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Special Agent
Department of Homeland Security 4.5
Criminal investigator job in Columbus, OH
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 $48,371.00 (GL-07, step 1), with promotion potential to $117,034.00 (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.
For more information on the Secret Service 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 $48,371.00 (GL-07, step 1), with promotion potential to $117,034.00 (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.
For more information on the Secret Service click here.
Overview
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Accepting applications
Open & closing dates
10/01/2025 to 01/15/2026
Salary $48,371 to - $117,034 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
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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 CriminalInvestigation
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-Q1-CI Control number 847106700
This job is open to
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The public
U.S. Citizens, Nationals or those who owe allegiance to the U.S.
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Duties
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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 criminalinvestigations 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 criminalinvestigations 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
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Conditions of employment
* U.S. Citizenship.
* 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).
* Applicants must be 21 at the time of application and under 37 at the time of a conditional offer, unless they have prior federal law enforcement service under special retirement provisions. Veterans' preference applicants must receive a conditional offer before age 40.
* 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.
* Be available for assignment to any of the U.S. Secret Service Field Offices. Preferences are not guaranteed.
* Candidates are required to complete intensive training at the Federal Law Enforcement Training Center (FLETC) in Glynco, GA, followed by specialized 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.
* Possess uncorrected visual acuity of no worse than 20/100 binocular, possess corrected visual acuity of 20/20 or better in each eye.(Note: Lasik, ALK, RK, and PRK corrective eye surgeries are acceptable eye surgeries for special agent applicants. Applicants will be considered eligible for the special agent position provided specific visual tests are passed. The following are waiting periods for visual tests: Lasik-2 months after surgery, PRK-6 months after surgery, ALK and RK-one year after surgery).
* 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 $48,371) 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 as described below.
* Maintained a grade-point average of "B" (a GPA of 3.0 or higher) for all completed undergraduate courses, or those completed in the last two years of undergraduate study; OR
* Rank in the upper one-third of your class in the college, university, or major subdivision; OR
* Be a member of a national honor (other than freshman honor societies) recognized by the Association of College Honor Societies. Please submit a college transcript(s) showing your grade point average for all four years of undergraduate study, including all transferred courses.
* NOTE: GPAs are rounded to one decimal place. For example, 2.95 will round to 3.0 and 2.94 will round to 2.9. If more than 10 percent of your undergraduate course work (credit hours) were taken on a pass/fail or similar basis, your claim must be based on class standing or membership in an honor society.
* At least one full year of graduate level education (i.e., 18 semester hours); OR
* At least 1 year of specialized experience in, or related to, the investigative methods, protective methods, and law enforcement techniques that provide the specific competencies to successfully perform the position's duties. Experience also includes exercising initiative; attention to detail; judgment in collecting, assembling and developing facts, evidence or other pertinent data; the ability to analyze and evaluate data or evidence to arrive at sound conclusions including applying new information; and the ability to partner with or lead others in the accomplishment of mission activities.
You are minimally qualified for the GL-09 Level (starting base salary $53,945) 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 meeting 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 $63,163) 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 criminalinvestigations 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 the first full year of doctoral 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.
Qualified applicants will only be referred at the highest grade level for which they qualify.
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
* 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 CriminalInvestigator 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 ************************.
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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
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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.
You will automatically be considered for all grade levels to maximize your consideration for this position.
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
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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. 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.
$15k-117k yearly 60d+ ago
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BCI Special Agent
Dasstateoh
Remote criminal investigator job
BCI Special Agent (260000BX) Organization: Attorney GeneralAgency Contact Name and Information: ********************* Unposting Date: Jan 26, 2026, 10:59:00 PMPrimary 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 CriminalInvestigation (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 CriminalInvestigation, known as BCI, is the state's official crime lab serving the criminal justice community and protecting Ohio families. BCI also provides expert criminalinvestigative 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 criminalinvestigations.- 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.
