Forgery/fraud investigator jobs near me - 58 jobs

Care Access is working to make the future of health better for all. With hundreds of research locations, mobile clinics, and clinicians across the globe, we bring world-class research and health services directly to communities that often face barriers to care. We are dedicated to ensuring that every person has the opportunity to understand their health, access the care they need, and contribute to the medical breakthroughs of tomorrow. With programs like Future of Medicine , which makes advanced health screenings and research opportunities accessible to communities worldwide, and Difference Makers , which supports local leaders to expand their community health and wellbeing efforts, we put people at the heart of medical progress. Through partnerships, technology, and perseverance, we are reimagining how clinical research and health services reach the world. Together, we are building a future of health that is better and more accessible for all. To learn more about Care Access, visit ******************* How This Role Makes a Difference The Sub-Investigator will be responsible for travel mixed with remote tele-medicine work to support our clinical research studies. Additionally, our Sub-Investigator will be skilled in administering investigational products (IV, SC, TD, IM, PO administration), performing physical examinations, monitoring for investigational product related reactions, among other duties beyond the standard clinical research Sub-Investigator role. Care Access is looking for highly motivated Nurse Practitioners or Physician's Assistants to support clinical trial related activities in states throughout the USA. How You'll Make An Impact Work closely with the Principal Investigator to oversee the execution of study protocols, delegating study related duties to site staff, as appropriate, and ensuring site compliance with study protocols, study-specific laboratory procedures, standards of Good Clinical Practice (GCP), Standard Operating Procedures (SOPs), quality (QA/QC) procedures, OSHA guidelines, and other state and local regulations as applicable. Attends and participates in meetings with the director, other managers, and staff as necessary. Complies with regulatory requirements, policies, procedures, and standards of practice. Read and understand the informed consent form, protocol, and investigator's brochure. Be available to see subjects virtually or in-person as dictated by project design, answer their questions, and resolve medical issues during the study visit. Sign and ensure that the study documentation for each study visit is completed. Perform all study responsibilities in compliance with the IRB approved protocol. Administration of Investigational Products (via subcutaneous, transdermal, intramuscular, intravenous, or oral routes). Proficiency in starting, monitoring, and maintaining intravenous lines. Proficiency in phlebotomy, proper blood collection practices, and laboratory processing practices (can be learned) Contribute as an active member of clinician team involved in the management of infusion or other investigational product related reactions. Maintain a clean, efficient clinical area to assure the highest standards of patient care. Follow safety and PPE procedures as well as maintain proper documentation of infusion procedures. Timely communications with internal teams, investigators, review boards, and study subjects Perform trial procedures as per delegation which can include the following but not limited to: Prescreen study candidates by telephone and review exclusionary conditions or medications prior to scheduling screening appointment. Obtain informed consent per SOP. Administer delegated study questionnaires, as appropriate. Collect and evaluate medical records. Complete visit procedures and ensure proper specimen collection, processing, and shipment in accordance with protocol. Train others and complete basic clinical procedures, such as blood draws, vital signs, ECGs, etc. Review screening documentation and approves subjects for admission to study. Review admission documentation and approves subject for randomization. Provide ongoing assessment of the study subject/patient to identify Adverse Events. Ensure that serious and unexpected adverse events are reported promptly to the Pl. Review and evaluates all study data and comments to the clinical significance of any out-of-range results. Perform physical examinations as part of screening evaluation and active study conduct. Provide medical management of adverse events as appropriate. Dispense study medication per protocol and/or IVRS systems. Educate patient on proper administration and importance of compliance. Monitor patient progress on study medication. Other duties as assigned. The Expertise Required Ability to check, perform, and document vitals as well as EKG (ECG) Phlebotomy and expert IV skills Excellent working knowledge of medical and research terminology Excellent working knowledge of federal regulations, good clinical practices (GCP) Ability to communicate and work effectively with a diverse team of professionals. Strong organizational skills: Able to prioritize, support, and follow through on assignments with good understanding of medical terminology. Communication Skills: Strong verbal and written communication skills as evidenced by positive interactions with coworkers, management, clients and vendors. Communication Skills: Strong verbal and written communication skills as evidenced by positive interactions with coworkers, management, clients and vendors. Team Collaboration Skills: Work effectively and collaboratively with other team members to accomplish mutual goals. Bring positive and supportive attitude to achieving these goals. Strong computer skills with demonstrated abilities using clinical trials database, IVR systems, electronic data capture, MS word and excel. Ability to balance tasks with competing priorities. Critical thinker and problem solver. Curiosity and passion to learn, innovative, and able to take thoughtful risks while communicating concerns and mitigations. Good management and organizational skills, understanding of medical procedures. Exceptional interpersonal skills, willingness to the ability to work independently. Ability to lift a minimum of 50 pounds. Command of professional and Business English (written and spoken). You must have the authorization to work in the US for any employer. You must not need visa sponsorship, either now or in the future. You must live in the USA and be willing and able to travel with 24-36-hour notice Certifications/Licenses, Education, and Experience: At least Master's Level Science Degree. Nurse Practitioner or Physician Assistant with 5+ years of clinical experience. Clinical practice experience desired with infusion skillset. Currently licensed in good standing in one or more states. A minimum of 1 year of relevant work experience as Sub-Investigator (preferred) in a Clinical Research setting. Preferred at least one (1) year of experience as a Clinical Research Coordinator or willingness to learn. How We Work Together Location: Remote within the United States. This is an on-site mixed with remote tele-medicine work position. Travel: Regional and nationwide travel requirements up to 100% dependent on project design and business need. Regularly planned travel will be required as part of the role. Physical demands associated with this position Include: The ability to use keyboards and other computer equipment. The expected salary range for this role is $130,000 - $165,000 USD per year for full time team members. Benefits & Perks (US Full Time Employees) Paid Time Off (PTO) and Company Paid Holidays 100% Employer paid medical, dental, and vision insurance plan options Health Savings Account and Flexible Spending Accounts Bi-weekly HSA employer contribution Company paid Short-Term Disability and Long-Term Disability 401(k) Retirement Plan, with Company Match Diversity & Inclusion We work with and serve people from diverse cultures and communities around the world. We are stronger and better when we build a team representing the communities we support. We maintain an inclusive culture where people from a broad range of backgrounds feel valued and respected as they contribute to our mission. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to, and will not be discriminated against on the basis of, race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law. Care Access is unable to sponsor work visas at this time. If you need an accommodation to apply for a role with Care Access, please reach out to: ********************************

