Criminal investigations division investigator jobs near me - 67 jobs

The Clinical Investigator monitors service delivery for program integrity through fraud and abuse investigations and audits, including review of claims data, clinical records and reference materials, investigative interviewing, provider education and technical assistance, and monitoring implementation of provider corrective actions. The Investigator reports overpayments and other irregularities and confers with Special Investigations Unit, Senior Management, Chief Compliance Officer and General Counsel as needed. This position will allow the successful candidate to work primarily remote schedule. The candidate must be a resident of North Carolina or reside within 40 miles radius of North Carolina's border. There is no expectation of being in the office routinely, however, the selected candidate will be required to travel to provider sites to conduct audits/investigations in Charlotte, North Carolina up to 3 times per month. Responsibilities & Duties Conduct Audit/Investigations and prepare reports Review allegation(s), conduct preliminary investigation and make disposition recommendations using independent judgment Develop audit/investigation plans and tools based upon alleged non-compliance and data analytics Request and/or collect medical records, personnel records, policies/procedures, compliance plans, and other documents from providers based on audit/investigation plans Systematically and accurately collect, document, and store evidence Conduct post-payment audits of Medicaid and State funded providers to ensure that services are rendered in accordance with established state and federal rules, regulations, policies, and terms of provider contractual agreements with the state Identify inappropriate billing and overpayments Utilize clinical knowledge and experience to determine if documented services were clinically appropriate and/or medically necessary Conduct interviews with provider employees, former employees, recipients of services, and other witnesses Document allegations, investigative activities, and findings in a detailed audit/investigation report Work with the Special Investigations Supervisor and Investigative Team to support investigative activities Assure that individuals served do not pay for health services inappropriately Track allegations of fraud, waste, and abuse in a case management system from referral to final disposition Consult with the Corporate Compliance Unit when potential internal compliance issues are identified Consult on cases Provide clinical guidance to non-clinical staff on documentation obtained from providers Provide guidance to non-clinical staff on Medicaid Clinical Coverage Policies and State Service Definitions and by participating in ad hoc meetings related to clinical regulatory matters Participate in ad hoc meetings related to clinical matters Conduct Regulatory Review/ Research Diligently research clinical policies, administrative code, federal/state laws in order to assess for non-compliance Analyze data Analyze data from a variety of sources, including but not limited to claims, authorizations, credentialing/enrollment, grievances, prior audits/investigations, incarceration records, incident reports, policies/procedures, to inform decision making Utilize various MicroStrategy reports data during the investigation process Analyze claims data to determine if an allegation is supported Analyze claims data during investigations to determine if there are indicators of fraud/abuse other than the allegation received Identify other data sources to review during investigations based on the allegation(s) Provide Case reports/presentations to internal and external stakeholders Present audit/investigation findings and make disposition recommendations using independent judgment to the Chief Compliance and Risk Officer, Senior Director of Program Integrity, Special Investigations Supervisor, and Alliance Compliance Committee Present case status updates in individual supervision sessions, unit team meetings, Division meetings (as designated by supervisor), and to NC Department of Justice (as requested) Conduct and participate in Investigation Planning meetings with the Investigation Team Interpret and convey highly technical information to others Provide Technical Assistance/Education Educate providers on the errors identified in the audit and investigation process Recognize when providers can improve through technical assistance (TA) rather than full investigation when FWA is not evident and/or pervasive Recognize quality of care issues in order to make recommendations to appropriate entities/authorities Monitor Provider Action and Follow-Up Document Improper Payment Charts, Statements of Deficiency, provides feedback and technical assistance to providers as needed/requested, and follows up on provider corrective action through the probation process, as applicable Prepare for and participate in provider appeal process and/or court hearings to explain and defend audit/investigation findings Recommend policy, procedure, or process changes Recommends revisions to Alliance Health procedures and policies Minimum Requirements Education & Experience Graduation from an accredited school of Nursing with a Registered Nurse (RN) license and five (5) years relevant post-graduate experience. OR Master's degree in human services/social sciences, health care compliance, analytics, government/public administration, auditing, security management, criminal justice, or pre-law and Five (5) years relevant post-graduate experience. Special Requirement- Current, unencumbered clinical license as an LCSW, LCMHC, LMFT, LCAS, LPA or RN Preferred Health care industry and/or Medicare/Medicaid/Behavioral Health experience and knowledge SIU and/or regulatory compliance work experience National Certified Investigator and Inspector Training (NCIT) Basic and Specialized Knowledge, Skills, & Abilities Knowledge of Health care industry and/or Medicare/Medicaid/Behavioral Health Knowledge of the state and federal Medicaid laws, state and federal criminal and civil fraud laws, regulations, policies, rules, guidelines, service limitations, and various Medicaid programs Knowledge and proficiency in claims adjudication standards & procedures Knowledge of investigative methods and procedures High degree of integrity and confidentiality required handling information that is considered personal and confidential Skill in using Microsoft Office products (such as Word, Excel, Outlook, etc.) Analytical skills and ability to make deductions; logical and sequential thinker Strong verbal and written communication skills. Ability to write clear, accurate and concise rationale in support of findings Ability to manage time, prioritize work, and use problem-solving approaches Ability to interpret contractual agreements, business-oriented statistics medical/administrative services and records Ability to identify resources, gather evidence, analyze raw data and generate reports A general understanding of all major managed care functions in particular as it relates to prior authorization, utilization reviews, grievance management, provider credentialing and monitoring Knowledge of the Alliance Health service benefit plans and network providers Employment for this position is contingent upon a satisfactory background and MVR (Motor Vehicle Registration) check, which will be performed after acceptance of an offer of employment and prior to the employee's start date. Salary Range $77,868 - $99,282/Annually Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity An excellent fringe benefit package accompanies the salary, which includes: Medical, Dental, Vision, Life, Long Term Disability Generous retirement savings plan Flexible work schedules including hybrid/remote options Paid time off including vacation, sick leave, holiday, management leave Dress flexibility

Handshake is recruiting Detectives and Criminal Investigator Professionals to contribute to an hourly, temporary AI research project-but there's no AI experience needed. In this program, you'll leverage your professional experience to evaluate what AI models produce in your field, assess content related to your field of work, and deliver clear, structured feedback that strengthens the model's understanding of your workplace tasks and language. The Handshake AI opportunity runs year-round, with project opportunities opening periodically across different areas of expertise. Details The position is remote and asynchronous; work independently from wherever you are. The hours are flexible, with no minimum commitment, but most average 5-20 hrs The work includes developing prompts for AI models that reflect your field, and then evaluating responses. You'll learn new skills and contribute to how AI is used in your field Your placement into a project will be dependent on project availability-if you apply now and can't work on this project, more will be available soon. Qualifications You have at least 4 years of professional experience in one or more of the following types of work. The examples below reflect the types of real-world responsibilities that you might have had in your role that will give you the context needed to evaluate and train high-quality AI models Conduct thorough investigations by collecting and analyzing evidence, interviewing witnesses and suspects, and documenting findings in detailed reports. Secure crime scenes, collaborate with other agencies, and prepare for court proceedings. Engage in surveillance and undercover operations, utilizing specialized equipment and techniques to gather critical information. You're able to participate in asynchronous work in partnership with leading AI labs. Application Process Create a Handshake account Upload your resume and verify your identity Get matched and onboarded into relevant projects Start working and earning Work authorization information F-1 students who are eligible for CPT or OPT may be eligible for projects on Handshake AI. Work with your Designated School Official to determine your eligibility. If your school requires a CPT course, Handshake AI may not meet your school's requirements. STEM OPT is not supported. For more information on what types of work authorizations are supported on Handshake AI.