$37.3-52.6 hourly Auto-Apply 43m ago
Special Agent - Tribal Gaming
State of Washington
Remote criminal investigator job
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 **************.
$59k-70k yearly est. 32d ago
Clinical Investigator (Full-Time Remote, Mecklenburg County, North Carolina Based)
Alliance 4.8
Remote criminal investigator job
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
$77.9k-99.3k yearly 11d ago
BCI Special Agent
State of Ohio 4.5
Remote criminal investigator job
Completion 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, Confidentiality
The 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#\: 26-01-014
Background Check Information:
Selected candidate(s) will be subject to the following background checks:
Criminal history
Driving record
Taxes
Drug Test
Polygraph Test
Field Investigation
Psychological Examination
Physical Examination
In 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.)
About 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.
What 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 CriminalInvestigation (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 CriminalInvestigation, known as BCI, is the state's official crime lab serving the criminal justice community and protecting Ohio families. BCI also provides expert criminalinvestigative 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 criminalinvestigations.
- 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.
At 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.
Ohio 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.
$37k-46k yearly est. Auto-Apply 1d ago
Investigator II
Elevance Health
Criminal investigator job in Columbus, OH
**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.
$69.4k-104.2k yearly 9d ago
Sr Investigative Analyst
Victoria's Secret 4.1
Criminal investigator job in Reynoldsburg, OH
Senior Investigative Analyst The Senior Investigative Analyst (Sr. IA) is a highly dependable position in the Asset Protection Department. The Sr. IA is responsible for reducing shrink through the identification and development of internal/external theft investigations managing the restitution procedures and vendor partnership and supporting background checks adjudication.
The Sr. IA needs to be analytical and detail oriented. The role requires the ability to transition from daily tasks to managing ad-hoc requests by the leadership and field team members with agility and speed to meet deadlines.
The Sr. IA will maintain a peer mentorship traveling as needed, to visit stores, attended industry conferences as directed, enhance product knowledge, and develop business acumen through such partnerships. In addition, the Sr. IA will assist and support multiple vendor partnerships in the areas of exception-based reporting, restitution, and background checks.
The Sr. IA must have strong customer services skills and be able to manage workload to complete tasks with minimal supervision at times. The Sr. IA must be able to analyze data from multiple sources and consistently building new/refining existing reports. The Sr. IA needs to be self-motivated to challenge themselves by developing new skills, leverage emerging technologies, and act as leader within the Asset Protection Operations Team. The Sr. IA needs to be willing to make recommendations or call outs based on the analysis trends and results. The Sr. IA reports to the Senior Manager of Asset Protection Analytics, working a hybrid schedule with a minimum of three days in office per week.
Why You Belong Here
At Victoria's Secret & Co, you'll join a world-leading specialty retail brand recognized globally for innovation and excellence in lingerie and fashion. You'll work alongside industry leaders to set the standard for what a retail brand can achieve, placing customers at the center of everything we do to create products and experiences that bring them joy.
We believe everyone deserves a place where they truly belong. We celebrate individuality and know that your passion, experience, and unique perspective strengthen our team and business. Here, you'll be empowered to perform, grow, and engage through unmatched opportunities to develop your skills, gain real-world experience, and learn from the best in the business.
Essential Functions/Core Responsibilities:
* Shrink reduction and prevention.
* Internal/external case identification and development.
* Data/trend analysis (POS, Internal Investigations, RFID, and background checks).
* Restitution/collections (reporting, field compliance, and vendor partnerships).
* Background check support.
* Other duties as assigned.
The Sr. IA will work on special projects involving various teams within the Asset Protection Department. The Sr. IA analyst will collaborate with members across the Asset Protection team as well as other cross-functional partners in the company.
Click here for benefit details related to this position.
Minimum Salary: $58,000.00
Maximum Salary: $76,125.00
VS&Co provides a range of compensation for this role as shown. Your actual salary will be determined by a number of factors, including: your specific skills and experience, geographic region, or other relevant factors.