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

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.

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.

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 general direction of the Director - Investigations, responsible for conducting investigations and providing support to the Global Security (GS) Department. A global corporate investigator plays a crucial role in maintaining the integrity and security of an organization by investigating potential misconduct, fraud, or violations of company policies. Further, the investigator is responsible for protecting Cencora's assets, reputation, and team members by ensuring ethical conduct and compliance with policies, procedures and regulations. Primary Duties and Responsibilities: Conducting Investigations Investigate allegations of internal misconduct such as fraud, product loss, workplace violence and policy violations Collect and analyze evidence, including documents, emails, CCTV footage, and other records Interview team members, witnesses, and other relevant parties to gather information Maintain confidentiality and ensure investigations are conducted in compliance with legal and ethical standards Reporting and Documentation Prepare detailed investigation reports outlining findings, evidence, and recommendations Document all steps of the investigation process to ensure transparency and accountability Communicate findings to leadership, HR, or legal teams as appropriate Policy and Compliance Monitoring Ensure company policies and procedures are being followed Identify gaps in compliance or vulnerabilities that may lead to misconduct Recommend improvements to internal controls, policies, and procedures to prevent future issues Collaboration with Internal and External Stakeholders Work closely with HR, legal, and management teams during investigations Coordinate with external agencies, such as law enforcement or regulatory bodies, when necessary Act as a liaison between corporate leadership and external investigators or auditors Risk Assessment and Prevention Identify potential risks or areas of vulnerability within the organization Develop and implement strategies to mitigate risks related to fraud, theft, or policy violations Conduct regular audits or reviews to ensure compliance with internal policies and external regulations Legal and Regulatory Compliance Ensure investigations comply with local, national, and international laws, as well as industry regulations Stay up to date on changes in laws, regulations, and best practices related to corporate investigations Crisis Management Respond quickly to urgent situations involving potential misconduct or security breaches Manage sensitive cases, such as whistleblower complaints, with discretion and professionalism Support the organization in handling reputational risks or public relations issues arising from investigations Required Skills and Qualifications Strong analytical and problem-solving skills Excellent interpersonal and communication skills for interviewing and reporting Knowledge of corporate governance, compliance, and legal standards Experience with investigative techniques, forensic tools, and data analysis Ability to maintain confidentiality and handle sensitive information with discretion Willingness to travel up to 40% of the time and on short notice Requires broad training in related field through completion of a four-year Bachelor's Degree program or equivalent combination of education and experience, BA or BS Degree in related field preferred Normally requires a minimum of six (6) years directly related and progressively responsible experience, previous work experience in law enforcement, or the pharmaceutical industry Proficient investigative skills Proficient interview and interrogation skills Ability to work alone as well as with others; ability to collaborate with others Excellent verbal and written communication skills Ability to evaluate facts, determine alternative solutions to problems, evaluate courses of action, and make solid decisions Strong interpersonal skills; self-starter 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

