Background investigator jobs near me

Background Investigator - Independent Contractor/1099 Federal Background Investigations Division 1FORCE is currently seeking to engage with experienced Contractors and federally credentialed Background Investigators to conduct personnel security background investigations in a contractor capacity in support of our client's contracts with the federal government. We have work nationwide and if you currently hold credentials on a federal personnel security background investigations contract (or have held government credentials in the last 2 years), we want to partner to provide immediate, weekly work opportunities. DUTIES & RESPONSIBILITIES: Complete record searches. Conduct face-to-face interviews to elicit information about applicants seeking federal positions, contract positions or positions within the military. Obtain factual information from a variety of personal and record sources to produce a report of investigation, containing all pertinent facts, of an individual's background and character, in accordance with agency guidelines and instructions. Investigators work from home, set their own schedules, and work independently. Self-motivated, highly independent, and prepared to work non-traditional hours (i.e., evenings and weekends). POSITION REQUIREMENTS: Federally credentialed and experienced investigators will have met the background investigations national training standards and have 12 months or more of consecutive experience performing executive branch investigations. Superior organizational and time management skills. Excellent communication skills in both oral and written formats. Strong computer and typing skills for composing narrative reports of investigation in FWS and utilizing PIPS or other federally supported case management/reporting system. Sufficient E&O liability, car insurance and personal insurance. **All candidates must be a US Citizen and be able to obtain a TOP SECRET level security clearance.

Our team members are at the heart of everything we do. At Cencora, we are united in our responsibility to create healthier futures, and every person here is essential to us being able to deliver on that purpose. If you want to make a difference at the center of health, come join our innovative company and help us improve the lives of people and animals everywhere. Apply today! Job Details PRIMARY DUTIES AND RESPONSIBILITIES: 1. Responsible for Quality Assurance Investigations at ABC and ensuring adherence to applicable GMP regulations and policies and procedures. 2. Produces written reports that summarize the investigation, root cause determination, corrective actions and recommended disposition of affected product. 3. Conducts complaint investigations and maintains records of customer complaints. 4. Works with Production/QA to initiate investigations and minimize production down time. 5. Assists with the development of appropriate corrective actions. 6. Works with quality management to determine appropriate disposition of affected product. 7. Maintains the Investigation/CAPA Database and other databases as required. 8. Assists on follow-up checks on the effectiveness of corrective actions. 9. Performs other duties as assigned. EXPERIENCE AND EDUCATIONAL REQUIREMENTS: 1. BS in relevant Science or Engineering discipline. 2. At least 3 years of experience in a cGMP regulated environment 3. Must have a working knowledge of pharmaceutical packaging records, process and equipment; and experience in quality assurance in the pharmaceutical industry. MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS: 1. Strong critical thinking and deductive reasoning skills. 2. Strong oral, written, communication, presentation and interpersonal skills. 3. Ability to interact with Regulatory Agencies, vendors and all levels of associates within the organization, including management and plant associates. 4. Knowledge of QA principles, concepts, systems industry practices and standards. 5. Ability to work independently. 6. Ability to handle a variety of tasks simultaneously. 7. Attention to detail. 8. Strong skill in computer operations, experience with MS Word and Excel, ERP and Ensur) What Cencora offers We provide compensation, benefits, and resources that enable a highly inclusive culture and support our team members' ability to live with purpose every day. In addition to traditional offerings like medical, dental, and vision care, we also provide a comprehensive suite of benefits that focus on the physical, emotional, financial, and social aspects of wellness. This encompasses support for working families, which may include backup dependent care, adoption assistance, infertility coverage, family building support, behavioral health solutions, paid parental leave, and paid caregiver leave. To encourage your personal growth, we also offer a variety of training programs, professional development resources, and opportunities to participate in mentorship programs, employee resource groups, volunteer activities, and much more. For details, visit ************************************** Full time Equal Employment Opportunity Cencora is committed to providing equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, genetic information, national origin, age, disability, veteran status or membership in any other class protected by federal, state or local law. The company's continued success depends on the full and effective utilization of qualified individuals. Therefore, harassment is prohibited and all matters related to recruiting, training, compensation, benefits, promotions and transfers comply with equal opportunity principles and are non-discriminatory. Cencora is committed to providing reasonable accommodations to individuals with disabilities during the employment process which are consistent with legal requirements. If you wish to request an accommodation while seeking employment, please call ************ or email ****************. We will make accommodation determinations on a request-by-request basis. Messages and emails regarding anything other than accommodations requests will not be returned Affiliated CompaniesAffiliated Companies: Amerisource Health Services, LLC

Our team members are at the heart of everything we do. At Cencora, we are united in our responsibility to create healthier futures, and every person here is essential to us being able to deliver on that purpose. If you want to make a difference at the center of health, come join our innovative company and help us improve the lives of people and animals everywhere. Apply today! Job Details PRIMARY DUTIES AND RESPONSIBILITIES: 1. Responsible for Quality Assurance Investigations at ABC and ensuring adherence to applicable GMP regulations and policies and procedures. 2. Produces written reports that summarize the investigation, root cause determination, corrective actions and recommended disposition of affected product. 3. Conducts complaint investigations and maintains records of customer complaints. 4. Works with Production/QA to initiate investigations and minimize production down time. 5. Assists with the development of appropriate corrective actions. 6. Works with quality management to determine appropriate disposition of affected product. 7. Maintains the Investigation/CAPA Database and other databases as required. 8. Assists on follow-up checks on the effectiveness of corrective actions. 9. Performs other duties as assigned. EXPERIENCE AND EDUCATIONAL REQUIREMENTS: 1. BS in relevant Science or Engineering discipline. 2. At least 3 years of experience in a cGMP regulated environment 3. Must have a working knowledge of pharmaceutical packaging records, process and equipment; and experience in quality assurance in the pharmaceutical industry. MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS: 1. Strong critical thinking and deductive reasoning skills. 2. Strong oral, written, communication, presentation and interpersonal skills. 3. Ability to interact with Regulatory Agencies, vendors and all levels of associates within the organization, including management and plant associates. 4. Knowledge of QA principles, concepts, systems industry practices and standards. 5. Ability to work independently. 6. Ability to handle a variety of tasks simultaneously. 7. Attention to detail. 8. Strong skill in computer operations, experience with MS Word and Excel, ERP and Ensur) What Cencora offers We provide compensation, benefits, and resources that enable a highly inclusive culture and support our team members' ability to live with purpose every day. In addition to traditional offerings like medical, dental, and vision care, we also provide a comprehensive suite of benefits that focus on the physical, emotional, financial, and social aspects of wellness. This encompasses support for working families, which may include backup dependent care, adoption assistance, infertility coverage, family building support, behavioral health solutions, paid parental leave, and paid caregiver leave. To encourage your personal growth, we also offer a variety of training programs, professional development resources, and opportunities to participate in mentorship programs, employee resource groups, volunteer activities, and much more. For details, visit ************************************** Full time Equal Employment Opportunity Cencora is committed to providing equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, genetic information, national origin, age, disability, veteran status or membership in any other class protected by federal, state or local law. The company's continued success depends on the full and effective utilization of qualified individuals. Therefore, harassment is prohibited and all matters related to recruiting, training, compensation, benefits, promotions and transfers comply with equal opportunity principles and are non-discriminatory. Cencora is committed to providing reasonable accommodations to individuals with disabilities during the employment process which are consistent with legal requirements. If you wish to request an accommodation while seeking employment, please call ************ or email ****************. We will make accommodation determinations on a request-by-request basis. Messages and emails regarding anything other than accommodations requests will not be returned Affiliated Companies Affiliated Companies: Amerisource Health Services, LLC