Joining the Secret Service as a Special Agent will allow you to perform critical protective and investigative assignments. The Special Agent position starts at a base salary of $48,854.00 (GL-07, step 1), with promotion potential to $118,204.00 (GS-13, step 10). This position is covered by Law Enforcement Availability Pay (LEAP) which is an additional compensation of 25% of the basic rate of pay. Recruitment bonuses up to $40,000. For more information click here. Summary Joining the Secret Service as a Special Agent will allow you to perform critical protective and investigative assignments. The Special Agent position starts at a base salary of $48,854.00 (GL-07, step 1), with promotion potential to $118,204.00 (GS-13, step 10). This position is covered by Law Enforcement Availability Pay (LEAP) which is an additional compensation of 25% of the basic rate of pay. Recruitment bonuses up to $40,000. For more information click here. Overview Help Accepting applications Open & closing dates 01/16/2026 to 03/31/2026 Salary $48,854 to - $118,204 per year Salary listed reflects the General Schedule (Base) table and, if applicable, will be adjusted to include the locality pay of the worksite location. Pay scale & grade GL 7 - 11 Locations MANY vacancies in the following locations: Anchorage, AK Birmingham, AL Mobile, AL Montgomery, AL Show morefewer locations (110) Little Rock, AR Phoenix, AZ Tucson, AZ Fresno, CA Los Angeles, CA Riverside, CA Sacramento, CA San Diego, CA San Francisco, CA San Jose, CA Santa Ana, CA Ventura, CA Denver, CO New Haven, CT Washington, DC Wilmington, DE Fort Myers, FL Jacksonville, FL Miami, FL Orlando, FL Tallahassee, FL Tampa, FL West Palm Beach, FL Albany, GA Atlanta, GA Savannah, GA Honolulu, HI Des Moines, IA Boise, ID Chicago, IL Springfield, IL Indianapolis, IN Wichita, KS Lexington, KY Louisville, KY Baton Rouge, LA New Orleans, LA Boston, MA Baltimore, MD Portland, ME Detroit, MI Grand Rapids, MI Saginaw, MI Minneapolis, MN Kansas City, MO Saint Louis, MO Springfield, MO Jackson, MS Billings, MT Charlotte, NC Greensboro, NC Raleigh, NC Wilmington, NC Omaha, NE Manchester, NH Atlantic City, NJ Newark, NJ Trenton, NJ Albuquerque, NM Las Vegas, NV Reno, NV Albany, NY Buffalo, NY Melville, NY New York, NY Queens, NY Rochester, NY Syracuse, NY White Plains, NY Cincinnati, OH Cleveland, OH Columbus, OH Dayton, OH Toledo, OH Oklahoma City, OK Tulsa, OK Portland, OR Harrisburg, PA Philadelphia, PA Pittsburgh, PA Scranton, PA San Juan, PR Providence, RI Charleston, SC Columbia, SC Greenville, SC Sioux Falls, SD Chattanooga, TN Knoxville, TN Memphis, TN Nashville, TN Austin, TX Dallas, TX El Paso, TX Houston, TX Lubbock, TX McAllen, TX San Antonio, TX Tyler, TX Waco, TX Salt Lake City, UT Norfolk, VA Richmond, VA Roanoke, VA Burlington, VT Seattle, WA Spokane, WA Madison, WI Milwaukee, WI Charleston, WV Remote job No Telework eligible No Travel Required 25% or less - Domestic and Foreign travel may be required. Relocation expenses reimbursed No Appointment type Term - The duration of this time limited Schedule B excepted appointment is 3 years and 120 days. Upon completion, you will either be converted to a career appointment in the competitive service or separated based on the expiration of the appointment. Work schedule Full-time Service Excepted Promotion potential 13 Job family (Series) * 1811 Criminal Investigation Supervisory status No Security clearance Top Secret Drug test Yes Position sensitivity and risk Critical-Sensitive (CS)/High Risk Trust determination process * Credentialing * Suitability/Fitness * National security Financial disclosure No Bargaining unit status No Announcement number SAB-26-Q2-CI Control number 854715100 This job is open to Help The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Clarification from the agency U.S. Citizens, Nationals, or those who owe allegiance to the U.S. Videos Duties Help Joining the United States Secret Service as a Special Agent offers a unique and rewarding career dedicated to serving the nation through our dual mission of criminal investigations and protection. Special Agents play a critical role in safeguarding the financial integrity of the United States and protecting its highest leaders, including the President, Vice President, and other designated individuals. Throughout their careers, Special Agents have the opportunity to work on diverse assignments across the country and around the globe, gaining unparalleled experience in both investigative and protective operations. Responsibilities include: * Conducting complex criminal investigations into financial crimes, including counterfeiting, cyber fraud, and other threats to the financial infrastructure of the United States. * Providing physical protection for the President, Vice President, their families, visiting foreign dignitaries, and other protectees, ensuring their safety in every environment. * Designing, planning, and implementing advanced security measures for National Special Security Events (NSSEs), such as presidential inaugurations, international summits, and other high-profile events. As a Special Agent, you will be part of an elite team committed to excellence, integrity, and service, with opportunities to serve at multiple duty stations both domestically and internationally. This dynamic and impactful career challenges you to rise to your fullest potential while making a difference for the nation. For more information about the Special Agent position, click here. Requirements Help Conditions of employment * U.S. citizenship is required. U.S. citizens are legally authorized to work in the United States without employer sponsorship and are entitled to all rights and protections under U.S. law. * Possess a current valid driver's license. Must be REAL ID compliant. * Use your official name on your application as it appears on your valid government identification (i.e., REAL ID Driver's License, State ID, Passport). * Must be at least 21 years old at the time of application and under 40 at referral. Exceptions may apply for those with current or prior service in federal law enforcement positions covered by special retirement provisions. The Secret Service has determined that age is essential to the performance of this position. * Submit to a drug test prior to your appointment and random drug testing while you occupy the position. Disclose any prior drug use, attempted use, and/or experimentation. * Obtain a Top-Secret Clearance and retain it during your career. * This position requires an automatic credit check after initial qualifications are met. * Carry and use a firearm. Maintaining firearm proficiency is mandatory. You will be ineligible to occupy this position if at any time you have been convicted of a misdemeanor crime of domestic violence, unless you received a pardon, or your conviction was expunged or set aside. * Candidates are required to complete an intensive 13-week training at the Federal Law Enforcement Training Center (FLETC) in Glynco, GA, followed by specialized 18-week training at the James J. Rowley Training Center in Laurel, MD. Failure to pass the training program may result in separation from the Secret Service. * Sign a mobility agreement stating your willingness to accept assignments anywhere within the United States and overseas. * Certify that you have registered with the Selective Service System or are exempt from having to do so, if you are a male applicant born after December 31, 1959. * Must have uncorrected vision of at least 20/100, correctable to 20/20 in each eye. LASIK, ALK, RK, and PRK surgeries are acceptable if required post-surgery visual tests are passed: Lasik (3 months), PRK (6 months), ALK/RK (1 year) waiting periods apply. * Hearing loss, as measured by an audiometer, must not exceed 25 decibels (A.S.A. or equivalent I.S.O.) in either ear in the 500,1000 and 2000Hz ranges. Qualifications As a condition of employment for accepting this position, you may be required to serve a 2-year trial period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider: * your performance and conduct; * the needs and interests of the agency; * whether your continued employment would advance organizational goals of the agency or the Government; and * whether your continued employment would advance the efficiency of the Federal service. Upon completion of your trial period your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest. You are minimally qualified for the GL-07 Level (starting base salary $48,854) if you possess one of the following: * A bachelor's degree from an accredited college or university with superior academic achievement (S.A.A.) which is based on class standing, grade-point average, or honor society membership. For more information on S.A.A. please click here; OR * Have at least one full year of graduate level education (i.e. 18 semester hours); OR * Have at least one year of specialized experience equivalent to the GL-5 level. Specialized experience is defined as, experience writing non-technical reports, drafting responses to requests for information, and writing brief, informative or routine reports; gathering information, analyzing it and summarizing the results of your findings; taking responsibility for own actions to meet deadlines; presenting specific, pre-determined information at meetings, conferences, or seminars as a representative of a work or academic group; OR * A combination of specialized experience, as described above, and related graduate level education. You are minimally qualified for the GL-09 Level (starting base salary $54,485) if you possess one of the following: * A master's or equivalent graduate degree (such as LL.B. or J.D.) or two full years of progressively higher graduate education, in a related field, leading to such a degree from an accredited college or university; OR * Have at least 1 year of specialized experience equivalent to the GL-7 level such as experience applying law enforcement, protective, or investigative techniques in the performance of job duties; identifying problem areas and proposing and implementing solutions; taking responsibility for own actions and those of team members to ensure the goals and deadlines for the team are met; and leading meetings or seminars on behalf of a professional or academic group; setting work priorities and allocating resources; partnering with other individuals from within and outside the organization; OR * A combination of specialized experience, as described above, and related graduate level education, beyond the first full year of graduate level study. You are minimally qualified for the GS-11 Level (Starting base salary $63,795) if you possess one of the following: * Ph.D. or equivalent doctoral degree, or 3 full years of progressively higher-level graduate education leading to such a degree, or LL.M.; OR * Have at least 1 year of specialized experience equivalent to the GL-9 level such as experience in, or related to planning and conducting complex criminal investigations to determine violations of Federal laws and regulations; collecting and assembling facts to identify logical conclusion; gathering, analyzing, and evaluating evidence or data; conducting interviews and interrogations; making arrests; conducting searches and seizures; taking responsibility for own actions and those of team members to ensure the goals and deadlines for the team are met; partnering with or leveraging networks or relationships from outside the organization, experience managing complex projects including setting priorities and determining resource requirements; OR * A combination of specialized experience, as described above, and related graduate level education beyond two full years of graduate level study. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional, philanthropic, religious, spiritual, community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. The qualification requirements listed above must be met by the closing date of this announcement. You will be considered for all grade levels; however, you will only be referred at the highest grade for which you are found to be best qualified. Applicants must successfully pass Phase 1 assessments (see below) to receive a Conditional Job Offer. In addition, applicants must successfully pass Phase II (see below) to receive final consideration for employment. Phase I: * National Crime Information Center (NCIC) * Special Agent Entrance Exam (SAEE) * Applicant Physical Abilities Test (APAT) * Interview Phase II: * Credit Check * Security Interview * Polygraph examination * Drug screening * Medical examination * Background investigation (a top-secret security clearance) The Secret Service follows stringent guidelines relating to illegal drug usage. An applicant's history is reviewed and a determination for employment is made according to our guidelines. For more information regarding the U.S. Secret Service drug guidelines, please click here to view our Drug Policy. As part of the application process the applicant will be required to complete the United States Secret Service Applicant Physical Abilities Test (APAT). It is a physical fitness assessment which consists of four components (push-ups, sit-ups, Illinois Agility Run and a 1.5 Mile Run). The APAT is designed to measure the current level of general physical fitness of an applicant, which serves as an indicator of an applicant's ability to safely complete a vigorous physical training program. It evaluates the applicant's ability to perform the physical tasks required on the job by measuring muscular and dynamic strength, endurance, flexibility, aerobic capacity and other factors related to physical aptitude. For more information about the APAT, please click here. General Medical Requirements: As determined by OPM the duties of this position require moderate to arduous physical exertion involving walking and standing, use of firearms, and exposure to inclement weather. Manual dexterity with comparatively free motion of fingers, wrist, elbows, shoulders, hips and knee joints is required. Arms, hands, legs and feet must function sufficiently in order for applicants to perform the duties satisfactorily. Additional information * Recruitment Incentive: Applicants may be eligible for a $40,000 recruitment incentive in accordance with regulatory requirements. The first installment of $15,000 will be paid following successful completion of Secret Service Criminal Investigator training. A second installment of $10,000 will be paid following one year of service post training and an acceptable performance rating. The final installment of $15,000 will be paid after a third year of service post training and an acceptable performance rating. Provision of these payments require the execution of a three-year Continued Service Agreement (CSA) with the agency. Newly hired employees who resign from the USSS prior to the expiration of the CSA will be required to repay the recruitment incentive. (NOTE: Eligibility is limited to "Newly appointed" Federal employees as defined by 5 CFR 575.102). Applicants selected for this position will be required to sign a CSA before being assigned to an initial training class. The CSA will commit the applicant to a specified period of employment with the Secret Service upon the successful completion of training. Applicants will be required to travel to all phases of the hiring process at their own expense. If a final job offer is extended, relocation expenses will not be authorized for first duty location. The Secret Service prohibits employees from having visible body markings (including but not limited to tattoos, body art and branding) on the head, face, neck, hand and fingers (any area below the wrist bone) (exception a single conservative and unobtrusive tattoo in the form of a ring is authorized on one finger). If you are deemed minimally qualified for this position, you will be required to complete an Optional Form 306, Declaration for Federal Employment, and to sign and certify the accuracy of all information in your application, prior to entering Phase 1 of the hiring process. False statements on any part of the application may result in withdrawal of offer of employment, dismissal after beginning work, fine, or imprisonment. Since the duties of this position are exacting and involve the responsibility for the safety of others under trying conditions, applicants must possess emotional and mental stability. Any condition that would hinder full efficient performance of the duties of this position or that would cause the individual to be a hazard to himself/herself or to others is disqualifying. There are also specific medical requirements for this position and any chronic disease or condition affecting the respiratory, cardiovascular, gastrointestinal, musculoskeletal, digestive, nervous, endocrine, lymphatic, nervous, genitourinary and other systems that would impair full performance of the duties of the position may also be disqualifying. Click here for more information. The Fair Chance to Compete for Jobs Act prohibits the Department of Homeland Security and its Components from requesting an applicant's criminal history record before that individual receives a conditional offer of employment. In accordance with 5 U.S. Code § 9202(c) and 5 C.F.R § 920.201 certain positions are exempt from the provisions of the Fair Chance to Compete Act. Applicants who believe they have been subjected to a violation of the Fair Chance to Compete for Jobs Act, may submit a written complaint to Equal ************************. Expand Hide additional information Candidates should be committed to improving the efficiency of the Federal government, passionate about the ideals of our American republic, and committed to upholding the rule of law and the United States Constitution. Benefits Help A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new window Learn more about federal benefits. DHS offers competitive salaries and an attractive benefits package, including health, dental, vision, life, and long-term care insurance; retirement plan; Thrift Savings Plan [similar to a 401(k)]; Flexible Spending Account; Employee Assistance Program; personal leave days; and paid federal holidays. Other benefits may include flexible work schedules; tuition reimbursement; transportation subsidies (government vehicle); uniform allowance; health and wellness programs; and fitness centers. DHS is committed to employee development and offers a variety of employee training and developmental opportunities. For more information, go to the DHS Careers website and select "Benefits." Disabled veteran leave will be available to any Federal employee hired on or after November 5, 2016, who is a veteran with a service- connected disability rating of 30 percent or more. Review our benefits Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered. How you will be evaluated You will be evaluated for this job based on how well you meet the qualifications above. We will review your resume and supporting documentation to ensure you meet the minimum qualification requirements. If you meet the minimum qualifications, you will receive a conditional job offer. The competencies needed to perform this job are: * Investigative methods * Protective methods * Law enforcement techniques * Exercising initiative * Attention to detail * Judgment and Problem Solving * Ability to analyze and evaluate data or evidence * Ability to partner with or lead others Interviews are required for this position. Failure to complete the interview may result in removal from further consideration. Your on-line application will be rated on the extent, quality, and relevance of the following: your experience, education and training, and competencies. All applicants are evaluated on competencies related to law enforcement methods and techniques, protective methods and techniques, investigative methods and techniques, initiative, attention to detail, learning, problem solving, partnering, planning and organizing, and leadership. All answers in the online process must be substantiated by your resume. Upon review your resume and transcripts need to support your answer choices. Overstating your qualifications and/or experience in your application materials or on the application questionnaire may result in your removal for consideration. Any offers of employment made pursuant to this announcement will be consistent with all applicable authorities, including Presidential Memoranda, Executive Orders, interpretive U.S. Office of Personnel Management guidance and U.S. Office of Management and Budget plans and policies concerning hiring. These authorities are subject to change. DHS uses E-Verify, an Internet-based system, to confirm the eligibility of all newly hired employees to work in the United States. Click here to learn more about E-Verify, including your rights and responsibilities. Benefits Help A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new window Learn more about federal benefits. DHS offers competitive salaries and an attractive benefits package, including health, dental, vision, life, and long-term care insurance; retirement plan; Thrift Savings Plan [similar to a 401(k)]; Flexible Spending Account; Employee Assistance Program; personal leave days; and paid federal holidays. Other benefits may include flexible work schedules; tuition reimbursement; transportation subsidies (government vehicle); uniform allowance; health and wellness programs; and fitness centers. DHS is committed to employee development and offers a variety of employee training and developmental opportunities. For more information, go to the DHS Careers website and select "Benefits." Disabled veteran leave will be available to any Federal employee hired on or after November 5, 2016, who is a veteran with a service- connected disability rating of 30 percent or more. Review our benefits Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered. Required documents Required Documents Help In addition to addressing the job opportunity announcement specific questions, you must also submit the following documentation: * Resume - Limit your resume to no more than two pages. The USAJOBS database will not allow an applicant to submit an application that includes a resume over two pages. In order to receive credit for experience contained in an uploaded resume, your employment history should show relevant work experience in detail and in month/year format (MM/YYYY), reflecting starting date and ending date, and include the number of hours worked per week. To learn how to format and submit a two-page resume, please visit the USAJOBS Help Center. * If you have earned a college degree, or if you are qualifying based on education or you are qualifying based on a combination of education and experience , or are claiming Superior Academic Achievement (overall grade point average of 3.0 or higher out of a possible 4.0 recorded on the unofficial college/university transcript) to qualify at the GL-07 level (as explained in the Qualifications section), you must submit a copy of your college/university transcript (unofficial is acceptable) which must show school name, student's name, credit earned, degree, and date awarded. Education must be obtained from an accredited institution recognized by the U.S. Department of Education. Education completed in foreign colleges or universities may be used to meet Federal qualification requirements if you can show that your foreign education is comparable to education received in accredited educational institutions in the United States. For example, specific courses accepted for college-level credit by an accredited U.S. college or university, or foreign education evaluated by an organization recognized for accreditation by the Department of Education as education equivalent to that gained in an accredited U.S. college or university. It is your responsibility to provide such evidence with your application. See Recognition of Foreign Qualifications for more information. Those with Foreign education, click here. * Are you a Veteran? Submit Member Copy 4 of your DD-214 (Certificate of Release or Discharge from Active Duty) or Statement of Service. If a DD-214 is not available, submit your Statement of Service from the Armed Forces that list the beginning and ending dates of active service, your rank, and confirm that you will be separated under honorable conditions. Those applying for 10-point preference must fill out the SF-15 (click here for the form) and provide the required documentation listed on the back of the form. Click here for more veterans' information. * Are you a current or former Federal Employee? Submit a copy of your SF-50, Notification of Personnel Action, showing your tenure code, position occupied and highest grade and step. In addition, if you have or had service in a Federal Law Enforcement position covered by law enforcement or firefighter retirement provisions, including early or mandatory retirement, the SF-50 must show the retirement code. You may have to submit more than one to show time in the code. An award SF-50 does not contain the required information. Also submit your performance appraisals and/or incentive awards. * The Office of Personnel Management (OPM) must authorize employment offers made to current or former political appointees. If you are currently, or have been within the last 5 years, a political Schedule A, Schedule C, Non-career SES or Presidential Appointee employee in the Executive Branch, you must disclose this information to the Human Resources Office. * Did you previously take the Special Agent Entrance Exam (SAEE)? Submit a copy of your SAEE results. If you are relying on your education to meet qualification requirements: Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education. Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.