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 Orlando area will be considered. This is a field position. Please note a company car provided. Job Responsibilities Supports Claims Department operations in the research and investigation of suspicious or questionable property damage and injury claims Conducts recorded statements and Examinations Under Oath as required Completes field work as required. Documents claim files and communicates in writing as required Provides office training to ensure recognition of potentially suspicious or fraudulent files in the branch Reports suspicious claims to the department of insurance as required by statute Must ensure compliance with industry and company policies Must understand regulatory / statutory requirements; develops and maintains knowledge of changes in law both at state and national levels Properly utilizes our claims and other various systems Attends industry meetings for communication trends Completes individual monthly Investigator report to manager Attends and participates in team meetings Participates in roundtable meetings Actively affiliates and maintains network of SIU, claims, law enforcement, attorney and related contacts to ensure investigation methods are current and proper operating procedures are utilized Responsible for meeting individual goals and objectives Maintains consistent, fair and diplomatic interactions with co-workers Performs other duties as assigned by SIU Manager Job Qualifications Formal Education & Certification Undergraduate College Degree or equivalent work experience will be considered. Knowledge & Experience 5 years of special investigation experience required. Casualty and PIP claims, as well as medical clinic investigations will be highly preferred. Claims and Property Damage investigations experience will be required. Skills & Competencies Must be able to work in a fast-paced, paperless/automated production environment. Excellent PC skills are required. Excellent communication/interpersonal skills and ability to work with all levels within the organization and deal tactfully and diplomatically with public and outside authorities. Must be able to work as a team player throughout the company. Ensures that the highest degree of professionalism and integrity is maintained, and that decisions are made within the scope of what is fair, reasonable and appropriate according to applicable law and industry standards. Must have the ability to travel when necessary. Bilingual preferred. Florida Adjuster's license is required prior to employment start date.

Job 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 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. Benefits Medical, Dental, Vision, 401K, PTO, Paid Holidays, Wellness Program, STD, LTD, Maternity/Paternity Leave

Job DescriptionDescriptionHealthcare Fraud Shield, a leader in healthcare fraud prevention and payment integrity solutions, is looking for a talented Coder or Clinical Coder/Fraud Investigator to join our team. Key Responsibilities Work with SIU Team (Clinical Reviewers, CPCs, Investigators, Analysts-including performing quality check on work, assisting in research, discuss to make appropriate coding determinations as needed) Analyze and interpret patient medical records (behavioral related and other specialties) pertaining to FWA investigations as needed Compare to information submitted on the claims in order to determine amount and nature of billable services as needed Determines appropriateness of billing and reimbursement as needed Documents findings for each claim line in a spreadsheet as needed Summarize findings in a written report as needed Abstracts CPT, HCPCS, Revenue Codes, DRG codes, and ICD-9/ICD-10 from medical records as needed Responsible for maintaining current knowledge of coding guidelines and relevant federal and/or state regulations as needed Perform data analysis and lead generation/data mining of client data as needed Conduct various aspects of FWA investigations as needed Provide Subject Matter Expertise and SIU support to clients as needed Comply with Privacy and Security standards Understands and complies with all company Privacy and Security standards Employee may not use or disclose any protected health information, except as otherwise permitted, or required, by law Other duties as needed Skills, Knowledge and Expertise Knowledge of medical terminology Knowledge of coding including CPT, HCPCS, Revenue Codes, DRG Codes, and ICD-10 Knowledge of specialty medical practices Must be detail oriented Ability to communicate effectively both verbally and in writing Strong listening skills Independent Responsible Self-disciplined Ability to meet defined performance and production goals Strong computer skills This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management CERTIFICATE/LICENSE Certified Professional Coder - (CPC ) through governing body AAPC or equivalent certification Minimum of one year of coding and/or billing experience is required. Benefits Medical, Dental & Vision insurance 401(k) retirement savings with employer match Vacation and sick paid time off 7 paid holidays & 2 floating holidays Paid maternity/paternity leave Disability & Life insurance Flexible Spending Account (FSA) Employee Assistance Program (EAP) Professional and career development initiatives Remote work eligible REMOTE WORK REQUIREMENTS Must have high speed Internet (satellite is not allowed for this role) with a minimum speed of 25mbs download and 5mbs upload. Healthcare Fraud Shield is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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

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.