OMNIPLEX World Services Corporation is seeking talented individuals committed to excellence, honesty, and integrity to join our team. We are a trusted provider of high quality background investigations programs to Department of Homeland Security (DHS) and the intelligence community at locations throughout the United States. OMNIPLEX is seeking to fill immediate and upcoming openings for Contract Investigators. A Contract Investigator works for us on an as needed basis and no hours are guaranteed. We prefer Contractors to be available to work a minimum of ten hours per week where work is available. Candidate must be willing to travel within a 35-50 mile radius from city location. Candidate must be local to Columbus, OH QUALIFICATIONS: U.S. Citizenship; H.S. Diploma or equivalent; Minimum of 1 year of specialized Federal Background investigative experience within the last 5 years; Must have some FIS Experience; Reliable personal vehicle, valid driver's license, and satisfactory driving record; Willing to travel on temporary duty assignments as needed (by car or plane); Successfully pass background checks and all required training; Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists; Ability to interpret a variety of instructions furnished in oral, written, diagram, or schedule form; Ability to read, analyze, and interpret professional journals, technical procedures, or governmental regulations; Ability to write reports and business correspondence; Ability to work in a MS Window based operating environment, including proficiency with Microsoft Office (Word, Excel, PowerPoint), Internet and E-mail; Current (within the last 2 years) Single Scope Background Investigation (SSBI) or active Secret level security clearance based on an SSBI and able to obtain the required security clearance. Job Duties and Responsibilities: Conduct in-person, one-on-one subject interviews to obtain factual information about the individual's background and character, in accordance with agency guidelines and instructions. Obtain factual information from a variety of personal and record sources to produce a report of investigation that contains all pertinent facts of an individual's background and character in accordance with agency guidelines and instructions. Travel throughout the geographic area of responsibility to conduct investigations at various places of employment, residence, and education institutions as cases are assigned. Must be willing to travel in and around assigned location within 30-50 miles (or more) as needed Engage in dialogue on a regular basis with managers and representatives at contractor facilities, various U. S. Government organizations, and law enforcement agencies to develop and maintain effective and cooperative working relationships. Adapt to changing situations and environments as they occur and be able to interact with people from all walks of life and socioeconomic levels. Demonstrate strong verbal and written communications skills and exhibit professional demeanor in all situations. Work load based on availability of cases in geographic area. Some voluntary, temporary duty assignments in other areas of the country (typically 2-4 weeks at a time) are possible. Other duties as required. Desired Experience and Education: Background Investigator Training that meets the National Training Standards (NTS) Prior background investigations experience supporting government contracts. Associate or Bachelor degree in Criminal Justice or a related field. Current Top Secret clearance WORKING CONDITIONS: Work is typically based in the investigator's home office as well as in the investigator's personal vehicle traveling to various field locations to conduct interviews. Coverage area varies and could include some extended drives. Work hours vary depending on availability of leads and do not always fall within normal business hours, to include potential weekend hours or third-shift appointments. PHYSICAL REQUIREMENTS: Requires intermittent standing, writing/typing, walking, sitting, and driving throughout the workday, and may include for multiple hours.

Job Description 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 an Experienced Field Investigator to conduct surveillance and investigative activities to identify potential fraudulent insurance claims. This role involves performing both stationary and mobile surveillance, obtaining video and photographic evidence, and preparing thorough, detailed reports for clients. KEY RESPONSIBILITIES: Case Preparation: Prepare for surveillance assignment by reviewing Ethos' preliminary reports and case information. Field Surveillance: Perform covert surveillance from your vehicle by tracking and capturing high-quality video evidence of surveillance targets. Report Writing: Draft detailed and court-ready investigative reports summarizing activity and key findings. Documentation: Finalize case file by submitting case reports and uploading video footage via personal laptop at the end of the day. Communication: Work closely with the field supervisor and operations teams, receiving regular guidance and mentorship. REQUIREMENTS: Previous Experience: Demonstrated proficiency in covert surveillance techniques, capturing high-quality video footage, and preparing thorough, well-organized investigative reports. Driver's License: Valid driver's license and proof of automobile insurance. Personal Vehicle: A well-maintained vehicle that is always reliable (preferably with tinted windows). Surveillance Equipment: A handheld camcorder with high-quality zoom and a covert camera device. Use of stabilization equipment (gimbals, tripods, etc.) is strongly encouraged. Technology: A reliable laptop, cell phone, and internet service are needed for communication and administrative tasks. Private Investigator License: Active Private Investigator license or willingness to obtain one (where required by state). WORKING CONDITIONS: 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 Most surveillance cases start at 6:00AM. End time can vary depending on activity and a typical workday can vary from 3-12 hours. Weekends/holidays are common workdays as claimants are more likely to be active. This is an independent role often requiring long hours alone in your vehicle, regardless of weather conditions. Must remain alert with no external distractions, ready to use videography equipment to document subjects. 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. Job Posted by ApplicantPro

Affirmative Civil Enforcement (ACE) InvestigatorEmployment Type: Full-Time, Experienced Department: Legal Services CGS is seeking an experienced ACE Investigator with extensive knowledge and skills in investigative techniques and fraud detection to provide assistance for a large Federal agency initiative. CGS brings motivated, highly skilled, and creative people together to solve the government's most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities. Skills and attributes for success:- The investigator will generate new investigations, and to continue with ongoing investigation and civil actions involving fraud in areas such as healthcare, contracting, and grants, as well as other fraud and abuse of federal public funds and programs. - Regularly meets with the ACE attorneys and with designated agency personnel for the purpose of generating fraud investigations. - Performs a variety of ancillary investigations-related services in direct support of any assigned fraud- Utilizes electronic databases such as public records, property records, business records, and other government-maintained databases, to identify documents, witnesses and other physical evidence. - Prepares reports on progress of investigations for use by AUSAs and supervisory attorneys. These reports may include significant findings and conclusions, analyses of information located in electronic databases, presentations, recommendations for additional investigative actions and candid assessments of strengths and weaknesses of witnesses, documentary evidence, or other aspects of a case. - Examines books, ledgers, payrolls, cost reports, billing statements, invoices, correspondence, computer data, and other records pertaining to the transactions, events, or allegations under investigation. - Performs sophisticated analyses of large-scale hard-copy and electronic data, such as health care claims data, financial transaction data, accounting records, or bank records to develop investigative leads and to determine their potential relevance to the allegations at issue. - Gathers and analyzes facts including witness statements, timelines, and scientific or technical data for the purpose of advancing investigative objectives. Establishes and verifies relationships between facts and evidence obtained or presented to confirm authenticity of documents, to corroborate witness statements, and to otherwise build proof necessary for successful litigation or settlement. - Develops and analyzes evidence and collects information relating to such evidence, or other legal matters under consideration, from appropriate primary and secondary sources. Performs analysis to clarify the target suspect's or organization's pattern of operations, to identify information relevant to the legal issues involved, and to recommend valuable approaches to the AUSAs or other members of the investigative team. Develops and refines proof required to assist in determining legal responsibility for violations. - Assists ACE AUSAs with in-person and/or telephonic interviews of witnesses, depositions, and sworn witness examinations. - Assists with the preparation and service of subpoenas for documentary materials, interrogatory answers, or witness testimony in connection with ACE investigations. - Develops an understanding of all applicable federal, state, or local laws to the extent necessary to make sound decisions on direction and scope of investigations. Determines proof required to affix responsibility for violations, and devise methods for obtaining, preserving, and presenting evidence to the greatest effect. - Assists with determining the most efficacious methods for planning, scheduling, and conducting investigations, and identifies any resources that may be required. - Performs other related ACE investigator duties as assigned and within scope. - Attends meetings and trainings as may be required and appropriate. Qualifications:- Computer Skills: Applicant shall have the ability to use MS Word, MS Excel, MS Outlook, MS Access, and other databases as well as Adobe Acrobat Professional. Experience with working on document review/management platforms such as Relativity, with analyzing spreadsheets of claims data, and with utilizing docketing software is a plus. - Ability to review and understand the import of a wide variety of documents, both legal and non-legal, including Motions and Briefs. - Ability to think independently and to develop investigative strategies in response to the needs of a specific case. - Communication skills are extremely important. Applicant shall work and interact professionally and effectively with all levels of staff. - Ability to meet established deadlines and work as a team player in a professional office. - Skill in meeting and dealing with people in a courteous and tactful manner. Our Commitment:Contact Government Services (CGS) strives to simplify and enhance government bureaucracy through the optimization of human, technical, and financial resources. We combine cutting-edge technology with world-class personnel to deliver customized solutions that fit our client's specific needs. We are committed to solving the most challenging and dynamic problems. For the past seven years, we've been growing our government-contracting portfolio, and along the way, we've created valuable partnerships by demonstrating a commitment to honesty, professionalism, and quality work. Here at CGS we value honesty through hard work and self-awareness, professionalism in all we do, and to deliver the best quality to our consumers mending those relations for years to come. We care about our employees. Therefore, we offer a comprehensive benefits package. - Health, Dental, and Vision- Life Insurance- 401k- Flexible Spending Account (Health, Dependent Care, and Commuter)- Paid Time Off and Observance of State/Federal Holidays Contact Government Services, LLC is an Equal Opportunity Employer. Applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Join our team and become part of government innovation! Explore additional job opportunities with CGS on our Job Board:******************* com/join-our-team/For more information about CGS please visit: ************ cgsfederal. com or contact:Email: info@cgsfederal. com #CJ