Qualifications
Your Experience
* 7-10 years of relevant work experience in retail or asset protection.
* 5 years' experience conducting retail investigations with a focus on internal/external theft and ORC.
* 2 years' experience of managing complex projects and vendor partnerships.
* Advanced understanding of POS analysis, inventory systems, case management software, and exception-based reporting.
* Experience managing and/or system administration support of AP software.
* Proficient in Microsoft Office (i.e., Excel, PowerPoint, Outlook).
* Strong team leadership, relationship building cross-functional partnership.
* Excellent organizational, verbal, and written communication skills.
* Must be able to work onsite Tuesday, Wednesday, and Thursday.
* Must be able to travel quarterly to stores for special projects
#LI-WM1
We will consider for employment all qualified applicants, including those with arrest records, conviction records, or other criminal histories, in a manner consistent with the requirements of any applicable state and local laws. Please see links: California Fair Chance Act, Los Angeles Fair Chance Initiative for Hiring Ordinance, Philadelphia Fair Chance Law, San Francisco Fair Chance Ordinance, Los Angeles County Fair Chance Ordinance
An equal opportunity employer, we do not discriminate in hiring or terms and conditions of employment because of an individual's race, color, religion, gender, gender identity, national origin, citizenship, age, disability, sexual orientation, marital status or any other protected category recognized by state, federal or local laws. We only hire individuals authorized for employment in the United States.
$58k-76.1k yearly 27d ago
Investigator
Ethos Risk Services
Criminal investigator job in Columbus, OH
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.
$50k-89k yearly est. 18d ago
Contract Investigator - Columbus, OH
Omniplex World Services Corporation, A Constellis Company
Criminal investigator job in Columbus, OH
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.
$50k-89k yearly est. 60d+ ago
Investigator II - Diversion Control
MWI Animal Health
Remote criminal investigator job
Our team members are at the heart of everything we do. At Cencora, we are united in our responsibility to create healthier futures, and every person here is essential to us being able to deliver on that purpose. If you want to make a difference at the center of health, come join our innovative company and help us improve the lives of people and animals everywhere. Apply today!
Job Details
Summary:
Under the general direction of the Director of Diversion Control Program, supports the Diversion Control Program through investigative research and other duties, as assigned.
Primary Duties and Responsibilities:
Assists in the implementation and operation of the Diversion Control Program
Conducts investigative research via the Internet and public record databases
Conducts Customer Due Diligence (DD) and Suspicious Order Monitoring (SOM) Investigations
Supports the Diversion Control Analyst in the generation of sales reporting as a result of information requests from state and/or federal regulatory authorities
Supports the Diversion Control Analyst in updating the monthly parameter and related OMP maintenance
Monitors and adjusts customer OMP parameters, according to Diversion Control Program policy, as required
Acts as liaison and maintains contact with Sales and Customer Maintenance departments regarding diversion control concerns, as necessary
Acts as liaison with distribution center compliance teams
Generates statistical data on a monthly basis, as directed
Assists with conducting analysis of customer dispensing reports
Assists with conducting targeted, on-site pharmacy visits, as assigned
Assists with DC pre-audit preparation and interviews with state and federal regulators
Conducts internal associate training on the Diversion Control Program to other ABC business units, as assigned
Composes comprehensive written reports relative to investigative analysis
Documents all work in a timely and organized fashion for future retrieval purposes
Works independently, requiring less oversight from management and offering coaching to Investigator I level team members
Willingness to travel up to 25%
Perform related duties as assigned
Minimum Skills and Qualifications:
Requires broad training in fields such as criminal justice, business administration, accountancy, sales, marketing, computer sciences or similar vocations generally obtained through completion of a four (4) year bachelor's degree program or equivalent combination of experience and education
Normally requires five (5) + years of directly related and progressively responsible experience
Excellent organization and administrative skills
Excellent computer skills including Microsoft Office and preferably familiarity with SAP
Strong written and verbal communication skills
Strong research skills
Ability to multi-task
What Cencora offers
We provide compensation, benefits, and resources that enable a highly inclusive culture and support our team members' ability to live with purpose every day. In addition to traditional offerings like medical, dental, and vision care, we also provide a comprehensive suite of benefits that focus on the physical, emotional, financial, and social aspects of wellness. This encompasses support for working families, which may include backup dependent care, adoption assistance, infertility coverage, family building support, behavioral health solutions, paid parental leave, and paid caregiver leave. To encourage your personal growth, we also offer a variety of training programs, professional development resources, and opportunities to participate in mentorship programs, employee resource groups, volunteer activities, and much more. For details, visit **************************************
Full time Salary Range*$74,000 - 105,820
*This Salary Range reflects a National Average for this job. The actual range may vary based on your locale. Ranges in Colorado/California/Washington/New York/Hawaii/Vermont/Minnesota/Massachusetts/Illinois State-specific locations may be up to 10% lower than the minimum salary range, and 12% higher than the maximum salary range.