Investigator (2600007S) Organization: Psychology BoardAgency Contact Name and Information: Jennifer Gates, *************************** Unposting Date: Jan 19, 2026, 4:59:00 AMWork Location: Riffe Tower 77 South High Street Concourse Columbus 43215Primary Location: United States of America-OHIO-Franklin County-Columbus Compensation: $27.92/hr Schedule: Full-time Work Hours: 8:00AM-5:00PMClassified Indicator: ClassifiedUnion: OCSEA Primary Job Skill: InvestigationTechnical Skills: InvestigationProfessional Skills: Attention to Detail, Building Trust, Critical Thinking, Listening, Confidentiality Agency Overview Since 1972, the Ohio Board of Psychology has been providing protections to the public through examinations, licensing, education, and investigating complaints and maintaining accountability among Ohio's psychologists, school psychologists licensed for private practice, supervised providers, and applicants for licensure. The Board is responsible for enforcement of ORC Chapter 4732 and OAC Chapter 4732, the Laws and Rules Governing Psychologists and School Psychologists. In addition, the Board became responsible for regulating the practice of Certified Ohio Behavior Analysts with the enactment of ORC 4783 and the promulgation of rules in OAC 4783 effective in January 2014. The Ohio Board of Psychology's greatest responsibility is to protect the well-being and safety of Ohioans who receive or seek psychological or applied behavior analysis services and stopping illegal practice. The Board is comprised of ten members appointed by the governor-seven license holders and three patient advocates. The Board office is staffed by five full-time employees focused on fulfilling the Board's mission and vision and implementing its core values through a strong customer service model.MISSION: The State Board of Psychology ensures Ohioans' access to safe and competent psychological services through examination, licensing, education, and enforcement.VISION: The State Board of Psychology represents excellence and common sense in occupational regulation in the State of Ohio and is a leader among the members of the Association of State and Provincial Psychology Boards.CORE VALUES: The State Board of Psychology and its employees share a set of core values, which are reflected in investigations, licensing, public relations, and policy making.Job DescriptionThe Investigator plays an important part at the Board. In this role, you will be responsible for: • Conducting investigations of complaints and alleged violations of the Ohio Revised Code 4732/4783 and the Ohio Administrative Code 4732/4783.• Interviewing complainants, witnesses, public members, licensees subject to allegations and unlicensed individuals who may be practicing illegally or using titles, terminology and/or techniques restricted by law.• Preparing reports and making recommendations regarding investigation strategy, case status.• Interpreting application of administrative rules, Ohio Revised Code, ethical principles and Psychology Board policy and procedures.• Responding to inquiries from citizens regarding complex and sensitive material related to confidentiality, client rights, mental disorders and occupational standards of care in psychology.• Drafting legal correspondence and documents including case notes, reports, subpoenas, letters, notice of opportunity for hearing letters, consent agreements and adjudication orders.• Preparing confidential investigation reports and recommendations.• Maintaining files and records and conferring with legal personnel. • Requesting and serving Psychology Board subpoenas.• Testifying in administrative hearings on behalf of the Psychology Board and/or criminal hearings on behalf of the Board.• Handling sensitive inquiries received via telephone, in writing, or in person from psychology physicians, legal counsel, consumers and the general public.• Assisting in development of Psychology Board investigative policies, procedures and methods in accordance with related civil service laws.• Entering and maintaining case information in Psychology Board's investigative case tracking database.• Attending and participating in law enforcement seminars and training and serving on committees and task forces. 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.Qualifications30 months of training or 30 months of investigative experience with experience corresponding to type of complaints & alleged violations appearing in job posting/approved position description AND valid driver's license. -OR Completion of associate core program in law enforcement, criminal justice or in academic field commensurate with program area to be assigned per approved Position Description on file AND 12 months of experience conducting investigations and/or inspections AND valid driver's license. -OR 30 months of training or 30 months of experience as Investigator Assistant, 26210 with experience corresponding to type of complaints & alleged violations appearing in job posting/approved position description AND valid driver's license. -OR equivalent of Minimum Class Qualifications for Employment noted above. Job Skills: InvestigationSupplemental InformationWhen completing your application, be sure to clearly describe how you meet the minimum qualifications outlined in this job posting. If you require reasonable accommodation for the application process, please email the Human Resources contact on this posting so arrangements can be made.The final candidate selected for this position will be required to undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position. An individual assessment of an applicant's prior criminal convictions will be made before excluding an applicant from consideration. The Ohio Board of Psychology is an Equal Employment Opportunity Employer and does not discriminate on the basis of race, color, religion, gender, gender identity or expression, national origin (ancestry), military status, disability, age (40 years or older), genetic information, sexual orientation, or caregiver status, in making employment-related decisions about an individual.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.Drug-Free WorkplaceThe State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.