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 to 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 travel mixed with remote tele-medicine work to support our clinical research studies. Additionally, our Sub-Investigator will be skilled in administering investigational products (IV, SC, TD, IM, PO administration), performing physical examinations, monitoring for investigational product related reactions, among other duties beyond the standard clinical research Sub-Investigator role. Care Access is looking for highly motivated Nurse Practitioners or Physician's 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. Administration of Investigational Products (via subcutaneous, transdermal, intramuscular, intravenous, or oral routes). Proficiency in starting, monitoring, and maintaining intravenous lines. Proficiency in phlebotomy, proper blood collection practices, and laboratory processing practices (can be learned) Contribute as an active member of clinician team involved in the management of infusion or other investigational product related reactions. Maintain a clean, efficient clinical area to assure the highest standards of patient care. Follow safety and PPE procedures as well as maintain proper documentation of infusion procedures. Timely communications with internal teams, investigators, review boards, and study subjects Perform trial procedures as per delegation which can include the following but not limited to: Prescreen study candidates by telephone and review exclusionary conditions or medications prior to scheduling screening appointment. Obtain informed consent per SOP. Administer delegated study questionnaires, as appropriate. Collect and evaluate medical records. Complete visit procedures and ensure proper specimen collection, processing, and shipment in accordance with protocol. Train others and complete basic clinical procedures, such as blood draws, vital signs, ECGs, etc. 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. Dispense study medication per protocol and/or IVRS systems. Educate patient on proper administration and importance of compliance. Monitor patient progress on study medication. Other duties as assigned. The Expertise Required Ability to check, perform, and document vitals as well as EKG (ECG) Phlebotomy and expert IV skills 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 with good understanding of medical terminology. Communication Skills: Strong verbal and written communication skills as evidenced by positive interactions with coworkers, management, clients and vendors. 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, innovative, and able to take thoughtful risks while communicating concerns and mitigations. Good management and organizational skills, understanding of medical procedures. Exceptional interpersonal skills, willingness to the ability to work independently. Ability to lift a minimum of 50 pounds. Command of professional and Business English (written and spoken). You must have the authorization to work in the US for any employer. You must not need visa sponsorship, either now or in the future. You must live in the USA and be willing and able to travel with 24-36-hour notice Certifications/Licenses, Education, and Experience: At least Master's Level Science Degree. Nurse Practitioner or Physician Assistant with 5+ years of clinical experience. Clinical practice experience desired with infusion skillset. Currently licensed in good standing in one or more states. A minimum of 1 year of relevant work experience as Sub-Investigator (preferred) in a Clinical Research setting. Preferred at least one (1) year of experience as a Clinical Research Coordinator or willingness to learn. How We Work Together Location: Remote within the United States. This is an on-site mixed with remote tele-medicine work position. Travel: Regional and nationwide travel requirements up to 100% dependent on project design and business need. Regularly planned travel will be required as part of the role. Physical demands associated with this position Include: The ability to use keyboards and other computer equipment. The expected salary range for this role is $130,000 - $165,000 USD per year for full time team members. Benefits & Perks (US Full Time Employees) 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: ********************************

