special investigation unit investigator

Allied Universal Compliance and Investigations

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

SIU Investigator

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

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

Major Case Unit Investigator

Ethos Risk Services

<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, we provide accurate data and actionable insights that translate into better decision-making for our clients. 
JOB SUMMARY:
Our dynamic Ethos team is seeking a Special Unit Investigations (SIU) Field Investigator 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. 
KEY RESPONSIBILITIES:<ul><li>
Scene Investigations: Conduct thorough on-site investigations of accidents and property losses.</li><li>
Interviews &amp; Statements: Conduct in-person interviews and obtain accurate, detailed statements from all parties involved.</li><li>
Online Research: Gather case information through digital sources and background checks.</li><li>
Report Writing: Draft thorough, detailed investigative reports summarizing findings and observations.</li><li>
Case Documentation: Conduct in-person interviews and obtain accurate, detailed statements from all parties involved, and retrieve relevant documents to support investigative findings.</li><li>
Case Management: Track case progress, time, and expenses accurately within Ethos systems.</li><li>
Fraud Detection: Recognize compensability issues, misrepresentation, and other red flags in claims.</li><li>
Client Communication: Maintain professional contact with clients and claim handlers throughout the investigation process.</li></ul> 
QUALIFICATIONS:
Education: Associate's or Bachelor's degree in Criminal Justice or a related field preferred.
Experience:<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>
Licenses/Certifications:<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>
Other Requirements:<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> 
WORKING CONDITIONS:<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> 
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.</div>

Special Investigations Unit (SIU) - Field 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)

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SIU Investigator

Field SIU Investigator - Tampa

Major Case Unit Investigator

Special Investigations Unit (SIU) - Field Investigator

Senior Investigator, Special Investigations Unit (Aetna SIU)

Senior Investigator, Special Investigations Unit (Aetna SIU)

Senior Investigator, Special Investigations Unit (Aetna SIU)