special investigator

Allied Universal Compliance and Investigations

<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>

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