**Hybrid:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The Investigator II is responsible for the identification, investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on fraudulent claims. **How you will make an impact:** + Claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims. + Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company health plan, line of business and/or state. + Effectively establish rapport and on-going working relationship with law enforcement. + May interface internally with Senior level management and legal department throughout investigative process. + May assist in training of internal and external entities. + Assists in the development of policy and/or procedures to prevent loss of company assets. **Minimum Requirements:** + Requires a BA/BS and minimum of 3 years related experience; or any combination of education and experience, which would provide an equivalent background. **Preferred Skills, Capabilities and Experiences:** + Fraud certification from CFE, AHFI, AAPC or coding certificates preferred. + Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred. + Health insurance, law enforcement experience preferred. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $69,440 to $104,160. Location: Columbus, OH In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

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.

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.

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 and bilingual Spanish is highly preferred. 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.

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

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.

The Special Investigations Unit (SIU) III is responsible for investigating and resolving high complexity allegations of healthcare fraud, waste and abuse (FWA) by medical professional, facilities, and members. Researches, gathers, and analyzes data to identify trends, patterns, aberrancies, and outliers in provider billing behavior. Serves as a subject matter expert for other investigators. Qualified candidates must live in Massachusetts or surrounding states. Essential Functions: Develop, coordinate and conduct strategic fact-driven investigative projects including business process review, execution of investigative activities, and development of investigation outcome recommendations Manage the development, production, and validation of reports generated from detailed claims, eligibility, pharmacy, and clinical data and translate analytical findings into actionable items Manage strategic investigative plan and drive investigative outcome for the team Ensure quality outcomes for investigative team through auditing and oversight Prioritize, track, and report status of investigations Report identified corporate financial impact issues Use concepts and knowledge of coding guidelines to analyze complex provider claim submissions Research, comprehend and interpret various state specific Medicaid, federal Medicare, and ACA/Exchange laws, rules and guidelines Identify, research and comprehend medical standards, healthcare authoritative sources and apply knowledge to investigative approach Collaborate with data analytics team and utilize RAT STATS on Statistically Valid Random Sampling Coordinate and conduct on-site and desk audits of medical record reviews and claim audits Manage and decision claims pended for investigative purposes Maintain a working knowledge of all state and federal laws, rules, and billing guidelines for various provider specialty types Prepare and conduct in-depth complex interviews relevant to investigative plan Execute and manage provider formal corrective action plans Participate in meetings with operational departments, business partners, and regulatory partners to facilitate investigative case development Participate in meetings with Legal General Counsel to drive case legal actions, formal corrective actions, negotiations with recovery efforts, settlement agreements, and preparation of evidentiary documents for litigation Present, support, and defend investigative research to seek approval for formal corrective actions Establish and maintain relationships with Federal and State law enforcement agencies, task force members, other company SIU staff and external contacts involved in fraud investigation, detection and prevention SME in the designated market and ability to apply external intelligence to their analysis and case development Develop and present internal and external formal presentations, as needed Attend fraud, waste, and abuse training/conferences, as needed Support regulatory fraud, waste, and abuse reports to federal and state Medicare/Medicaid agencies Manage and maintain sensitive confidential investigative information Maintain compliance with state and federal laws and regulations and contracts Adhere to the CareSource Corporate Compliance Plan and the Anti-Fraud Plan Assist in Federal and State regulatory audits, as needed Perform any other job-related instructions, as requested Education and Experience: Bachelor's Degree or equivalent years of relevant work experience in Health-Related Field, Law Enforcement, or Insurance required Master's Degree (e.g., criminal justice, public health, mathematics, statistics, health economics, nursing) preferred Minimum of five (5) years of experience in healthcare fraud investigations, medical coding, pharmacy, medical research, auditing, data analytics or related field is required Competencies, Knowledge and Skills: Intermediate proficiency level in Microsoft Office to include Outlook, Word, Excel, Access, and PowerPoint Effective listening and critical thinking skills and the ability to identify gaps in logic Strong interpersonal skills, high level of professionalism, integrity and ethics in performance of all duties Excellent problem solving and decision making skills with attention to details Background in research and drawing conclusions Ability to perform intermediate data analysis and to articulate understanding of findings Ability to work under limited supervision with moderate latitude for initiative and independent judgment Ability to manage demanding investigative case load Ability to develop, prioritize and accomplish goals Self-motivated, self-directed Strong written skills with ability to compose detailed investigative reports and professional internal and external correspondences Presentation experience, beneficial Knowledge of Medicaid, Medicare, healthcare rules preferred Background in medical terminology, CPT, HCPCS, ICD codes or medical billing preferred Complex project management skills preferred Display leadership qualities Licensure and Certification: One of the following certifications is required: Accredited Healthcare Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE) Certified Professional Coder (CPC) is preferred NHCAA or other fraud and abuse investigation training is preferred Working Conditions: General office environment; may be required to sit or stand for extended periods of time Occasional travel (up to 10%) to attend meetings, training, and conferences may be required Compensation Range: $70,800.00 - $113,200.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-SD1