Our Company At AssuranceAmerica, we are more than a unique blend of insurance assets. We believe in creating a culture where every associate has the opportunity to learn and grow. We strive to create a work environment to meet associate needs and we are determined to achieve excellence in everything we do. This is an opportunity to join a dynamic team in a company that is a leader in the non-standard auto insurance space and functions with a small company, entrepreneurial style. This position will require someone with an understanding that one needs to have a “roll up your sleeves” attitude to help make things happen. Job Summary The SIU Investigator is responsible for conducting thorough investigations throughout the 10 states in which we conduct business. The Investigator is responsible for analytical review of suspicious claims utilizing various investigative methods and techniques. The investigator must evaluate relevant information essential in resolving suspicious and complex investigations. This position requires demonstrated effectiveness in the understanding and application of legal and claim principles. The SIU Investigator works under minimal supervision outside the office and would have access to transportation. Only candidates located in the Miami area will be considered. This is a field position. Please note a company car provided. Job Responsibilities Supports Claims Department operations in the research and investigation of suspicious or questionable property damage and injury claims Conducts recorded statements and Examinations Under Oath as required Completes field work as required. Documents claim files and communicates in writing as required Provides office training to ensure recognition of potentially suspicious or fraudulent files in the branch Reports suspicious claims to the department of insurance as required by statute Must ensure compliance with industry and company policies Must understand regulatory / statutory requirements; develops and maintains knowledge of changes in law both at state and national levels Properly utilizes our claims and other various systems Attends industry meetings for communication trends Completes individual monthly Investigator report to manager Attends and participates in team meetings Participates in roundtable meetings Actively affiliates and maintains network of SIU, claims, law enforcement, attorney and related contacts to ensure investigation methods are current and proper operating procedures are utilized Responsible for meeting individual goals and objectives Maintains consistent, fair and diplomatic interactions with co-workers Performs other duties as assigned by SIU Manager Job Qualifications Formal Education & Certification Undergraduate College Degree or equivalent work experience will be considered. Knowledge & Experience 5 years of special investigation experience required. Casualty and PIP claims, as well as medical clinic investigations will be highly preferred. Claims and Property Damage investigations experience will be required. Skills & Competencies Must be able to work in a fast-paced, paperless/automated production environment. Excellent PC skills are required. Excellent communication/interpersonal skills and ability to work with all levels within the organization and deal tactfully and diplomatically with public and outside authorities. Must be able to work as a team player throughout the company. Ensures that the highest degree of professionalism and integrity is maintained, and that decisions are made within the scope of what is fair, reasonable and appropriate according to applicable law and industry standards. Must have the ability to travel when necessary. Bilingual preferred. Florida Adjuster's license is required prior to employment start date.

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'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse. Conduct investigations of potential waste, abuse, and fraud Document activity on each case and refer issues to the appropriate party Perform data mining and analysis to detect aberrancies and outliers in claims Develop new queries and reports to detect potential waste, abuse, and fraud Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions Assist with complex allegations of healthcare fraud Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies Complete various special projects and audits Performs other duties as assigned Complies with all policies and standards Education/Experience: Bachelor's Degree in Business, Criminal Justice, Healthcare, related field or equivalent experience. 1+ years of medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation experience. Pay Range: $55,100.00 - $99,000.00 per year 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. 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. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Care Access is working to make the future of health better for all. With hundreds of research locations, mobile clinics, and clinicians across the globe, we bring world-class research and health services directly into communities that often face barriers to care. We are dedicated to ensuring that every person has the opportunity to understand their health, access the care they need, and contribute to the medical breakthroughs of tomorrow. With programs like Future of Medicine, which makes advanced health screenings and research opportunities accessible to communities worldwide, and Difference Makers, which supports local leaders to expand their community health and wellbeing efforts, we put people at the heart of medical progress. Through partnerships, technology, and perseverance, we are reimagining how clinical research and health services reach the world. Together, we are building a future of health that is better and more accessible for all. To learn more about Care Access, visit ******************* How This Role Makes a Difference The Sub-Investigator will be responsible for regional travel mixed with remote tele-medicine work to support our clinical research. Care Access is looking for Nurse Practitioners or Physicians Assistants to support clinical trial related activities in states throughout the USA. How You'll Make An Impact * Work closely with the Principal Investigator to oversee the execution of study protocols, delegating study related duties to site staff, as appropriate, and ensuring site compliance with study protocols, study-specific laboratory procedures, standards of Good Clinical Practice (GCP), Standard Operating Procedures (SOPs), quality (QA/QC) procedures, OSHA guidelines, and other state and local regulations as applicable * Attends and participates in meetings with the director, other managers, and staff as necessary * Complies with regulatory requirements, policies, procedures, and standards of practice * Read and understand the informed consent form, protocol, and investigator's brochure * Be available to see subjects virtually or in-person as dictated by project design, answer their questions, and resolve medical issues during the study visit * Sign and ensure that the study documentation for each study visit is completed * Perform all study responsibilities in compliance with the IRB approved protocol * Review screening documentation and approves subjects for admission to study * Review admission documentation and approves subject for randomization * Provide ongoing assessment of the study subject/patient to identify Adverse Events * Ensure that serious and unexpected adverse events are reported promptly to the Pl * Review and evaluates all study data and comments to the clinical significance of any out of range results * Perform physical examinations as part of screening evaluation and active study conduct * Provide medical management of adverse events as appropriate The Expertise Required * Excellent working knowledge of medical and research terminology * Excellent working knowledge of federal regulations, good clinical practices (GCP) * Ability to communicate and work effectively with a diverse team of professionals * Strong organizational skills: Able to prioritize, support, and follow through on assignments * Communication Skills: Strong verbal and written communication skills as evidenced by positive interactions with coworkers, management, clients and vendors * Team Collaboration Skills: Work effectively and collaboratively with other team members to accomplish mutual goals. Bring positive and supportive attitude to achieving these goals * Strong computer skills with demonstrated abilities using clinical trials database, IVR systems, electronic data capture, MS word and excel * Ability to balance tasks with competing priorities * Critical thinker and problem solver * Curiosity and passion to learn, innovate, able to take thoughtful risks and get things done * Friendly, outgoing personality; maintain a positive attitude under pressure * High level of self-motivation and energy * Ability to work independently in a fast-paced environment with minimal supervision * Must have a client service mentality Certifications/Licenses, Education, and Experience: * Nurse Practitioner or Physician Assistant with 5+ years of clinical experience * Currently licensed in good standing in one or more states listed above * A minimum of 1 year of relevant work experience as Sub-Investigator (preferred) in a Clinical Research setting How We Work Together * Location: This role is 100% on-site at our Memphis, TN clinic. * Travel: This is a remote position with less than 10% travel requirements. Occasional planned travel may be required as part of the role. * Physical demands associated with this position Include: The ability to use keyboards and other computer equipment. Benefits & Perks * Paid Time Off (PTO) and Company Paid Holidays * 100% Employer paid medical, dental, and vision insurance plan options * Health Savings Account and Flexible Spending Accounts * Bi-weekly HSA employer contribution * Company paid Short-Term Disability and Long-Term Disability * 401(k) Retirement Plan, with Company Match Diversity & Inclusion We work with and serve people from diverse cultures and communities around the world. We are stronger and better when we build a team representing the communities we support. We maintain an inclusive culture where people from a broad range of backgrounds feel valued and respected as they contribute to our mission. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to, and will not be discriminated against on the basis of, race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law. Care Access is unable to sponsor work visas at this time. If you need an accommodation to apply for a role with Care Access, please reach out to: ********************************