Equal Employment Opportunity
Cencora is committed to providing equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, genetic information, national origin, age, disability, veteran status or membership in any other class protected by federal, state or local law.
The company's continued success depends on the full and effective utilization of qualified individuals. Therefore, harassment is prohibited and all matters related to recruiting, training, compensation, benefits, promotions and transfers comply with equal opportunity principles and are non-discriminatory.
Cencora is committed to providing reasonable accommodations to individuals with disabilities during the employment process which are consistent with legal requirements. If you wish to request an accommodation while seeking employment, please call ************ or email ****************. We will make accommodation determinations on a request-by-request basis. Messages and emails regarding anything other than accommodations requests will not be returned
.
Affiliated Companies:Affiliated Companies: AmerisourceBergen Services Corporation
$74k-105.8k yearly Auto-Apply 11d ago
Sub Investigator
Care Access 4.3
Remote criminal investigator job
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 regional travel mixed with remote tele-medicine work to support our clinical research. Care Access is looking for Nurse Practitioners or Physicians Assistants to support clinical trial related activities in states throughout the USA.
How You'll Make An Impact
* Work closely with the Principal Investigator to oversee the execution of study protocols, delegating study related duties to site staff, as appropriate, and ensuring site compliance with study protocols, study-specific laboratory procedures, standards of Good Clinical Practice (GCP), Standard Operating Procedures (SOPs), quality (QA/QC) procedures, OSHA guidelines, and other state and local regulations as applicable
* Attends and participates in meetings with the director, other managers, and staff as necessary
* Complies with regulatory requirements, policies, procedures, and standards of practice
* Read and understand the informed consent form, protocol, and investigator's brochure
* Be available to see subjects virtually or in-person as dictated by project design, answer their questions, and resolve medical issues during the study visit
* Sign and ensure that the study documentation for each study visit is completed
* Perform all study responsibilities in compliance with the IRB approved protocol
* Review screening documentation and approves subjects for admission to study
* Review admission documentation and approves subject for randomization
* Provide ongoing assessment of the study subject/patient to identify Adverse Events
* Ensure that serious and unexpected adverse events are reported promptly to the Pl
* Review and evaluates all study data and comments to the clinical significance of any out of range results
* Perform physical examinations as part of screening evaluation and active study conduct
* Provide medical management of adverse events as appropriate
The Expertise Required
* Excellent working knowledge of medical and research terminology
* Excellent working knowledge of federal regulations, good clinical practices (GCP)
* Ability to communicate and work effectively with a diverse team of professionals
* Strong organizational skills: Able to prioritize, support, and follow through on assignments
* Communication Skills: Strong verbal and written communication skills as evidenced by positive interactions with coworkers, management, clients and vendors
* Team Collaboration Skills: Work effectively and collaboratively with other team members to accomplish mutual goals. Bring positive and supportive attitude to achieving these goals
* Strong computer skills with demonstrated abilities using clinical trials database, IVR systems, electronic data capture, MS word and excel
* Ability to balance tasks with competing priorities
* Critical thinker and problem solver
* Curiosity and passion to learn, innovate, able to take thoughtful risks and get things done
* Friendly, outgoing personality; maintain a positive attitude under pressure
* High level of self-motivation and energy
* Ability to work independently in a fast-paced environment with minimal supervision
* Must have a client service mentality
Certifications/Licenses, Education, and Experience:
* Nurse Practitioner or Physician Assistant with 5+ years of clinical experience
* Currently licensed in good standing in one or more states listed above
* A minimum of 1 year of relevant work experience as Sub-Investigator (preferred) in a Clinical Research setting
How We Work Together
* Location: This role is 100% on-site at our Memphis, TN clinic.