Our roster has an opening with your name on it This role is responsible for leading and conducting comprehensive, complex investigations related to regulator concerns related to deposit fraud, play integrity, abuse, account takeovers, organized fraud, and other fraud specific investigations. This position will be a part of internal quality assurance testing as it relates to fraud processes along with preparing and presenting findings. This role is required to stay current on fraud trends and emerging threats and present case studies to the broader team on a recurring basis. As a Fraud Investigative Lead Supervisor, you will be contributing to state-specific reporting and regulatory-related fraud reviews. In addition to completing and leading investigations, this role will be responsible for overseeing direct reports, and managing tasks such as coordinating job rotations, providing regular and consistent feedback to direct reports, reporting significant findings and activity updates to the Fraud investigative Manager, goal coaching, and other supervisory tasks. This role may assist in designing, documenting, implementing, and monitoring of new procedures/services. Candidates for this role must pass the required licensing as mandated by various state gaming and racing regulatory bodies. Failure to be licensed or retain licensure will result in termination of employment. This position reports to the Fraud Investigative Manager. In addition to the specific responsibilities outlined above, employees may be required to perform other such duties as assigned by the Company. This ensures operational flexibility and allows the Company to meet evolving business needs. THE GAME PLAN Everyone on our team has a part to play Train and mentor Fraud Investigators and Fraud Prevention Analysts within our department Participate in quality assurance testing related to fraud prevention efforts Prepare investigation reports, summaries, and present findings Investigate and research allegations of fraud or abuse of system controls and communicate root cause findings Lead applicable state-specific regulatory fraud form reporting and regulator investigations Research, evaluate, and analyze information and intelligence to determine risk Aid in developing fraud mitigation strategies OSINT collection and analysis Collaborate with other departments within our organization, such as Security, Risk, Compliance, and other related teams Analyze past and current fraud trends and suspicious behavior tracking Continually learn and adapt to changing fraud trends and behavior Other tasks and projects as assigned by the leadership team THE STATS What we're looking for in our next teammate 3+ years of fraud experience in daily fantasy sports, online gaming or related industries 1+ years of leadership experience preferred Proficiency with SQL required Experience with digital payments and understanding of e-Commerce platforms Cybersecurity experience a plus Experience interacting with regulators and compliance a plus Prior experience using open-source intelligence Strong verbal and written communication skills Bachelor's degree in related field preferred Demonstrated aptitude for process execution, including identification of areas for improvement In-depth knowledge and understanding of common fraud trends and emerging threats Advanced knowledge of common fraud prevention strategies and systems Intermediate understanding of Check, ACH, Wire, Debit/Credit card, PayPal and other payment channel operating rules Effective communication, organizational, problem-solving, and analytical skills Passion for sports and/or gaming industry a plus Licensure: Must be able to pass required licensing as mandated by various state racing and gaming regulatory bodies ABOUT FANDUEL FanDuel Group is the premier mobile gaming company in the United States and Canada. FanDuel Group consists of a portfolio of leading brands across mobile wagering including: America's #1 Sportsbook, FanDuel Sportsbook; its leading iGaming platform, FanDuel Casino; the industry's unquestioned leader in horse racing and advance-deposit wagering, FanDuel Racing; and its daily fantasy sports product. In addition, FanDuel Group operates FanDuel TV, its broadly distributed linear cable television network and FanDuel TV+, its leading direct-to-consumer OTT platform. FanDuel Group has a presence across all 50 states, Canada, and Puerto Rico. The company is based in New York with US offices in Los Angeles, Atlanta, and Jersey City, as well as global offices in Canada and Scotland. The company's affiliates have offices worldwide, including in Ireland, Portugal, Romania, and Australia. FanDuel Group is a subsidiary of Flutter Entertainment, the world's largest sports betting and gaming operator with a portfolio of globally recognized brands and traded on the New York Stock Exchange (NYSE: FLUT). PLAYER BENEFITS We treat our team right We offer amazing benefits above and beyond the basics. We have an array of health plans to choose from (some as low as $0 per paycheck) that include programs for fertility and family planning, mental health support, and fitness benefits. We offer generous paid time off (PTO & sick leave), annual bonus and long-term incentive opportunities (based on performance), 401k with up to a 5% match, commuter benefits, pet insurance, and more - check out all our benefits here: FanDuel Total Rewards. *Benefits differ across location, role, and level. FanDuel is an equal opportunities employer and we believe, as one of our principles states, “We are One Team!”. As such, we are committed to equal employment opportunity regardless of race, color, ethnicity, ancestry, religion, creed, sex, national origin, sexual orientation, age, citizenship status, marital status, disability, gender identity, gender expression, veteran status, or any other characteristic protected by state, local or federal law. We believe FanDuel is strongest and best able to compete if all employees feel valued, respected, and included. FanDuel is committed to providing reasonable accommodations for qualified individuals with disabilities. If you have a disability and need a workplace accommodation or adjustment during the application and hiring process, including support for the interview or onboarding process, please email ********************. The applicable salary range for this position is $78,000 - $97,000 USD, which is dependent on a variety of factors including relevant experience, location, business needs and market demand. This role may offer the following benefits: medical, vision, and dental insurance; life insurance; disability insurance; a 401(k) matching program; among other employee benefits. This role may also be eligible for short-term or long-term incentive compensation, including, but not limited to, cash bonuses and stock program participation. This role includes paid personal time off and 14 paid company holidays. FanDuel offers paid sick time in accordance with all applicable state and federal laws. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. #LI-Hybrid