Job DescriptionDescriptionHealthcare Fraud Shield, a leader in healthcare fraud prevention and payment integrity solutions, is looking for a talented Coder or Clinical Coder/Fraud Investigator to join our team. Key Responsibilities Work with SIU Team (Clinical Reviewers, CPCs, Investigators, Analysts-including performing quality check on work, assisting in research, discuss to make appropriate coding determinations as needed) Analyze and interpret patient medical records (behavioral related and other specialties) pertaining to FWA investigations as needed Compare to information submitted on the claims in order to determine amount and nature of billable services as needed Determines appropriateness of billing and reimbursement as needed Documents findings for each claim line in a spreadsheet as needed Summarize findings in a written report as needed Abstracts CPT, HCPCS, Revenue Codes, DRG codes, and ICD-9/ICD-10 from medical records as needed Responsible for maintaining current knowledge of coding guidelines and relevant federal and/or state regulations as needed Perform data analysis and lead generation/data mining of client data as needed Conduct various aspects of FWA investigations as needed Provide Subject Matter Expertise and SIU support to clients as needed Comply with Privacy and Security standards Understands and complies with all company Privacy and Security standards Employee may not use or disclose any protected health information, except as otherwise permitted, or required, by law Other duties as needed Skills, Knowledge and Expertise Knowledge of medical terminology Knowledge of coding including CPT, HCPCS, Revenue Codes, DRG Codes, and ICD-10 Knowledge of specialty medical practices Must be detail oriented Ability to communicate effectively both verbally and in writing Strong listening skills Independent Responsible Self-disciplined Ability to meet defined performance and production goals Strong computer skills This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management CERTIFICATE/LICENSE Certified Professional Coder - (CPC ) through governing body AAPC or equivalent certification Minimum of one year of coding and/or billing experience is required. Benefits Medical, Dental & Vision insurance 401(k) retirement savings with employer match Vacation and sick paid time off 7 paid holidays & 2 floating holidays Paid maternity/paternity leave Disability & Life insurance Flexible Spending Account (FSA) Employee Assistance Program (EAP) Professional and career development initiatives Remote work eligible REMOTE WORK REQUIREMENTS Must have high speed Internet (satellite is not allowed for this role) with a minimum speed of 25mbs download and 5mbs upload. Healthcare Fraud Shield 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.

Block is one company built from many blocks, all united by the same purpose of economic empowerment. The blocks that form our foundational teams - People, Finance, Counsel, Hardware, Information Security, Platform Infrastructure Engineering, and more - provide support and guidance at the corporate level. They work across business groups and around the globe, spanning time zones and disciplines to develop inclusive People policies, forecast finances, give legal counsel, safeguard systems, nurture new initiatives, and more. Every challenge creates possibilities, and we need different perspectives to see them all. Bring yours to Block. The Role We are looking for an Investigator to join Block and support the continued buildout and evolution of our Special Investigations Team within the Block Compliance organization. The mission of the Special Investigations Unit (SIU) at Block is to monitor and act upon high-level, complex compliance-related escalations and referrals within both Square and Cash App; investigate and document incidents of potential money laundering, fraud, terrorist financing, elder abuse, human exploitation, employee misconduct investigations, and other illicit activities; work with several law enforcement agencies and track/log inquiries; write and review Suspicious Activity Reports to be transmitted to FinCEN and other applicable agencies. We investigate to ensure the safety and soundness of the Block system and maintain a healthy, compliant user base. You will support the SIU team by investigating potentially suspicious activity across the Block ecosystem. You will collaborate with the broader Intelligence team to ensure compliance with applicable laws, regulations and industry best practices. You Will Monitor and act upon high-level, complex compliance-related escalations and referrals within Square and Cash App Investigate and document incidents of potential money laundering, fraud, terrorist financing, and other illicit activities across the Square and Cash App platforms Write and review Suspicious Activity Reports to be transmitted to FinCEN and applicable agencies Use detective-like mentality to investigate potentially suspicious activity across all AML typologies across the Square and Cash App platforms Verify customer and counterparty information and conduct reviews for AML/BSA purposes Work with company partners to ensure full compliance with all applicable laws and policies Occasionally attend compliance-related seminars to stay up to date with the compliance industry You Have 3+ years experience working within the Law Enforcement or Intelligence Community, with specialization in Drug Trafficking, Human Trafficking or related typologies. Investigative skills, including familiarity with public record research and database tools. Knowledge of AML transaction monitoring/suspicious activity reporting typologies and risks regarding funds transfers/peer-to-peer payments, equities, and cryptocurrency. Intermediate experience with SQL or Snowflake You should demonstrate transaction skills that apply across numerous financial products in complex scenarios Comprehension and understanding of AML laws, rules and regulations Experience and comprehension of Excel and the entire suite of Google products Can work well in a team setting, and liaison with different law enforcement agencies and government agencies Meet regulatory mandates and filing deadlines Support Block Compliance and work in collaboration with Customer Support, Risk, Engineering, and other operations teams within the company as a whole Technologies We Use and Teach Relevant industry certifications (CAMS, CFE, CFCS, CRCM) Previous experience drafting and authoring SAR narratives for a financial institution such as a bank or broker dealer Create presentations for stakeholders and vendor staff. Experience with QC design, implementation, and operations. Manage projects and tasks end to end autonomously, providing regular updates to management We're working to build a more inclusive economy where our customers have equal access to opportunity, and we strive to live by these same values in building our workplace. Block is a proud equal opportunity employer. We work hard to evaluate all employees and job applicants consistently, based solely on the core competencies required of the role at hand, and without regard to any legally protected class. We believe in being fair, and are committed to an inclusive interview experience, including providing reasonable accommodations to disabled applicants throughout the recruitment process. We encourage applicants to share any needed accommodations with their recruiter, who will treat these requests as confidentially as possible. Want to learn more about what we're doing to build an inclusive workplace? Check out our Inclusion & Diversity page Block takes a market-based approach to pay, and pay may vary depending on your location. U.S. locations are categorized into one of four zones based on a cost of labor index for that geographic area. The successful candidate's starting pay will be determined based on job-related skills, experience, qualifications, work location, and market conditions. These ranges may be modified in the future. To find a location's zone designation, please refer to this resource. If a location of interest is not listed, please speak with a recruiter for additional information. Zone A:$106,600-$159,800 USDZone B: $99,100-$148,700 USDZone C:$90,600-$136,000 USDZone D:$80,000-$120,000 USD Use of AI in Our Hiring Process We may use automated AI tools to evaluate job applications for efficiency and consistency. These tools comply with local regulations, including bias audits, and we handle all personal data in accordance with state and local privacy laws. Contact us at privacy@block.xyz with hiring practice or data usage questions. Every benefit we offer is designed with one goal: empowering you to do the best work of your career while building the life you want. Remote work, medical insurance, flexible time off, retirement savings plans, and modern family planning are just some of our offering. Check out our other benefits at Block. Block, Inc. (NYSE: XYZ) builds technology to increase access to the global economy. Each of our brands unlocks different aspects of the economy for more people. Square makes commerce and financial services accessible to sellers. Cash App is the easy way to spend, send, and store money. Afterpay is transforming the way customers manage their spending over time. TIDAL is a music platform that empowers artists to thrive as entrepreneurs. Bitkey is a simple self-custody wallet built for bitcoin. Proto is a suite of bitcoin mining products and services. Together, we're helping build a financial system that is open to everyone. Privacy Policy