* Travel: This is a remote position with less than 10% travel requirements. Occasional planned travel may be required as part of the role.
* Physical demands associated with this position Include: The ability to use keyboards and other computer equipment.
Benefits & Perks
* Paid Time Off (PTO) and Company Paid Holidays
* 100% Employer paid medical, dental, and vision insurance plan options
* Health Savings Account and Flexible Spending Accounts
* Bi-weekly HSA employer contribution
* Company paid Short-Term Disability and Long-Term Disability
* 401(k) Retirement Plan, with Company Match
Diversity & Inclusion
We work with and serve people from diverse cultures and communities around the world. We are stronger and better when we build a team representing the communities we support. We maintain an inclusive culture where people from a broad range of backgrounds feel valued and respected as they contribute to our mission.
We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to, and will not be discriminated against on the basis of, race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.
Care Access is unable to sponsor work visas at this time.
If you need an accommodation to apply for a role with Care Access, please reach out to: ********************************
$56k-95k yearly est. 60d+ ago
SIU Investigator (Field)- Miami, FL
TWAY Trustway Services
Remote criminal investigator job
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.
$54k-93k yearly est. Auto-Apply 5d ago
Affirmative Civil Enforcement (ACE) Investigator
Contact Government Services, LLC
Remote criminal investigator job
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
Treliant is a global consulting firm serving banks, mortgage originators and servicers, FinTechs, and other companies providing financial services. 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 advisory and consulting, implementation, staffing and managed services solutions to the regulatory compliance, risk, financial crimes, and capital markets functions of our clients.
Founded in 2005, Treliant is headquartered in Washington, DC, with offices across the United States, London, Belfast, and Łódź, Poland. For more information visit *****************
Treliant is committed to fostering a diverse, equitable and inclusive environment that values and embraces all races, religions, ages, abilities, gender, sexual orientations, ethnicities, languages, nationalities, political parties, socioeconomic groups and other characteristics that inform an individual worldwide view and experiences and systems of beliefs (“the principles”). We believe in championing every voice and ensuring everyone's full potential.
We are looking for Financial Crimes Investigators with an expertise in blockchain and cryptocurrencies to join our team for remote, project-based opportunities.
Responsibilities
While the scope of each project may be different, your duties & responsibilities may include:
Conduct thorough Blockchain Tracing investigations into potential financial crimes, including AML, fraud, and sanctions violations.
Ensure clients meet regulatory and compliance standards by performing EDD/ CDD checks, KYC assessments and analyzing source of funds.
Analyze cryptocurrency transactions and wallet addresses, leveraging blockchain explorers and analytics tools to track illicit activity or suspicious behavior.
Draft and submit SARs to relevant authorities
Identify and assess potential financial crime risks across all client portfolios, leveraging both traditional and crypto-related financial systems.
Work closely with regulatory agencies, and financial institutions to ensure compliance with global anti-money laundering (AML) and counter-financing of terrorism (CFT) regulations.
Investigate high-volume or high-value transactions, including cross-border transfers, to identify red flags or signs of illegal activities.
Qualifications
Strong education background; Bachelor's Degree preferred.
3+ years of experience in Financial Crime; either directly with a bank/financial institution or via a third party providing consulting services.