Employee Applicant Privacy Notice Who we are: Welcoming, collaborative and having the opportunity to make an impact - is how our employees describe working here. Galileo is a financial technology company that provides innovative and revolutionary software products and services that power some of the world's largest Fintechs. We are the only payments innovator that applies tech and engineering capabilities to empower Fintechs and financial institutions to unleash their full creativity to achieve their most inspired goals. Galileo leads its industry with superior fraud detection, security, decision-making analytics and regulatory compliance functionality combined with customized, responsive and flexible programs to accelerate the success of all payments companies and solve tomorrow's payments challenges today. We hire energetic and creative employees while providing them the opportunity to excel in their careers and make a difference for our clients. Learn more about us and why we work here at ********************************************** Job Description Compensation and Benefits The base pay range for this role is listed below. Final base pay offer will be determined based on individual factors such as the candidate's experience, skills, and location. This role may also be eligible for a bonus and/or long term incentives. Your recruiter will provide more information to you. All roles are eligible for competitive benefits. More information about our employee benefits can be found in the link below. Benefits To view all of our comprehensive and competitive benefits, visit our Benefits at SoFi & Galileo page! US-Based Base Compensation $25.60-$47.70 USD Galileo Financial Technologies provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion (including religious dress and grooming practices), sex (including pregnancy, childbirth and related medical conditions, breastfeeding, and conditions related to breastfeeding), gender, gender identity, gender expression, national origin, ancestry, age (40 or over), physical or medical disability, medical condition, marital status, registered domestic partner status, sexual orientation, genetic information, military and/or veteran status, or any other basis prohibited by applicable state or federal law. The Company hires the best qualified candidate for the job, without regard to protected characteristics. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. New York applicants: Notice of Employee Rights Galileo is committed to an inclusive culture. As part of this commitment, Galileo offers reasonable accommodations to candidates with physical or mental disabilities. If you need accommodations to participate in the job application or interview process, please let your recruiter know or email accommodations@sofi.com. Due to insurance coverage issues, we are unable to accommodate remote work from Hawaii or Alaska at this time. Internal Employees If you are a current employee, do not apply here - please navigate to our Internal Job Board in Greenhouse to apply to our open roles.