Treliant is an essential consulting firm serving banks, mortgage originators and servicers, fintechs, and other companies providing financial services globally. We are led by practitioners from the industry and the regulatory community who bring deep domain knowledge to help our clients drive business change and address the most pressing compliance, regulatory, and operational challenges. We provide data-driven, technology-enabled consulting, implementation, staffing, and managed services solutions to the regulatory compliance, risk, credit, financial crimes, and capital markets functions of our clients. Founded in 2005, Treliant is headquartered in Washington, DC, with offices across the United States, Europe, and Asia. Treliant is committed to fostering a diverse, equitable and inclusive environment that values and embraces all races, religions, ages, abilities, genders, sexual orientations, ethnicities, languages, nationalities, political parties, socioeconomic groups and other characteristics that inform an individual's worldview, experiences and system of beliefs (“the principles”). We believe in championing every voice and ensuring everyone's full potential. Treliant is hiring experienced AML/BSA Analysts and Investigators for project-based client engagements. All work will be 100% remote. Responsibilities While the scope of each project may be different, your duties & responsibilities may include: Review and independently assess cases derived from Anti-Money Laundering (AML)/Bank Secrecy Act (BSA) suspicious activity monitoring and Economic Sanctions/Office of Foreign Assets Control (OFAC) screening conducted by Treliant or client. Review and independently assess Customer Due Diligence (CDD) and Enhanced Due Diligence (EDD) cases derived from customer profile monitoring to ensure complete and accurate Know Your Customer (KYC) profiles and Customer Identification Program (CIP) requirements. Utilize transaction monitoring and case management systems (as available), vendor solutions, and open source tools to conduct investigations. Compare observed activity with client KYC and expected activity profiles for potentially suspicious transactions or behaviors. Prepare observations from review and analysis through compiling of review notes, documentation and resolution. Interact with client compliance and operational staff, customer service areas and management in conducting reviews. Determine whether activity should be escalated for further review based on alert reviews. Determine whether suspicious activity reports (SARs) should be filed based on case investigations. Manage of weekly case load in a timely fashion in accordance with Treliant's Service Level Agreement (SLA's). Meet weekly time-keeping and reporting requirements vis-à-vis client and Treliant. Communicate professionally, transparently, and in a timely fashion regarding weekly scheduling to client and/or Treliant Supervisors. Qualifications Knowledge of government regulatory requirements and expectations for identifying unusual or suspicious activity in connection with financial transactions, related to economic sanctions (e.g., OFAC), and the requirements to file suspicious activity reports. Five (5) years of experience conducting AML/BSA and/or Economic Sanctions/OFAC investigations at financial institutions. Strong analytical skills derived from previous experience in a Financial Intelligence Unit (FIU) or similar investigative setting including former law enforcement. Strong written and verbal communication skills a must to work effectively with all levels of consultants and client staff. Ability to work well with others as well as independently and with minimal supervision. Strong organizational and time management skills and ability to handle multiple tasks/projects simultaneously. Proficient in various software applications including Excel, Word, PowerPoint, email, banking systems and transaction monitoring/case management software (e.g., Mantas, Actimize, Fircosoft, Fiserve AML Manager, PRIME Compliance Suite). Experience conducting and interpreting Lexis Nexis and Negative News Searches. Experience writing SAR and alert/case narratives summarizing the results of investigations and selecting requisite supporting documentation. Experience with historical transaction analyses (i.e., “lookbacks”) preferred, including conducting flow of funds analysis and compiling associated supporting documentation. Prior consulting experience preferred. Benefits Primary Location: Remote Primary Location Salary Range: $25/hr - $65/hr Treliant offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefit package that reflects our commitment to creating a diverse and supportive workplace. In addition to a competitive base salary, candidate is eligible for incentive pay as well as a full range of health benefits, vacation plan, and 401k plan. If you want to be part of a dynamic team of professionals, we invite you to join the team at Treliant. We invest in people, and challenge you to advance your career while achieving your aspirations and goals. Here at Treliant, we pride ourselves on our collaborative team culture, where we embrace diversity of thought and innovation. If you strive for excellence and seek an inclusive environment apply on line treliant.com and follow us on LinkedIn. Right to Work Treliant is not in the position to provide sponsorship for this current position and so applicants must be able to work in the United States without requiring sponsorship. Please note, Treliant receives a high volume of applications for all roles. While we will endeavor to respond to all applicants, this is not always possible. Should you not receive a response to your application within 2 weeks, it is likely that you will have been unsuccessful on this occasion. However, we would like to retain your details on our systems and may contact you should another potentially suitable vacancy arise. Treliant LLC is an Equal Opportunity Employer and does not discriminate on the basis of race, color, national origin, sex, sexual orientation, genetic information, religion, age, disability, or military status in employment or provision of services. When contacted for an interview, an applicant who requires special accommodations due to a disability should notify the office so that proper arrangements can be made.