Strong background in AML, CTF or Sanctions, with an understanding of the compliance and regulatory frameworks that apply.
Familiarity with cryptocurrency blockchain tracing and blockchian technologies including investigating transactions on blockchain platforms and identifying risks associated with digital assets.
Familiarity with blockchain forensics tools such as Chainalysis, Elliptic, or CipherTrace to trace and analyze crypto transactions.
Knowledge of global regulatory frameworks for crypto - understanding of evolving cryptocurrency regulations, including FATF's Travel Rule, KYC/AML compliance for digital assets, and the legal landscape around crypto in different regions.
Experience in developing risk mitigation strategies for crypto-based financial crimes, including fraud prevention and transaction monitoring in the crypto space.
We are committed to being an Equal Opportunity Employer and want to build a diverse, inclusive and authentic workplace. If you are interested in working for Treliant but don't tick all the boxes, we encourage you to apply as you may be the perfect candidate for this or other roles.
Benefits
Primary Location:
Remote
Primary Location Salary Range:
$50/hr - $60/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.
$50 hourly Auto-Apply 60d+ ago
SIU Investigator
Healthcare Fraud Shield
Remote criminal investigator job
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.
$47k-84k yearly est. 23d ago
APS Investigator - Region 2 (Northeast)
Briljent
Remote criminal investigator job
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.
$38k-67k yearly est. 19d ago
APS Investigator - Region 2 (Northeast)
Briljent LLC
Remote criminal investigator job
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.
$36k-64k yearly est. 19d ago
SIU Program Integrity Investigator - Remote (In Idaho)
Magellan Health 4.8
Remote criminal investigator job
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.
Hours: 40 Pay Details: $72,280 - $117,520 USD TD is committed to providing fair and equitable compensation opportunities to all colleagues. Growth opportunities and skill development are defining features of the colleague experience at TD. Our compensation policies and practices have been designed to allow colleagues to progress through the salary range over time as they progress in their role. The base pay actually offered may vary based upon the candidate's skills and experience, job-related knowledge, geographic location, and other specific business and organizational needs.
As a candidate, you are encouraged to ask compensation related questions and have an open dialogue with your recruiter who can provide you more specific details for this role.
Line of Business:
Financial Crime Risk Management
Job Description:
Department Overview:
Our team currently operates under a primarily offsite work model, employees must be available to come into a TD location for "moments that matter" at a frequency determined by the business.
FCRM Investigations is responsible for investigations of complex anti-money laundering, counter-terrorism finance, and insider risk matters resulting from law enforcement referrals, proactive initiatives, 314a/314b, and internal referrals.
This Financial Crime Risk Senior Investigator will be a part of the Digital Assets and Cyber Enabled Crime Team.
Depth & Scope:
* Investigatescriminal cases ranging from simple to complex in nature
* Sound knowledge of Bank products, systems, policies and procedures
* Strong knowledge of criminalinvestigative techniques, related laws governing collection of evidence, court proceedings and financial/criminal trends
* Manages programs/projects/ initiatives of low to moderate scope and complexity
* Expert level professional role requiring in-depth knowledge/expertise in own field of specialty and working knowledge of broader related areas
* Integrates the broader organizational context into advice and solutions within own area
* Understands the industry, competition and the factors that differentiate the organization
* Impacts a range of functional programs across own and related teams
* Interprets guidelines, standards, policies, and results of analysis to inform decision making at senior levels
* Builds stakeholder alignment in leading projects and activities
* Works independently as the senior technical lead and guides others within area of expertise
* Identifies and leads problem resolution for complex issues at all levels
Education & Experience:
* Undergraduate degree or equivalent work experience
* 5+ years of experience
Preferred Skills:
* Bachelor's or Master's degree in cybersecurity, cyber crime, intelligence, international studies, criminal justice, forensic accounting, data analytics, or a similar focus.
