ul>
 
 Working Conditions
 
 
 
 <ul>
 <li>
 Most surveillance cases start at 6:00AM. End time can vary depending on activity and a typical workday can vary from 3-12 hours.
 </li>
 <li>
 Weekends/holidays are common workdays as claimants are more likely to be active.
 </li>
 <li>
 This is an independent role often requiring long hours alone in your vehicle, regardless of weather conditions.
 </li>
 <li>
 Must remain alert with no external distractions, ready to use videography equipment to document subjects.
 
 
 </li>
 </ul>
 
 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.
 
 
 
 A background check will be conducted, in accordance to the local state law and regulations.
 
 
 Salary: $23 per hour
 
 
 
 
 Job Posted by ApplicantPro
 
 
</div>

Entry-Level Investigator

Kemper

<div>Location(s)
Tampa, Florida
Details
Kemper is one of the nation&rsquo;s leading specialized insurers. Our success is a direct reflection of the talented and diverse people who make a positive difference in the lives of our customers every day. We believe a high-performing culture, valuable opportunities for personal development and professional challenge, and a healthy work-life balance can be highly motivating and productive. Kemper&rsquo;s products and services are making a real difference to our customers, who have unique and evolving needs. By joining our team, you are helping to provide an experience to our stakeholders that delivers on our promises.
Position Summary:
The SIU Investigator will conduct field as well as desk investigations of insurance claims referred to and accepted for investigation by the Special Investigative Unit. Our Special Investigator will function as a remote investigator working from her/his residence and servicing the Tampa and surrounding areas. Basic functions include: Investigation of claims, analysis and development of facts and evidence, and conducting and/or directing Examinations Under Oath. This investigator will coordinate investigations with outside SIU contacts, the Department of Insurance Fraud Division, NICB, and various law enforcement agencies. A laptop computer, cell phone and digital camera, MP3 recorder and other office equipment will be provided. Applicants must have the ability to travel.
Position Responsibilities:
<ul><li>Attends necessary training schools and participates in training to develop and improve skills, develops contacts, and meets state regulatory educational requirements.</li><li>
Investigates files by using appropriate field, computer and telephone investigative techniques and provides appropriate documentation of actions in a thorough timely manner.</li><li>
Maintains a diary system on all assigned files. Diary system is to be worked so that the tempo is sufficient to assure prompt and timely recommendations.</li><li>
Prepares necessary reports for state fraud bureaus and cooperates with state agencies as required by law and management. Keeps the Special Investigation Unit and field managers advised of all critical situations.</li><li>
Reports findings of all investigations and makes recommendations to the responsible manager or other designee in a timely manner to facilitate prompt decisions.</li><li>
Develops and maintains contacts with other special investigative units and fraud related organizations.</li><li>
Acquires and maintains current knowledge in all appropriate jurisdictions regarding changes in law to ensure operations are within proper parameters established by law.</li></ul>
Position Qualifications:<ul><li>
College Degree or equivalent work experience.</li><li>
Three years of insurance claims investigation experience or professional investigation experience with law enforcement agencies; or</li><li>
Five years of professional investigation experience involving economic or insurance related matters; or an authorized medical professional to evaluate medical related claims.</li><li>
Must have a working knowledge of Digital photo and document metadata and have experience with using the internet and social networking for investigative purposes.</li><li>
The candidate must possess knowledge of the principles of casualty insurance and the auto casualty claims adjustment process.</li><li>
Investigative and legal expertise needed for this position.</li><li>
Completion of the NICB Basic and/or Advanced Academies and the Reid Interviewing and Interrogation Courses are desirable.</li><li>
Must have excellent communication skills and thorough working knowledge of Microsoft office applications.</li><li>
Must demonstrate a thorough knowledge of the workings of related state and federal agencies. The SIU investigator must possess oral and written communications skills and promote a favorable company image to the public.</li><li>
Fraud Claims Law Specialist (FCLS) or Fraud Claims Law Associate (FCLA) designations and Certified Insurance Fraud Investigator (CIFI) or Certified Fraud Examiner (CFE) designations are preferred.</li><li>
A valid driver&rsquo;s license and clean driving record is required.</li></ul>
Kemper is proud to be an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, disability status or any other status protected by the laws or regulations in the locations where we operate. We are committed to supporting diversity and equality across our organization and we work diligently to maintain a workplace free from discrimination. 
 
Kemper does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Kemper and Kemper will not be obligated to pay a placement fee.
Kemper will never request personal information, such as your social security number or banking information, via text or email. Additionally, Kemper does not use external messaging applications like WireApp or Skype to communicate with candidates. If you receive such a message, delete it.</div>

Field SIU Investigator - Tampa

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Senior Investigator, Special Investigations Unit (Aetna SIU)

Senior Investigator, Special Investigations Unit (Aetna SIU)

Senior Investigator, Special Investigations Unit (Aetna SIU)

Senior Investigator, Special Investigations Unit (Aetna SIU)

Senior Investigator, Special Investigations Unit (Aetna SIU)

Entry-Level Investigator

Field SIU Investigator - Tampa