Mission Lane is combining the power of data, technology, and exceptional service to pave a clear way forward for millions of people on the path to financial success. By attracting top talent and leveraging cutting-edge technology, we're enabling people to unlock real financial progress. Sound like a mission you can get behind? We're seeking an inspirational people manager with expertise in fraud operations and a passion for fostering team engagement to join our Fraud Investigation Team (FIT) as an Operations Lead. This is a unique opportunity to make an impact at a company on the verge of becoming the household name in consumer credit for the 50% of Americans who are not served by traditional financial institutions. The Impact You'll Make in this Role: You'll drive forward our mission of enabling financial progress by empowering your team to protect cardholders and Mission Lane from fraudulent activity. Your leadership will inspire team engagement, optimize performance, and drive efficiency. You'll lead a dynamic team of ~15 Fraud Investigation associates, delivering exceptional customer experiences while meeting internal goals and regulatory obligations. Through coaching, collaboration and efficient time management, you'll play a pivotal role in driving success across the FIT team. As Operations Lead, Fraud Investigations Team, you wil: Coach for Growth: Provide continuous feedback, conduct performance reviews, and support team members' development, helping them excel in their roles and prepare for future opportunities. Foster Engagement: Create a culture of trust, collaboration, and accountability by promoting open communication, recognizing achievements, and supporting individual and team well-being. Monitor and Optimize Performance: Analyze team and individual data to identify improvement areas, coaching team members to drive efficiency and achieve goals. Improve Processes: Lead local initiatives, identify opportunities for process enhancement, and contribute to cross-functional projects that enhance the customer experience. Communicate Effectively: Keep the team informed of company updates, priorities, and changes, while managing schedules, time-off requests, and project updates seamlessly. Be Present and Supportive: Act as a resource for escalations, assist with complex cases, and provide guidance whenever team members require additional support. You'll thrive in this role if you have: 1+ years of supervisory experience in Fraud Operations, in the credit or banking industry. Solid understanding of fraud detection and investigation practices in a frontline setting. Strong leadership and coaching skills, with a proven ability to inspire and influence others. Excellent communication skills, including written, verbal, and listening abilities. Advanced problem-solving, prioritization, and time management skills to navigate a fast-paced environment. Ability to collaborate with cross-functional teams and ensure alignment with policies, goals, and objectives. Compensation Annual full-time base salary range: $59,000 - $65,000 Additional compensation in the form(s) of participation in our annual incentive program and equity are dependent on role. Pay is based on factors such as work experience, education, certification(s), training, skills, and competencies related to the role. Mission Lane also offers a comprehensive benefits plan, which includes unlimited paid time off, 401(k) match, a monthly wellness stipend, health/ dental/ vision insurance options, disability coverage, paid parental leave, flexible spending account (for childcare and healthcare), life insurance, and a remote-friendly work environment. About Mission Lane: Founded in December 2018, Mission Lane is a purpose-driven fintech company based in the U.S., with headquarters in Richmond, Virginia. It all started with a realization: nearly fifty percent of the adult population in the U.S. doesn't have access to a clear line of credit. Most traditional credit card companies either overlook or overcharge this group because they have less-than-perfect credit scores or no scores at all. We decided this just wouldn't do. In partnership with our sponsor banks, we offer credit cards under the Mission Lane brand name, with better, clearer terms, and a more refined customer experience than the alternatives available to people working hard to improve their credit. To date, over four million consumers have chosen Mission Lane, earning high customer ratings on Credit Karma for its market segment and industry leading Net Promoter scores. Mission Lane has cumulatively raised over $600 million of equity from leading investors, including Invus Opportunities, QED Investors, LL Funds, funds affiliated with Oaktree Capital Management, and other leading investors. Our commitment to a workplace built on respect and dignity is guided by our core value of Unity. We believe that everyone plays a vital role in our shared purpose, and we actively cultivate an environment where all individuals have the opportunity to do their best work. By fostering a culture of empathy and collaboration, we create a strong sense of belonging and support for every team member. Mission Lane is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, disability, genetic information, or any other protected status. Mission Lane provides reasonable accommodations to applicants who need them for medical or religious reasons, as required by law. Applicants can initiate an accommodation request by contacting ********************************. Mission Lane is not sponsoring new applicant employment authorization and please, no third-party recruiters. Application Integrity: Our cardholders trust us with their financial well-being, and this trust starts with the integrity of the people on our team. We're looking for team members who share our dedication to transparency and truth. Please verify that the information in your application is accurate and complete. Providing any information to Mission Lane that is not completely truthful at any point during the application or hiring process may result in removal from the hiring process, disqualification from future opportunities, withdrawal of an offer or other sanctions for candidates and, in addition for employees, disciplinary action, up to and including termination of employment.

At Quality Claims Management Corp. and our affiliate companies, we have years of expertise in representing financial institutions across a wide range of banking law matters, and we're looking for passionate, driven candidates to join our dynamic team! With offices in Arizona, Arkansas, California, Colorado, Nebraska, Nevada, New Mexico, Oregon, Texas, and Washington, we offer opportunities across multiple locations. Our workplace is more than just a job - it's a supportive, collaborative environment where your contributions truly matter. You'll be part of a team that values hard work, creativity, and dedication, while enjoying a strong sense of community. We offer performance-based bonuses, competitive compensation, and a range of incentives that reward your success. Plus, with generous benefits, enhanced employer contributions, and paid time off, we prioritize your well-being and work-life balance. Summary: Quality Claims is looking for a Junior Private Investigator to work with our investigative team. Qualified candidates are not required to be individually licensed but must be able to successfully complete the background screening necessary to become an investigator. This position provides hands-on training and experience in working actual case assignments for a private investigative agency. The candidate will perform investigations to include skip tracing, background investigations, locating subjects evading service of process, surplus funds investigations, and locating mobile assets. Key Responsibilities: Collect information, documentation, and physical evidence associated with investigations Perform online research and genealogy research Obtain records online or through state and local agencies Interview subjects and extract information Draft formal investigative reports and emails Identify and compile supporting documents Calculate billable hours worked and prepare invoices Enter notes and update files Source local investigators and process servers (nationwide) for in-personal interviews and personal service Provide other direct assistance to investigative staff throughout the investigative process May perform other duties as assigned to support department goals. May occasionally work extended hours based on operational needs. Experience and Skills: Strong written and verbal communication skills Ability to connect with people An inquisitive nature/ability to solve puzzles Strong analytical skills Strong online research skills (including social media) Familiarity with Microsoft suite of products Qualifications: Bachelor's degree in a relevant field or 1 year of investigative experience Bi-lingual (Spanish & English) preferred Work Schedule: This is a 100% office position requiring your physical presence Monday through Friday, with business hours from 8:00 AM to 5:00 PM. Salary Range: The salary for this position typically ranges from $21-$23/hour, depending on qualifications, experience, and other factors. Please note that the final offer may differ based on the candidate's specific qualifications, skills, and experience, as well as internal equity and business needs. Benefits: Quality Claims Management Corp. and affiliated companies promote work/life balance with a robust wellness program, PTO, remote work, and flexible schedules (when available). Full-time employees become eligible for benefits following a 30-day waiting period, with benefit offerings that include medical, dental, vision, life, AD&D, EAP, STD, and LTD. Additionally the firm provides parental leave for both primary and non-primary caregivers as well. Also available are voluntary income protection benefits such as supplemental life, accident, critical illness, and short and long-term care insurances, as well as a 401(k)-retirement plan with a company match. Part-time employees may have access to some of these benefits, which may be on a pro-rated basis. Security Requirement: While performing the duties of this job, the employee is required to ensure the security and confidentiality of all sensitive information, including but not limited to threats or hazards to the security or integrity of sensitive information that could result in any harm or inconvenience to any customer, employee or company. Work Environment: A corporate office environment with a professional setting, characterized by a quiet to moderate noise level. Employees may work in individual or shared workspaces, with standard office equipment such as computers, printers, and telephones. Occasional meetings, collaborative discussions, and business activities may contribute to variations in noise levels. Next Steps: Ready to take the next step? Apply now and be part of our thriving team! ************************************************************************************************************************ Id=**********673_2&lang=en_US Notices: The above information on this job description is designed to indicate the general nature and level of work performed by incumbents. Other duties and responsibilities not specifically described may be assigned from time to time, consistent with the knowledge, skills, and abilities of the incumbent. Quality Claims Management Corp. is an Equal Opportunity Employer. We are committed to providing a work environment free from discrimination and harassment. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law. We celebrate diversity and are dedicated to creating an inclusive environment for all employees. Qualified applicants with a criminal history will be considered pursuant to the San Diego County Fair Chance Ordinance, the California Fair Chance Act, and other applicable state or local laws. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made. After making a conditional offer and running a background check, if there are concerns about a conviction directly related to the job, you will be given the chance to explain the circumstances, provide mitigating evidence, or challenge the accuracy of the background report. For more information about the Fair Chance Ordinance, visit the San Diego County Office of Labor Standards and Enforcement webpage. As part of our commitment to maintaining a lawful and compliant workforce, we participate in the E-Verify program. All candidates who accept a job offer will be required to complete the E-Verify process to verify their employment eligibility in the United States. Applications will be accepted until November 3, 2025.