BCI Special Agent (260000BX) Organization: Attorney GeneralAgency Contact Name and Information: ********************* Unposting Date: Jan 27, 2026, 4:59:00 AMPrimary Location: United States of America-OHIO-Franklin CountyOther Locations: United States of America-OHIO-Ashland County, United States of America-OHIO-Pickaway County, United States of America-OHIO-Marion County, United States of America-OHIO-Licking County, United States of America-OHIO-Knox County, United States of America-OHIO-Delaware County, United States of America-OHIO-Richland County, United States of America-OHIO-Hocking County, United States of America-OHIO-Fairfield County, United States of America-OHIO-Ross County, United States of America-OHIO-Morrow County, United States of America-OHIO-Union County Compensation: $37.34/hr-$52.64/hr Schedule: Full-time Work Hours: Variable/Non-StandardClassified Indicator: ClassifiedUnion: Attorney General FOP Primary Job Skill: InvestigationTechnical Skills: InvestigationProfessional Skills: Attention to Detail, Collaboration, Critical Thinking, Decision Making, Confidentiality Agency OverviewAbout Us:The Ohio Attorney General's Office has played a vital role in shaping Ohio's past and present and the work it does today helps chart the state's future. The office consists of nearly 30 distinct sections that advocate for consumers and victims of crime, assist the criminal justice community, provide legal counsel for state offices and agencies, and enforce certain state laws. In these and other capacities, staff members interact with tens of thousands of Ohioans each year.Job DutiesWhat You'll Do:The Ohio Attorney General's Office is currently seeking an experienced individual for a BCI Special Agent vacancy in the Bureau of Criminal Investigation (BCI) Section, Crime Scene Unit. This position will primarily be designated for remote working. There may be in person requirements for training and operational needs. The headquarter location is London, OH. The Bureau of Criminal Investigation, known as BCI, is the state's official crime lab serving the criminal justice community and protecting Ohio families. BCI also provides expert criminal investigative services to local, state, and federal law enforcement agencies upon request. With offices throughout the state, BCI stands ready to respond 24/7 to local law enforcement agencies' needs at no cost to the requesting agency. Staff at BCI work every day to provide the highest level of service. This includes special agents who are on call 24/7 to offer investigative assistance at crime scenes, knowledgeable scientists and forensic specialists using cutting edge technology to process evidence to bring criminals to justice, and criminal intelligence analysts and identification specialists who help local law enforcement solve cases. Experienced special agents, forensic scientists, and other law enforcement experts' staff BCI's three main divisions: 1) Identifications 2) Investigations and 3) Laboratory.The successful candidate must reside in or be willing to relocate within 90 days to one of the following counties: Ashland, Delaware, Fairfield, Fayette, Franklin, Hocking, Knox, Licking, Marion, Morrow, Pickaway, Richland, Ross, Union, counties only.The duties for this position include, but are not limited to, the following:- Serves as case agent assuming responsibility for conducting overt and/or covert criminal investigations.- Performs various tasks in the field such as crime scene processing, subject, victim and witness interviewing.- Develops informants and confidential sources.- Conducts raids, searches and surveillance.- Performs background investigations.- Makes arrests.- Gathers, evaluates and forwards criminal intelligence information.- Completes and submits investigative reports for criminal and/or administrative actions.- Serves as liaison to and works in cooperation with local, state, federal and other law enforcement/investigatory agencies.- Provides courtroom evidence and testifies in court.- Confers with prosecuting attorneys.- Delivers speeches or presentations to specialized audiences and/or general public.- Other duties as assigned. Why Work for the State of OhioAt the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes: Medical Coverage Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period Paid time off, including vacation, personal, sick leave and 11 paid holidays per year Childbirth, Adoption, and Foster Care leave Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more) Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation) *Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.QualificationsCompletion of undergraduate core program in criminal justice, social sciences (e.g., criminology, sociology, psychology) or related field; OPOTC Peace Officer certification; 2 yrs. experience in investigations with a law enforcement agency; valid driver's license. -Or 2 yrs. Exp. as a BCI Investigator, Class No. 26130AG; OPOTC Peace Officer certification or equivalent Peace Officer certification (e.g., another state, another government agency, military); valid driver's license. -Or equivalent of Minimum Class Qualifications for Employment noted above. Job Skills: Investigation, Critical Thinking, Collaboration, Decision Making, Attention to Detail, ConfidentialitySupplemental InformationThe Attorney General's Office is a dynamic organization that offers career opportunities across many different disciplines to people from all backgrounds and experiences. We do not discriminate in any way. All people are equal under the law, and it is so at the AGO. This is a workplace where talent gains you entry and performance determines your career path. Staff can join and lead employee resource groups and participate in online or in-person events to learn about the experiences of others.Employees of the Attorney General's Office must have been in their current positions for at least 12 months in order to be eligible for consideration.The Attorney General's Office may fill additional, similar positions as a result of this posting.The Ohio Attorney General's Office is an Equal Opportunity Employer.AGO#: 26-01-014Background Check Information:Selected candidate(s) will be subject to the following background checks:Criminal history Driving record TaxesDrug TestPolygraph TestField InvestigationPsychological ExaminationPhysical ExaminationIn addition, an Internet search may be conducted of publicly available and job related information through social media(Facebook, LinkedIn, Twitter, etc.) or through the use of search engines (Google, Bing, etc.) ADA StatementOhio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.