* Experience with blockchain analysis and blockchain analytics software such as Chainalysis, TRM Labs, Elliptic, etc.
* Relevant Industry certifications such as CAMS, CFE, CRC, CISC, TRM-CI, CCAS, etc.
* Experience conducting intelligence collection or investigations into activities involving cryptocurrency or cyber enabled crime (e.g. Darknet Markets, Ransomware, Money Laundering, Counter Terror Finance, Drug Trafficking, Fraud/Scams, etc.)
* Strong knowledge of financial crime typologies and AML regulations, including the Bank Secrecy Act (BSA), USA PATRIOT Act, and OFAC requirements
* Experience leading or supporting investigative projects; strong project management skills a plus.
* Experience leveraging data analytics to identify trends, anomalies, or support investigative findings related to financial crimes.
* Strong analytical and problem-solving skills.
* Ability to work independently and as part of a team, with a high level of integrity and attention to detail.
* Excellent written and verbal communication skills, with the ability to present findings clearly and concisely.
Customer Accountabilities:
* Conducts a variety of complex investigations, including AML, Sanctions/ABAC and Financial Crime
* Applies sound methodologies to collect, preserve, and analyze evidence while staying current on global emerging risks and technology threats
* Assesses and prioritizes files and investigates assigned cases ensuring proper protocols are in place and effectively applied
* Works effectively with counterparts at other FI's, law enforcement, Non-Profits, and others in government within prescribed protocols to maximize opportunities for information sharing and to reduce TDBFG exposure
* Conducts investigations in a professional and timely manner
* Identifies and communicates procedural weaknesses to businesses
* Identifies industry and typologies risk and trends for respective program areas and shares knowledge with appropriate stakeholders
* Maintains and establishes working relationships with internal partners (e.g., HR, Employment Standards and Legal etc.,) for investigative purposes
* Applies sound methodologies to collect, preserve, and analyze digital evidence in accordance with investigative mandate
Shareholder Accountabilities:
* Leads workstream by acting as a project lead for large or complex projects/initiatives in accordance with project management methodologies
* Evaluates the effectiveness of processes/services and recommends/champions possible enhancements
* Recommends improvements to escalation processes within the investigative unit and a feedback mechanism to relevant stakeholders
* Plans and delivers efficient and cost-effective processes that support and promote the implementation of programs
* Conducts internal and external research projects; supports the development/delivery of presentations/communications to management or broader audience
* Adheres to enterprise frameworks or methodologies that relate to activities for respective business area(s)
* Monitors service, productivity and assesses efficiency levels within own function and implements continuous process/performance improvements where opportunities exist
* Consistently exercises discretion in managing correspondence, information and all matters of confidentiality; escalates issues where appropriate
* Protects the interests of the organization - identifies and manages risks, and ensures the prompt and thorough resolution of escalated non-standard, high-risk issues
* Runs analysis at the functional or enterprise level using results to draw conclusions, makes recommendations, assesses the effectiveness of programs/policies/practices
* Keeps abreast of emerging issues, trends, and evolving regulatory requirements and assesses potential impacts
* Maintains a culture of risk management and control, supported by effective processes in alignment with risk appetite
Employee/Team Accountabilities:
* Participates fully as a member of the team, supports a positive work environment that promotes service to the business, quality, innovation and teamwork and ensures timely communication of issues/points of interest
* Shares industry knowledge for own area of expertise and participates in knowledge transfer within the team and business unit
* Keeps current on emerging trends/developments and grows knowledge of the business, related tools and techniques
* Participates in personal performance management and development activities, including cross training within own team
* Keeps others informed and up to date about the status/progress of projects and/or all relevant or useful information related to day-to-day activities
* Contributes to team development of skills and capabilities through mentorship of others, by sharing knowledge and experiences and leveraging best practices
* Leads, motivates and develops relationships with internal and external business partners/stakeholders to develop productive working relationships
* Contributes to a fair, positive and equitable environment that supports a diverse workforce