Your career starts now. We are looking for the next generation of health care leaders. is remote however, you must live and be able to travel within Ohio as business needs. At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to hear you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at *************************** The Investigator is responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving the full range of products at the AmeriHealth Caritas Family of Companies (ACFC). Major Accountabilities: * Ensures compliance with all requirements related to Special Investigation Units and fraud, waste and abuse investigations. * Conducts investigations of potential fraud, waste and/or abuse with a focus on thoroughness and attention to detail, quality, timeliness and cost control. * Conducts comprehensive interviews with providers, members and witnesses to obtain information which would be considered admissible under generally accepted criminal and civil rules of evidence. * Proactively performs research using the Internet, data analysis tools, etc., to analyze aberrant claims billing and practice patterns. * Analyzes data as part of the investigative process using available fraud detection software and corporate resources. * Represents ACFC in conducting settlement negotiations with providers, counsel and/or other associated parties. * Prepares and submits investigative reports covering all phases of the investigation. * Interprets and conveys highly technical information to others. * Establishes and maintains liaison with public officials, law enforcement and others to obtain assistance in conducting investigations. * Performs necessary functions to support all aspects of SIU investigations and responsibilities to include, but not limited to: Intake; Screening; Reviews; Referrals; Recoveries; and Provider Investigative Site Visits. Education/ Experience: * Bachelor's degree with a minimum of two years of experience in the healthcare field working in fraud, waste, and abuse investigations and audits OR * An associate's degree, with a minimum of four years of experience working in healthcare fraud, waste, and abuse investigations and audits. * Experience and training/certifications commensurate with position requirements in lieu of formal educational requirements for the Lead SIU Investigator position may be considered. * Valid driver's license required * Data Analytics experience preferred. * Ability to work independently with minimal supervision, and manage a high volume of assignments. * Strong verbal and written communication skills. * High degree of integrity and confidentiality required handling information that is considered personal and confidential. * Analytical skills and ability to make deductions; logical and sequential thinker. * A minimum of 3-5 years experience conducting comprehensive health care fraud investigations; interacting with state, federal and local law enforcement agencies. Other Skills: * Health care industry and/or Medicare/Medicaid/Pharmacy/Behavioral Health/Pharmacy Benefit Management knowledge required. * Clinical Experience preferred * SIU and/or State Medicaid regulatory compliance work experience preferred. * Knowledge and proficiency in claims adjudication standards & procedures preferred. * Solid knowledge of Medicaid, Medicare, and pharmacy benefit laws and requirements; federal, state, civil and criminal statutes. * Experience with decision support tools used for data analysis. * Advanced knowledge and experience working on various approaches to fraud, waste and abuse. * Working knowledge of Microsoft applications, especially Excel required. * Knowledge of available resources (internal and external) to assist in investigations. Diversity, Equity, and Inclusion At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve. We keep our associates happy so they can focus on keeping our members healthy. Our Comprehensive Benefits Package Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values - honesty, integrity, loyalty and service - define how we treat each other and our members. Be part of what truly makes us special and impactful. The Opportunity We are seeking a talented Fraud Governance Advisor Lead who will be dedicated support for the Life Company Fraud Program, engaging in the planning, execution, and delivery of First Line Fraud projects intended to accomplish business goals and objectives within prescribed timeframes and applicable compliance frameworks. Effectively influencing key stakeholders, project/program teams, Second Line of Defense, and management/executive leadership to ensure objectives are met. This role establishes, executes and governs fraud management activities to include risk assessments, policies, frameworks, standards, processes and tools as a first line of defense function. Serves as a fraud risk management subject matter expert to ensure documents, projects, programs, processes, and product initiatives comply with regulatory, legal requirements, and fraud policies and standards. Partners and collaborates with the lines of business, Compliance and Risk Management, Audit Services, Legal, and Regulators to support enterprise fraud management-based initiatives for the Staff Agency or Line of Business (LOB) supported. We offer a flexible work environment that requires an individual to be in the office 4 days per week. This position will be based on the San Antonio campus. Relocation assistance is not available for this position. What you'll do: Leads cross-functional team members in strategic development, implementation and execution of highly complex or unique fraud risk management workstreams, projects and solutions. Provides thought leadership and subject matter expertise to guide the strategic direction of fraud risk requirements on business action plans, projects or operational requests based on regulatory guidance. Applies a holistic understanding of fraud risk management requirements, policies, laws, and regulations to business strategies, programs and solutions. Anticipates how the organization must adapt to changes in the industry to sustain competitive advantage. Oversees the execution of risk assessments with business partners and the lines of business to include root cause analysis to determine impact and solutions. Anticipates and identifies operational inefficiencies and emerging fraud management risks, compliance, and control issues in the operating environment, concurrent with implementing action plans to mitigate business impact. Provides technical guidance of a complex or unique nature to functional areas within Enterprise Fraud Management on regulatory requirements and requests to ensure proper execution of conduct examinations. May oversee regulatory requirements and requests and/or conduct examinations. Serves as a primary resource to d team members and to cross-functional teams in support of fraud-based initiatives. Regularly briefs executive management on enterprise projects and initiatives that may impact fraud risk. Anticipates future training needs tied to fraud risk management through understanding regulatory and industry trends. Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures. What you have: Bachelor's degree OR 4 years of related fraud, compliance, risk, audit or regulatory experience (in addition to the minimum years of experience required) may be substituted in lieu of degree. (Total of 12 years of experience without bachelor's degree) 8 years of operations experience in a relevant functional area to include financial services, Fraud, AML, compliance, risk, audit, third party risk management or other related operational areas that support fraud risk management initiatives within the business. 6 years of fraud, compliance, risk, audit, or regulatory related experience with accountability for projects, programs, processes or policies. Expert knowledge of relevant laws, regulatory, compliance, industry regulations and regulatory data sources. Demonstrated analytical, organizational and problem-solving abilities requiring a high attention to detail to identify fraud risks and trends. Strong communication skills with the ability to collaborate and execute among cross-functional teams, including all levels of the organization and with external regulatory agencies. Proven ability to lead and influence others in a cross-functional environment. Knowledge of federal laws, rules, and regulations to include: PCI, REG CC, REG E, UCC, FCRA, BSA/AML, Elder Financial Exploitation guidance, OCC Fraud Risk Management 2019-37. What sets you apart: US military experience through military service or a military spouse/domestic partner Demonstrated experience in Business Process Management (planning, development of relevant business objectives/metrics/tactics, execution, post implementation support, Issue Management, Experience and/or Process Ownership). Strong knowledge and experience in Fraud, AML, or Program Management frameworks including experience with governance documentation. Experience creating/building/delivering process flows, connections, data driven insights, trending, and executive/management presentations and deliverables Proven skills in collaboratively interacting with partners, stakeholders to influence, facilitate, and drive projects, process improvements, initiatives, efforts, etc. Strong (oral and written) communication with executive leadership and key stakeholders to provide effective reporting and insights. Proven experience in driving and achieving a continuous process improvement team environment. Experience leading projects and/or efforts that utilize blended agile & waterfall methodologies. Fraud or AML-related certifications/designations i.e.., CFE, CAMS, CAFS, CFCI Compensation range: The salary range for this position is: $127,310 - $229,160 USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.). Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors. The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job. Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals. For more details on our outstanding benefits, visit our benefits page on USAAjobs.com. Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting. USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start **Caring. Connecting. Growing together.** Work at home! The Medical Director for UnitedHealthcare's Investigations Unit (UHC IU) is a valuable national leader for UnitedHealthcare. The Medical Director oversees a coding team, ensuring accurate and efficient healthcare payments, accurate appeal outcomes, and collaborates with clinical and coding teams across UnitedHealthcare and Optum, as well as UHG business leaders and stakeholders, to drive informed decision-making and optimize outcomes. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. **Primary Responsibilities:** + Oversee and perform medical record reviews of retrospective medical claims relative to fraud, waste and abuse to include all levels of complexity + Have the ability to review/code a variety of medical records using CPT, HCPCS and ICD-10 codes for office, outpatient, inpatient, surgical, hospital ancillary, nursing facility, urgent care, ambulatory surgery center and other charges for physicians and other providers of professional billing + Provide clinical oversight and guidance to UHC IU medical record review team and UHC IU investigative staff + Serve as a resource and Subject Matter Expert for team members in the UHC IU + Document medical review findings on a claim level and draft reports of findings, actions and outcomes to be relied on in investigations of fraud, waste, and abuse cases in accordance with policies, and regulatory and accreditation requirements + Ensure compliance with the UnitedHealthcare (UHC) Fraud, Waste and Abuse policies and other federal/state regulations or contractual obligations + Communicate with UnitedHealthcare investigative staff regarding coding/clinical rationales + Supply all criteria that was relied on, supporting all recommendations for denial or modification of claim payment errors + Serve as a clinical resource for team members in the UHC IU + Support the UHC IU in their interactions with providers to explain review/ medical record review findings and the application of coding/clinical criteria + Engage with requesting providers as needed in peer-to-peer discussions + Actively participate in team meetings focused on communication, feedback, problem solving, process improvement, staff training and evaluation, and the sharing of program results + Provide clinical and strategic input when participating in organizational committees, projects, and task forces + Develop quality audit practices to ensure UHC SIU's Medical Record Review Team is adhering to proper coding/clinical guidelines and ensuring clinical justification meets expected standards You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + MD or DO with an active, unrestricted license + Board certification approved by the American Board of Medical Specialties (ABMS/AOBMS) + 5+ years of clinical practice experience + Familiarity with current medical issues and practices + Proficiency in performing medical record case reviews in accordance with established reimbursement and medical policies + Intermediate or higher level of proficiency with managed care + Proven excellent telephonic communication skills; excellent interpersonal communication skills + Proven solid critical thinking and analytic skills + Proven ability to manage multiple competing priorities + Demonstrated ability to communicate effectively, to include written and verbal forms of communication + Proven data analysis and interpretation skills + Proven excellent presentation skills for both clinical and non-clinical audiences + Proven creative problem-solving skills + Proven excellent computer skills, typing, word processing, presentation, and spreadsheet applications skills. Internet research skills + Proven solid team player and team building skills **Preferred Qualifications:** + Coding certification (CPC, CCS, etc.) + Knowledge and experience in health care fraud, waste, and abuse (FWA) investigations + Broad knowledge and experience in state and federal regulatory FWA requirements *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Compensation for this specialty generally ranges from $238,000 to $357,500. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