Innovative. Collaborative. Client-Focused. Growth-Minded. Caring. These are 5 words used to describe Briljent and the Briljent culture. We are seeking Adult Protective Services Investigators with these same qualities to conduct thorough investigations and document investigation activities involving allegations of abuse, neglect, and exploitation involving endangered adults Briljent is dedicated to hiring a unique team of qualified people to serve our clients. We pledge to continue building a company culture where everyone is valued and accepted. Check out our Communication Creed and Non-Negotiable Items that help define the company culture. And ask us about Never Letting Donkeys In The Pool. Must be eligible to work in the United States. No sponsorships are available currently. While this job does work remotely, this role does require on-site investigations. Travel will be required within the NE region of Indiana. Here are the day-to-day duties of this position: Investigate allegations of abuse, neglect, and exploitation involving endangered adults Conduct thorough investigations, including interviews, record reviews, and collaboration with other investigative agencies Initiate and facilitate referrals to services and community resources Document investigation activities, including case planning, safety planning, case notes, and findings Serve as the Priority A (within 24 hours of receipt) responder to initiate timely contact with clients facing immediate harm on a rotating basis Respond to all assigned investigations within the required timeframe Review and respond to quality assurance evaluations Skills needed to be successful in this role: Ability to think critically, incorporating multiple factors into larger concepts Strong organizational skills with abilities to simultaneously manage multiple investigations Ability to work with and relate to others with customer relation techniques, professionalism, and respect for other cultures Ability to effectively use active listening and interviewing skills Ability to adapt quickly when policies and regulations change Must be computer literate and have MS Word, Excel, Outlook, and Internet skills Ability to foster teamwork with all levels of management and staff Ability to work well independently and within a team Superior verbal and written communication skills Strong decision-making skills, with accuracy and attention to detail Requirements Requirements: Experience with Adult Protective Services, Investigatory, Social Services, Human Services, or Law Enforcement work Bachelor's degree preferred Must have reliable transportation, a valid drivers license, and a clean driving record Must be willing and able to commute to the following Indiana counties: Adams, Allen, Blackford, DeKalb, Elkhart, Grant, Huntington, Jay, Kosciusko, LaGrange, Noble, Steuben, Wabash, Wells, Whitley What else does it take to be successful at Briljent? Consultative Mindset -Listen. Stay client-focused. Understand and prioritize the needs, goals, and concerns of clients. Customize solutions to meet the specific requirements and expectations. Encourage open-communication and collaboration. Flexible - Be open to change and adaptable to new situations, ideas, and approaches. Learning Leader - At Briljent, we seek new ideas, find creative ways to hone skills, and share lessons learned so we can continually bring our best to our clients. It's not always easy. Honestly, it's not always comfortable. But that's okay. We love a good challenge. Impeccable Integrity - Maintain a high level of integrity, honesty and ethics in all interactions and decision making. Do what's right, do what you say you're going to do, and do it all honestly. If this sounds exciting and you have the qualifications plus something unique to add to the team, apply now! Physical Requirements & Environmental Conditions These physical demands must be met by an employee to successfully perform the essential functions of this job. The employee is regularly required to communicate, remain in a stationary position, and utilize technology tools such as a laptop computer for extended periods of time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Equal Opportunity Employer Briljent is a solutions-based company. Solutions come from creative ideas; ideas come from being creative with differences. Briljent believes collaboration and perspective are critical to the success of the company. Employment at Briljent is based on merit and professional qualifications. We do not discriminate against any employee or applicant because of race, creed, color, religion, gender, sexual orientation, national origin, disability, age, veteran status, marital status, or any other basis protected by federal, state, or local law, regulation, or ordinance.

Full-time Description Innovative. Collaborative. Client-Focused. Growth-Minded. Caring. These are 5 words used to describe Briljent and the Briljent culture. We are seeking Adult Protective Services Investigators with these same qualities to conduct thorough investigations and document investigation activities involving allegations of abuse, neglect, and exploitation involving endangered adults Briljent is dedicated to hiring a unique team of qualified people to serve our clients. We pledge to continue building a company culture where everyone is valued and accepted. Check out our Communication Creed and Non-Negotiable Items that help define the company culture. And ask us about Never Letting Donkeys In The Pool. Must be eligible to work in the United States. No sponsorships are available currently. While this job does work remotely, this role does require on-site investigations. Travel will be required within the NE region of Indiana. Here are the day-to-day duties of this position: Investigate allegations of abuse, neglect, and exploitation involving endangered adults Conduct thorough investigations, including interviews, record reviews, and collaboration with other investigative agencies Initiate and facilitate referrals to services and community resources Document investigation activities, including case planning, safety planning, case notes, and findings Serve as the Priority A (within 24 hours of receipt) responder to initiate timely contact with clients facing immediate harm on a rotating basis Respond to all assigned investigations within the required timeframe Review and respond to quality assurance evaluations Skills needed to be successful in this role: Ability to think critically, incorporating multiple factors into larger concepts Strong organizational skills with abilities to simultaneously manage multiple investigations Ability to work with and relate to others with customer relation techniques, professionalism, and respect for other cultures Ability to effectively use active listening and interviewing skills Ability to adapt quickly when policies and regulations change Must be computer literate and have MS Word, Excel, Outlook, and Internet skills Ability to foster teamwork with all levels of management and staff Ability to work well independently and within a team Superior verbal and written communication skills Strong decision-making skills, with accuracy and attention to detail Requirements Requirements: Experience with Adult Protective Services, Investigatory, Social Services, Human Services, or Law Enforcement work Bachelor's degree preferred Must have reliable transportation, a valid drivers license, and a clean driving record Must be willing and able to commute to the following Indiana counties: Adams, Allen, Blackford, DeKalb, Elkhart, Grant, Huntington, Jay, Kosciusko, LaGrange, Noble, Steuben, Wabash, Wells, Whitley What else does it take to be successful at Briljent? Consultative Mindset -Listen. Stay client-focused. Understand and prioritize the needs, goals, and concerns of clients. Customize solutions to meet the specific requirements and expectations. Encourage open-communication and collaboration. Flexible - Be open to change and adaptable to new situations, ideas, and approaches. Learning Leader - At Briljent, we seek new ideas, find creative ways to hone skills, and share lessons learned so we can continually bring our best to our clients. It's not always easy. Honestly, it's not always comfortable. But that's okay. We love a good challenge. Impeccable Integrity - Maintain a high level of integrity, honesty and ethics in all interactions and decision making. Do what's right, do what you say you're going to do, and do it all honestly. If this sounds exciting and you have the qualifications plus something unique to add to the team, apply now! Physical Requirements & Environmental Conditions These physical demands must be met by an employee to successfully perform the essential functions of this job. The employee is regularly required to communicate, remain in a stationary position, and utilize technology tools such as a laptop computer for extended periods of time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Equal Opportunity Employer Briljent is a solutions-based company. Solutions come from creative ideas; ideas come from being creative with differences. Briljent believes collaboration and perspective are critical to the success of the company. Employment at Briljent is based on merit and professional qualifications. We do not discriminate against any employee or applicant because of race, creed, color, religion, gender, sexual orientation, national origin, disability, age, veteran status, marital status, or any other basis protected by federal, state, or local law, regulation, or ordinance.

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.