* Acts as a brand ambassador for your business area/function and the bank, both internally and/or externally
Physical Requirements:
Never: 0%; Occasional: 1-33%; Frequent: 34-66%; Continuous: 67-100%
* Domestic Travel - Occasional
* International Travel - Never
* Performing sedentary work - Continuous
* Performing multiple tasks - Continuous
* Operating standard office equipment - Continuous
* Responding quickly to sounds - Occasional
* Sitting - Continuous
* Standing - Occasional
* Walking - Occasional
* Moving safely in confined spaces - Occasional
* Lifting/Carrying (under 25 lbs.) - Occasional
* Lifting/Carrying (over 25 lbs.) - Never
* Squatting - Occasional
* Bending - Occasional
* Kneeling - Never
* Crawling - Never
* Climbing - Never
* Reaching overhead - Never
* Reaching forward - Occasional
* Pushing - Never
* Pulling - Never
* Twisting - Never
* Concentrating for long periods of time - Continuous
* Applying common sense to deal with problems involving standardized situations - Continuous
* Reading, writing and comprehending instructions - Continuous
* Adding, subtracting, multiplying and dividing - Continuous
The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required. The listed or specified responsibilities & duties are considered essential functions for ADA purposes.
Who We Are:
TD is one of the world's leading global financial institutions and is the fifth largest bank in North America by branches/stores. Every day, we deliver legendary customer experiences to over 27 million households and businesses in Canada, the United States and around the world. More than 95,000 TD colleagues bring their skills, talent, and creativity to the Bank, those we serve, and the economies we support. We are guided by our vision to Be the Better Bank and our purpose to enrich the lives of our customers, communities and colleagues.
TD is deeply committed to being a leader in customer experience, that is why we believe that all colleagues, no matter where they work, are customer facing. As we build our business and deliver on our strategy, we are innovating to enhance the customer experience and build capabilities to shape the future of banking. Whether you've got years of banking experience or are just starting your career in financial services, we can help you realize your potential. Through regular leadership and development conversations to mentorship and training programs, we're here to support you towards your goals. As an organization, we keep growing - and so will you.
Our Total Rewards Package
Our Total Rewards package reflects the investments we make in our colleagues to help them and their families achieve their financial, physical and mental well-being goals. Total Rewards at TD includes base salary and variable compensation/incentive awards (e.g., eligibility for cash and/or equity incentive awards, generally through participation in an incentive plan) and several other key plans such as health and well-being benefits, savings and retirement programs, paid time off (including Vacation PTO, Flex PTO, and Holiday PTO), banking benefits and discounts, career development, and reward and recognition. Learn more
Additional Information:
We're delighted that you're considering building a career with TD. Through regular development conversations, training programs, and a competitive benefits plan, we're committed to providing the support our colleagues need to thrive both at work and at home.
Colleague Development
If you're interested in a specific career path or are looking to build certain skills, we want to help you succeed. You'll have regular career, development, and performance conversations with your manager, as well as access to an online learning platform and a variety of mentoring programs to help you unlock future opportunities. Whether you have a passion for helping customers and want to expand your experience, or you want to coach and inspire your colleagues, there are many different career paths within our organization at TD - and we're committed to helping you identify opportunities that support your goals.
Training & Onboarding
We will provide training and onboarding sessions to ensure that you've got everything you need to succeed in your new role.
Interview Process
We'll reach out to candidates of interest to schedule an interview. We do our best to communicate outcomes to all applicants by email or phone call.
Accommodation
TD Bank is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or any other characteristic protected under applicable federal, state, or local law.
If you are an applicant with a disability and need accommodations to complete the application process, please email TD Bank US Workplace Accommodations Program at ***************. Include your full name, best way to reach you and the accommodation needed to assist you with the applicant process.
$72.3k-117.5k yearly Auto-Apply 5d ago
Program Integrity Clinical Investigator (Remote-NC)
Partners Behavioral Health Management 4.3
Remote criminal investigator job
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.