Ethos Risk Services is continuing to expand our team of Private Field Surveillance Investigators! We are looking for Experienced Licensed Investigators to investigate fraud and conduct covert surveillance in the field (from your vehicle). Ethos Risk is one of the largest and most respected fraud investigations businesses in the US. Join us in uncovering the facts, keeping insurance costs from rising, and serving our clients in a fully remote position. Are you ready to join the best fraud investigation company in the industry? Apply now! Ethos Risk Services: What drives us At Ethos, you'll find more than just a job - you'll discover a purposeful career where your contributions make a lasting impact. Join us and become a trusted partner in insurance claims management and fraud investigations, delivering certainty and peace of mind to every client we serve. What does aN Experienced Surveillance Investigator do? As a Surveillance Investigator at Ethos Risk Services, you will conduct covert surveillance, review files, and draft detailed case reports. Working autonomously from your vehicle, you will capture video evidence of surveillance targets, collaborate with our Operations Managers, and ultimately improve the integrity of the health care and insurance industry. Join a team that celebrates high performers, values employees, and delivers results. What you need to be successful To qualify for this position candidates must possess: A valid private investigator license A valid driver's license A well-maintained / reliable vehicle (preferably with tinted windows) In this role you will use discretion, communicate with our Operations Managers regularly, and apply critical thinking skills while conducting surveillance and gathering evidence. Adaptability, attention to detail, and strong analytical capabilities are essential qualities for success at Ethos. Candidates who are self-motivated, resourceful, and able to maintain a high level of professionalism in various situations will thrive in this position. Work Schedule Most investigations will begin at 6AM and may require you to leave your home between 4-5AM. Candidates who are willing to work most weekends and holidays will be prioritized in the hiring process. Make your move If you think this position is a fit for what you are looking for, applying is a snap - just follow the instructions on this page. Good luck! 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 protected by law. A background check will be conducted, in accordance to the local state law and regulations.

Job Description Care Access is working to make the future of health better for all. With hundreds of research locations, mobile clinics, and clinicians across the globe, we bring world-class research and health services directly into communities that often face barriers to care. We are dedicated to ensuring that every person has the opportunity to understand their health, access the care they need, and contribute to the medical breakthroughs of tomorrow. With programs like Future of Medicine , which makes advanced health screenings and research opportunities accessible to communities worldwide, and Difference Makers , which supports local leaders to expand their community health and wellbeing efforts, we put people at the heart of medical progress. Through partnerships, technology, and perseverance, we are reimagining how clinical research and health services reach the world. Together, we are building a future of health that is better and more accessible for all. To learn more about Care Access, visit ******************* How This Role Makes a Difference The Sub-Investigator will be responsible for regional travel mixed with remote tele-medicine work to support our clinical research. Care Access is looking for Nurse Practitioners or Physicians Assistants to support clinical trial related activities in states throughout the USA. How You'll Make An Impact Work closely with the Principal Investigator to oversee the execution of study protocols, delegating study related duties to site staff, as appropriate, and ensuring site compliance with study protocols, study-specific laboratory procedures, standards of Good Clinical Practice (GCP), Standard Operating Procedures (SOPs), quality (QA/QC) procedures, OSHA guidelines, and other state and local regulations as applicable Attends and participates in meetings with the director, other managers, and staff as necessary Complies with regulatory requirements, policies, procedures, and standards of practice Read and understand the informed consent form, protocol, and investigator's brochure Be available to see subjects virtually or in-person as dictated by project design, answer their questions, and resolve medical issues during the study visit Sign and ensure that the study documentation for each study visit is completed Perform all study responsibilities in compliance with the IRB approved protocol Review screening documentation and approves subjects for admission to study Review admission documentation and approves subject for randomization Provide ongoing assessment of the study subject/patient to identify Adverse Events Ensure that serious and unexpected adverse events are reported promptly to the Pl Review and evaluates all study data and comments to the clinical significance of any out of range results Perform physical examinations as part of screening evaluation and active study conduct Provide medical management of adverse events as appropriate The Expertise Required Excellent working knowledge of medical and research terminology Excellent working knowledge of federal regulations, good clinical practices (GCP) Ability to communicate and work effectively with a diverse team of professionals Strong organizational skills: Able to prioritize, support, and follow through on assignments Communication Skills: Strong verbal and written communication skills as evidenced by positive interactions with coworkers, management, clients and vendors Team Collaboration Skills: Work effectively and collaboratively with other team members to accomplish mutual goals. Bring positive and supportive attitude to achieving these goals Strong computer skills with demonstrated abilities using clinical trials database, IVR systems, electronic data capture, MS word and excel Ability to balance tasks with competing priorities Critical thinker and problem solver Curiosity and passion to learn, innovate, able to take thoughtful risks and get things done Friendly, outgoing personality; maintain a positive attitude under pressure High level of self-motivation and energy Ability to work independently in a fast-paced environment with minimal supervision Must have a client service mentality Certifications/Licenses, Education, and Experience: Nurse Practitioner or Physician Assistant with 5+ years of clinical experience Currently licensed in good standing in one or more states listed above A minimum of 1 year of relevant work experience as Sub-Investigator (preferred) in a Clinical Research setting How We Work Together Location: This role is 100% on-site at our Memphis, TN clinic. Travel: This is a remote position with less than 10% travel requirements. Occasional planned travel may be required as part of the role. Physical demands associated with this position Include: The ability to use keyboards and other computer equipment. Benefits & Perks Paid Time Off (PTO) and Company Paid Holidays 100% Employer paid medical, dental, and vision insurance plan options Health Savings Account and Flexible Spending Accounts Bi-weekly HSA employer contribution Company paid Short-Term Disability and Long-Term Disability 401(k) Retirement Plan, with Company Match Diversity & Inclusion We work with and serve people from diverse cultures and communities around the world. We are stronger and better when we build a team representing the communities we support. We maintain an inclusive culture where people from a broad range of backgrounds feel valued and respected as they contribute to our mission. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to, and will not be discriminated against on the basis of, race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law. Care Access is unable to sponsor work visas at this time. If you need an accommodation to apply for a role with Care Access, please reach out to: ********************************