Job Description Nymbus (******************** is a high growth fintech company that enables financial institutions to transform their capabilities and drive value in today's digital finance world. At Nymbus, we believe when you set off on the path to innovation you should feel excitement and confidence, not fear and dread. With Nymbus we are bringing delight back into the banking process. We want our partners to be thrilled about the possibilities we are creating together and the lasting impact our collaboration will bring to the industry and consumers. The journey to growth begins with doing something different. And that journey starts with the great people that make Nymbus. Thank you for considering and entrusting Nymbus to be the catalyst that helps take your career through your next chapter. WORK ENVIRONMENT: We are a remote first company. This role, as most of our positions, is remote. You may be required at times to visit client sites or attend meetings at designated locations. POSITION SUMMARY: The Fraud Investigator plays a critical role in protecting the financial assets, operational integrity, and reputation of Nymbus clients by leading advanced investigations into complex and high-impact fraud cases across multiple payment channels and products. This role involves the proactive identification of suspicious patterns and anomalies through the review of transactional data, case alerts, and non-alert-based referrals from both internal and external sources. The Investigator will perform in-depth case analysis, connect cross-channel and cross-client fraud activity, and determine the root cause of fraudulent behavior. They will work directly with clients to present investigative findings, provide recommendations for risk mitigation, and ensure timely resolution of escalated cases. This includes preparing comprehensive reports, tracking key trends, and recommending targeted process enhancements. Collaboration is essential, as the Fraud Investigator partners closely with internal operations teams, external client contacts, and third-party fraud detection platforms to resolve cases efficiently and in compliance with regulatory standards. The role also involves drafting and maintaining investigative procedures, mentoring Fraud Analysts, and contributing to the development of enterprise-wide fraud prevention strategies. The ideal candidate will have proven expertise in fraud investigation, strong pattern-recognition skills, deep knowledge of financial regulations, and the ability to work effectively under pressure in a high-volume, deadline-driven environment. ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES: Include, but are not limited to: Lead end-to-end investigations into complex and high-impact fraud cases, ensuring timely and thorough resolution. Analyze transactional data across multiple sources to identify patterns, trends, and emerging fraud typologies. Develop and maintain detailed fraud reports for clients, highlighting findings, trends, and recommended actions. Collaborate with internal operational and support teams to ensure accurate documentation, escalation, and resolution of fraud incidents. Work with clients to provide investigative updates, final case reports, and recommended preventive measures. Conduct in-depth reviews of customer claims involving Debit card, Credit card, ACH, P2P, Bill Payments, and other payment channels, with a focus on complex and recurring cases. Identify gaps and recommend procedural enhancements to strengthen fraud prevention measures. Draft, update, and maintain fraud investigation procedures and best practices documentation. Serve as a subject matter expert for escalated fraud inquiries from Fraud Analysts and other team members. Track and report investigation metrics for client review. Stay current on industry fraud trends, regulatory changes, and compliance requirements to ensure investigative processes remain effective. Provide training and mentorship to Fraud Analysts on investigative techniques and case handling. QUALIFICATIONS: Associates degree in Business, Criminal Justice, Finance, or a related field preferred. Minimum 5 years of experience in fraud investigation or advanced fraud analysis, preferably in a financial institution or fintech environment. Proven track record managing complex investigations from initiation to resolution. Strong understanding of fraud detection tools and platforms (e.g., Verafin, DataVisor) and the ability to leverage multiple systems for analysis. Fraud certification (CFE, CFCI, or equivalent) strongly preferred. Expertise in identifying patterns, connecting data points, and recognizing emerging fraud trends. Strong understanding of banking operations, payment systems, and relevant regulations. Exceptional written and verbal communication skills, including the ability to prepare and deliver investigation reports to diverse audiences. Proven analytical, research, and problem-solving skills, with a detail-oriented mindset. Ability to work independently on complex assignments while collaborating effectively with cross-functional teams. Proficient in Microsoft Office and Google applications, with strong Excel and data analysis skills. Comfortable navigating multiple systems and applications in a fast-paced, deadline-driven environment. HOURS: Monday - Friday, 8:00 AM - 5:00 PM EST Rotating weekend coverage as scheduled Occasional flexibility may be required for urgent investigations or client needs. SALARY & BENEFITS: $65,000 - $75,000 Annual Salary Annual Cash Bonus and Equity Options commensurate with the role level and experience 100% Fully Remote Robust 401(k) plan with company match Insurance - Health, Dental and Vision (Nymbus covers 100% of the Healthcare and Basic Dental premiums) Flexible Paid Time Off Ready to join? We invite you to watch this video and learn who we are and how we build and innovates together! Let's Go!

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Fraud Investigator in the United States.In this critical role, you will lead complex investigations into high-impact fraud cases across multiple payment channels, protecting clients' financial assets and operational integrity. You will analyze transactional data, identify suspicious patterns, and determine the root cause of fraudulent activity. Acting as a trusted advisor to both internal teams and clients, you will deliver actionable insights, present findings, and recommend risk mitigation strategies. Collaboration is key, as you will work with cross-functional teams and external platforms to resolve cases efficiently and in compliance with regulatory standards. This role combines analytical rigor, investigative expertise, and operational leadership in a dynamic, fast-paced environment.Accountabilities: Lead end-to-end investigations into complex fraud cases, ensuring timely and thorough resolution Analyze transactional data across multiple sources to detect patterns, trends, and emerging fraud typologies Prepare and present detailed reports for clients, highlighting findings, trends, and recommended actions Collaborate with internal operations and support teams to ensure accurate documentation, escalation, and resolution of cases Review customer claims across debit cards, credit cards, ACH, P2P, bill payments, and other payment channels Identify process gaps and recommend procedural enhancements to strengthen fraud prevention Maintain investigative procedures and serve as a subject matter expert for escalated inquiries Track and report investigation metrics, staying current on industry trends, regulatory changes, and compliance requirements Mentor and train Fraud Analysts in investigative techniques and case handling Requirements: Associate's degree in Business, Criminal Justice, Finance, or related field preferred Minimum 5 years of experience in fraud investigation or advanced fraud analysis in financial services or fintech Proven track record managing complex investigations from initiation to resolution Expertise with fraud detection platforms (e.g., Verafin, DataVisor) and multi-system analysis Fraud certification (CFE, CFCI, or equivalent) strongly preferred Strong understanding of banking operations, payment systems, and regulatory requirements Exceptional analytical, research, and problem-solving skills with strong attention to detail Excellent written and verbal communication, including preparing and delivering reports to diverse audiences Ability to work independently while collaborating effectively with cross-functional teams Proficient in Microsoft Office, Google applications, and data analysis tools Benefits: $65,000 - $75,000 annual salary, plus annual cash bonus and equity options Fully remote work environment 401(k) plan with company match Comprehensive health, dental, and vision insurance (company-covered premiums) Flexible paid time off policy Opportunities for professional growth in a fast-paced fintech environment Why Apply Through Jobgether?We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.We appreciate your interest and wish you the best! Why Apply Through Jobgether? Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time. #LI-CL1