Applicants must live near Boise, ID. This position is responsible for comprehensive management and ownership of fraud, waste and abuse investigations including development and presentation of investigative results. This individual carries out analytical and process management tasks with a high degree of autonomy. This individual serves as a corporate resource on fraud, waste and abuse issues and recommends cost containment projects with an emphasis on fraud prevention. INVESTIGATIONS Prioritize, triage and manage workload to meet internal performance metrics, regulatory and contractual requirements Use independent judgment to create investigative work plans and develop case strategies based upon analysis of referral data and contractual/regulatory requirements Analyze data and select audit samples using various sampling methodologies Plan and conduct desk audits, field audits and/or site visits Collect and analyze information to evaluate facts and circumstances through an extensive review of data from professional and facility providers, member data, contractual relationships, payment policies, Medicaid/Medicare rules and statutes, etc. Conduct research on medical policies and practices, provider characteristics, and related topics Interview patients, providers, provider staff, and other witnesses/experts Prepare correspondence Obtain and preserve physical and documentary evidence to support investigations Maintain comprehensive case files FRAUD, WASTE AND ABUSE DETECTION Triage and prioritize leads from internal and external sources Use knowledge of healthcare coding conventions, fraud schemes, and general areas of vulnerability, reimbursement methodologies, and relevant laws to find suspicious patterns in claims data, provider enrollment data, and other sources Remain up to date on published fraud cases, schemes, investigative techniques and methodologies, and industry trends PACKAGING OF FINDINGS AND RECOMMENDATIONS Organize data and prepare a written summary of investigative steps, conclusions, recommendations with attention to detail and a high level of accuracy Prepare clear and concise investigatory reports to support findings of potential fraud, waste and abuse CASE RESOLUTION Identify, communicate and recover losses as deemed appropriate Present case to internal department(s), law enforcement and/or regulatory agencies Support legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions Negotiate settlement agreements with subjects and/or attorneys Assist in preparation, execution, and follow-up of settlement agreement terms CUSTOMER INTERACTIONS Make presentations to customers, prospects, conference audiences, and law enforcement Collaborate, consult, and coordinate regularly with clients on the status and direction of assignments Develop and maintain contacts/liaisons with law enforcement, regulatory agencies, task force members, other company SIU staff and external contacts involved in fraud investigation, detection and prevention MISCELLANEOUS DUTIES Represent client at industry task force meetings and meetings with regulatory agencies Measure and report performance metrics Identify opportunities and make recommendations for reduction of exposure to fraud, waste and abuse Consult on anti-fraud policies and procedures Other duties as assigned The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description. Other Job Requirements Responsibilities Minimum of five years of experience in fraud investigations, related behavioral or medical healthcare insurance experience in claims, clinical, auditing, compliance, provider networks, management, or project planning. Demonstrated abilities in time management and establishing priorities. Strong listening and observation skills. Impeccable work ethic, completely dependable, and proactive; a problem solver. Proven ability to effectively handle cases of fraud and abuse in a discreet, confidential, and professional manner. Demonstrated strategic and analytical thinking skills, with ability to effectively communicate conclusions and recommendations to management. Comprehensive, practical knowledge of complex and diverse fraud investigative techniques and methodologies utilized in program audits. Understanding of insurance terms and policy interpretation. Ability to work to tight timelines when necessary. Works independently; collaborates well with peers and customers. Demonstrated ability to manage and prioritize case load with limited supervision. Strong computer skills consisting of Microsoft Excel, Access, Outlook, Word, and Power Point. General Job Information Title SIU Program Integrity Investigator - Remote (In Idaho) Grade 24 Work Experience - Required Fraud Investigations Work Experience - Preferred Education - Required A Combination of Education and Work Experience May Be Considered., Bachelor's Education - Preferred License and Certifications - Required License and Certifications - Preferred AHFI - Accredited Healthcare Fraud Investigator - EnterpriseEnterprise, CFE - Certified Fraud Examiner - EnterpriseEnterprise, CPC - Certified Professional Coder - EnterpriseEnterprise, LSSBB - Lean Six Sigma Black Belt Certification - EnterpriseEnterprise, RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtCare Mgmt Salary Range Salary Minimum: $58,440 Salary Maximum: $93,500 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Want to love your job but be able to retire at age 60 instead of the typical retirement age of 65 like most other state employees? WSGC Special Agents are participants in the Public Safety Employees Retirement System (PSERS) plan 2 If you're ready to take on a rewarding and challenging career, then don't miss out on this unique opportunity to work with our Tribal Gaming Unit, where you'll play an essential role in shaping the future of gaming. In this position, you'll work directly with tribal nations to ensure compliance with tribal-state compacts and state laws. You'll be at the forefront of making a meaningful impact in the gaming industry while upholding the values of professionalism, integrity, and dedication. To be eligible for this position, you must reside or be willing to reside in one of the following counties in Washington State: Okanogan, Ferry, Stevens, Pend Oreille, Chelan, Douglas, Lincoln, Spokane, Kittitas, Klickitat, Grant, Adams, Whitman, Yakima, Benton, Franklin, Walla Walla, Columbia, Garfield, and Asotin. Who We Are The Washington State Gambling Commission is a state accredited; limited-jurisdiction law enforcement agency whose mission is to protect the public by ensuring that gambling is legal and honest. We are the second oldest gambling agency in the country and the only statewide agency that licenses and regulates an estimated $3.5 billion gambling industry comprised of Tribal, commercial, and nonprofit businesses. What We Offer * Competitive salary and benefits package * Opportunities for professional development and growth * Collaborative and supportive work environment What We're Looking For: * Accountability & Independence: You will manage your own workload and be responsible for meeting critical deadlines-success in this role requires self-motivation and the ability to stay organized while multi-tasking. * Strong Communication & Relationship-Building Skills: Excellent interpersonal skills are essential as you will build trusting relationships with clients, stakeholders, and tribal partners within the tribal gaming sector. * Attention to Detail: You should take pride in delivering high-quality, detail-oriented work, ensure compliance and integrity * Collaboration: You should value and embrace a multicultural and inclusive environment, working in a way that reflects mutual respect, cooperation, and acceptance of diverse perspectives. Why Join Us? * Make a positive impact in an industry that continues to grow and evolve. * Work in a dynamic and supportive environment that values personal growth and professional development. If you're a driven individual with an interest in law enforcement, regulatory compliance, relationship-building, and making a difference in the gaming industry, this is your chance to take your career to the next level! As a Special Agent, you will work closely with Tribal Gaming Agencies to ensure that tribal casinos operate in compliance with tribal-state compacts and applicable gambling laws. Responsibilities include conducting onsite regulatory audits and investigations, reviewing record-keeping systems, and evaluating internal controls and game rules. You may also be asked to conduct or assist with criminal or administrative investigations and will participate in training and other special projects. You will be responsible for conducting regular inspections and will be assigned an agency vehicle for your travel needs. Required Education and Experience * High school graduation, GED, or equivalent education. * Two or more years of related experience in business, auditing, accounting, law enforcement, regulation, fraud, computer science, tribal gaming, or investigations. * Must be at least 21 years of age at time of hire. Must be Willing and Able to: * Carry and use a firearm and other issued equipment (handcuffs, cell phone, etc.) in a safe and appropriate manner while working. * Maintain firearm and use of force standards. * Travel overnight as necessary for off-site work, meetings, and training. * Work alone or in teams. * Work evening, weekends, hours other than 8 a.m. to 5 p.m., and extra hours when necessary to meet work objectives and deadlines. * Work indoors in a gambling environment, which may involve smoke filled and dirty areas, diverse populations, and intoxicated people. * Detain or arrest individuals. * Successfully complete the Washington State Criminal Justice Training Commission Basic Law Enforcement Academy (CJTC BLEA) within the first 18 months of employment* * Successfully complete the Gambling Commission's Use of Force training program within the first 45 days of employment * Pass a pre-hire Physical Ability Test if you are not a graduate of the Washington State Criminal Justice Training Center (CJTC) Basic Law Enforcement Academy (BLEA) or equivalent* * Undergo and able to pass an extensive background investigation, which includes a polygraph examination, criminal records check, credit check, and fingerprinting. * Undergo a post conditional offer psychological evaluation, medical examination, and drug test. * Note: This requirement may be met if you have prior experience or training as full-time, fully commissioned peace officer, or a limited jurisdiction, certified law enforcement officer for the State of Washington. We may give preference to candidates with the following qualifications and/or experience. * Proven experience conducting complex investigations. * Proven experience interpreting and applying complex rules, laws, and policies. * Demonstrated experience with financial auditing, financial record inspections, or financial record investigations. * Demonstrated experience with information technology working on or with computerized network systems. * Experience working in the gambling industry. * Exceptional communication and relationship building skills. * Successful completion of the WA State Basic Law Enforcement Academy (BLEA) or equivalent law enforcement academy (BLEEA) READY TO PURSUE THIS OPPORTUNITY? Applying to become a Special Agent can take up to six months or more. We value your time and interest and are committed to moving the process along as quickly as possible. 1. As a regulatory law enforcement agency, all our employees are required to meet the Special Requirements/Conditions of Employment 2. Complete an online application on careers.wa.gov ("Apply" button at top of this announcement). 3. Click on the Special Agent level that interests you to be taken to PST to begin the testing and exam process. NOTE: There are fees to take the written exam and PAT * Special Agent - Entry Level * Special Agent - Lateral (No testing required. Completed PHS required) Note: More information about the WSGC hiring process can be found here. IMPORTANT NOTES Special Agents working in the Tribal Gaming Unit are required to complete a basic law enforcement academy or equivalency. If you do not hold a current law enforcement certification you will be required to attend the Basic Law Enforcement Academy through the Washington State Criminal Justice Training Center. Prior experience and/or training as a fully commissioned peace officer, limited jurisdiction law enforcement officer for the State of Washington may substitute for this requirement. Include a minimum of three professional references within your online application. You must include a phone number and email for each. A professional reference is defined as an individual who has been paid to supervise your work and can attest to your work performance, technical skills, and job competencies. If you do not have any or sufficient professional references, include non-related professionals, such as educators or other professional associates. The Washington State Gambling Commission is an equal opportunity employer. Individuals with disabilities who need assistance with the application process or need this job announcement in an alternative format should provide contact information via email to ***********************. Applicants who are deaf or hard of hearing may call the Washington Relay Service by dialing 7-1-1 or **************. For questions regarding this recruitment announcement, email us at *********************** or call **************.

Competitive Compensation & Benefits Package! eligible for - Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and sick time accrual 12 paid holidays State Retirement (pension plan) 401(k) Plan with employer match Company paid life and disability insurance Wellness Programs Public Service Loan Forgiveness Qualifying Employer See attachment for additional details. Office Location: Flexible for any of our NC office locations (Must live in NC or within 40 miles of NC border) Projected Hiring Range: Depending on Experience Closing Date: Open Until Filled Primary Purpose of Position: This position will assist in the development, implementation, revision, maintenance, and promotion of the agency's fraud, waste, and abuse prevention and detection activities to ensure that the agency and the agency's network operates in a manner that complies with applicable State and Federal laws, regulations, agency policies, national accreditation, and Medicaid guidelines. This position will perform functions relating to data analysis, investigations, and auditing relating to the monitoring, detection, and resolution of healthcare fraud, waste, and abuse. Role and Responsibilities: Conduct, plan and perform independent and comprehensive audits, investigations and reviews (hereinafter referred to as investigations) into allegations of regulatory compliance violations, including fraud, waste, and abuse (FWA). Investigation includes the review of financial, consumer/clinical, provider, and/or other records, reports, and information necessary to thoroughly analyze and investigate suspected violations. Conduct clinical and non-clinical interviews, as necessary, to facilitate the investigative process. Work collaboratively with appropriate internal/external subject matter experts, agency and provider personnel, as necessary, to facilitate the investigative process. Conducts clinical chart reviews of instances of care authorized for utilization purposes, case reviews for individuals that are identified as either over or under-utilizers of services. Knowledge of documentation and clinical protocols for utilization purposes and case reviews for individual consumers in order to conduct clinical chart reviews. Clinical knowledge of managed systems of physical health services (professional and institutional), durable medical equipment, pharmacy, Mental Health, substance abuse, and Intellectual and Developmental Disabilities to also include co-occurring disorders. Knowledge of managed care practices and principles to detect fraud, waste and abuse. Clinical ability to recognize gaps in Partners Health Management service network and ability to communicate these identified gaps to appropriate parties. Serve as a Lead Investigator responsible for coordinating and leading agency investigative teams related to program integrity. Gather, evaluate, and synthesize evidence related to reported allegations to determine compliance with applicable state and federal policies, laws, and regulations. Prepare written and oral reports based on the results of assigned work that help to sustain findings and uphold disputed TNOs. Prepare timely, thorough, and accurate investigative reports; compile case file documentation; calculate overpayments; and synthesize findings in accordance with agency policies and procedures and departmental guidelines. Communicate effectively, both in writing and orally, to ensure accurate and timely completion of all assignments. Develop, implement, monitor, and maintain analytic reports to detect and prevent health care FWA. Conduct independent data mining and data analysis techniques utilizing claims data to detect abnormal claims and develop trends and patterns for potential cases. Independently prepare case documents for referral to the appropriate oversight agency and other external agencies involved in the prosecution of health care fraud. Manage cases from complaint intake through their ultimate conclusion, including supporting the case during all legal processes and appeals and the collection of final overpayments. Create, maintain, and manage cases within the case filing and tracking systems to ensure information is accurate, timely and complete. Consult with legal counsel in order to prepare testimony and other information necessary for appeals and as requested by external agencies investigating or prosecuting Medicaid fraud (as appropriate). Remain abreast of all federal and North Carolina rules and laws applicable to FWA and program integrity. Develop and conduct proactive audits, reviews and investigations of Partners' programs to facilitate the detection and resolution of FWA. Develop, coordinate, and facilitate educational training to the Provider Network and agency personnel on issues relating to the compliance program, FWA. Identify information system edits/alerts/reports in need of implementation in the claims processing system(s). Recommend and implement compliance initiatives, policies, procedures, and practices designed to promote and encourage the reporting of suspected FWA without fear of retaliation. Serve on and/or facilitate various agency committees as deemed necessary by the Program Integrity Director Use data collection instruments and protocols previously developed or adopted by the department and develop data collection instruments as needed for complex investigations. Analyze computer-generated data sets, including claims data, to identify individuals and organizations that are most likely to provide evidence to ascertain whether FWA is likely to have occurred. Develop summary reports that illustrate data analysis to a nonscientific audience. Use appropriate software and systems to complete work assignments. Consult with IT to manage data and generate needed program reports. Perform other duties as assigned. Knowledge, Skills and Abilities: Strong knowledge of state and federal laws, including those related to Medicaid FWA, and regulatory compliance are required. Knowledge of investigative methods and procedures. Knowledge of claims processing and clinical services. Excellent interpersonal and communication skills. Excellent analytical skills. Effective time management and organizational skills. Excellent conflict management skills. Proficient in Word, Excel, Outlook, and Power Point. Ability to learn and effectively manage various information systems including Partners' claims reporting and North Carolina TRACKS. Ability to develop solutions and make recommendations for necessary process improvements. Ability to interpret contractual agreements, business oriented statistics, clinical/administrative services and records. A high level of integrity and discretion is required to effectively carry out the responsibilities related to this position. Education and Experience Required: Master's degree in a Human Services field, Health Administration, health informatics/analytics, or related field, OR a Bachelor's of Science in Nursing and licensed to practice as a Registered Nurse in North Carolina by the N. C. Board of Nursing. Minimum of 3 years recent experience in the healthcare field with compliance monitoring, auditing or investigation experience. Licensed Clinical Social Worker, Licensed Clinical Mental Health Counselor, Licensed Clinical Addiction Specialist, Registered Nurse, Nurse Practitioner, Physician's Assistant, or another clinical license related to the healthcare field. Education and Experience Preferred: Five years recent experience in the healthcare field. Experience analyzing complex data, claims processing, utilization reviews, provider credentialing/monitoring, and/or fraud and abuse detection. Preferred credentials: Registered Health Information Technician (RHIT); Registered Health Information Administrator (RHIA); Certified Coding Specialist (CCS); Certified Fraud Examiner (CFE); and/or Accredited Healthcare Fraud Investigator (AHFI) certification. Licensure/Certification Requirements: Current unrestricted LCSW, LCMHC, LPA, LMFT or LCAS licensure with the appropriate professional board of licensure in the state of North Carolina or licensed to practice as a Registered Nurse, Nurse Practitioner in North Carolina by the N. C. Board of Nursing or licensure in the State of North Carolina or licensed to practice as a Physician's Assistant by the North Carolina Medical Board. Employee is responsible for complying with respective licensure board's continuing education/ training requirements in order to maintain an active license. Must maintain licensure or certification.

Qualified candidates are interested in utilizing their investigative skills to conduct a variety of investigations on insurance related matters; such as auto and property theft, fire damages, auto accidents, commercial claims, finding missing persons, courthouse searches, and other investigative tasks. For this position, you will also need to be fluent in writing, reading and speaking Spanish. This is a remote opportunity for part-time employment in our Special Investigations Unit (SIU). As an SIU Investigator, you will be joining an incredible team of investigators and industry leaders. PRINCIPAL RESPONSIBILITIES: Complete recorded detailed interviews of those insured, claimants, witnesses, and others as identified. Complete scene investigations, including photographing. Conduct in-person visit of medical clinics. Complete neighborhood canvasses. Make sound judgments during the course of the investigation. Provide timely progress updates. Complete detailed investigative reports. WHO SHOULD APPLY: Candidates with at least five (5) years of investigations experience are strongly encouraged to apply. We are looking for people who are enthusiastic about investigations, those who thrive in a diverse work environment, and individuals who have a commitment to the very highest standards of honesty, integrity, and respect. POSITION QUALIFICATIONS: MUST have current and active Private Investigation License to be eligible for hire. Self-motivated, determined, and intuitive with a strong initiative and work-ethic. Ability to identify critical issues quickly and accurately. Demonstrate observational, organizational, and listening skills. Excellent oral and written communication. Fluent in Spanish language (writing, reading, speaking). Ability to work independently, as well as in a team. Flexible schedule working weekends, holidays, and possible evenings. Candidate must own a reliable computer, preferably a laptop, with access to high-speed internet and a scanner or fax machine. Must have strong computer and internet skills. Proficient with a digital camera. Must possess a valid driving license and own your reliable vehicle. Applicants must pass an extensive background check. Must be able to pass a drug test with negative results (except when undergoing documented medical treatment). College Degree preferred. COMPENSATION & REIMBURSEMENTS: Hourly Rate is commensurate with education and experience. Paid travel time and reimbursement for mileage, tolls, and other per diem items. READY TO APPLY? Please submit your FULL resume, including salary requirements.