Mercury is building a banking* stack for startups. We work hard to create the easiest and safest banking* experience possible to simplify entrepreneurs' and business owners' financial lives. We're looking to hire a Senior Account Fraud QC Investigator to support quality control for account fraud alert investigations across Mercury's consumer and business banking products. This will be the first QC hire for the Account Fraud team and a key contributor in shaping the quality framework for our newly launched BPO partnership. As a Senior Account Fraud QC Investigator, you will be responsible for designing, implementing, and executing fraud quality processes and procedures. This includes conducting quality assessments of fraud alert investigations, creating reports and dashboards, performing quality trend analysis, and translating quality insights into actionable improvements. You'll also leverage your fraud and QC expertise to contribute directly to projects that advance Mercury's account fraud program and help scale high-quality decision-making across internal teams and external partners. *Mercury is a fintech company, not an FDIC-insured bank. Banking services provided through Choice Financial Group and Column N.A., Members FDIC. Here are some things you'll do on the job: Complete manual quality assessments of account fraud alert investigations, ensuring adherence to internal policies, procedures, and applicable regulatory requirements. Partner closely with Account Fraud leadership to define and operationalize the QC program, including quality standards, scoring methodologies, and feedback loops - particularly for BPO-reviewed work. Create quality dashboards, metrics, and trend reports to surface investigation accuracy, consistency, and risks. Provide clear, actionable insights and recommendations based on quality findings to drive continuous improvement across the account fraud program. Lead and participate in quality calibration sessions with internal teams and external BPO partners to ensure consistent investigation outcomes. Assist in the development, refinement, and documentation of fraud investigation quality processes and procedures. Maintain up-to-date knowledge of fraud typologies, industry best practices, regulatory expectations, and internal policy changes to ensure quality standards remain current. Participate in special projects, internal audits, and process improvement initiatives in support of fraud quality control and program scalability. You should: Have 4+ years of experience in the finance or fintech industry with a focus on fraud investigations and quality control, ideally in an account fraud or transaction monitoring environment. Have prior experience building a QC program and/or performing QC for fraud investigations, including reviewing alerts and investigator decisioning. Have experience working with or supporting BPO or vendor-managed fraud operations. Be a highly motivated self-starter who is comfortable building structure in ambiguous, fast-moving, and high-risk environments. Have a strong understanding of banking products and fraud risk across areas such as ACH, wires, checks, debit cards, and account-level activity. Exercise empathy and sound judgment when delivering quality feedback to investigators and partners. Communicate complex findings and recommendations with efficiency and clarity to both operational and cross-functional stakeholders. The total rewards package at Mercury includes base salary, equity (stock options), and benefits. Our salary and equity ranges are highly competitive within the SaaS and fintech industry and are updated regularly using the most reliable compensation survey data for our industry. New hire offers are made based on a candidate's experience, expertise, geographic location, and internal pay equity relative to peers. Our target new hire base salary ranges for this role are the following: US employees in New York City, Los Angeles, Seattle, or the San Francisco Bay Area: $121,700 - $152,100 US employees outside of New York City, Los Angeles, Seattle, or the San Francisco Bay Area: $109,500 - $136,900 Mercury values diversity & belonging and is proud to be an Equal Employment Opportunity employer. All individuals seeking employment at Mercury are considered without regard to race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, veteran status, gender identity, sexual orientation, or any other legally protected characteristic. We are committed to providing reasonable accommodations throughout the recruitment process for applicants with disabilities or special needs. If you need assistance, or an accommodation, please let your recruiter know once you are contacted about a role. We use Covey as part of our hiring and / or promotional process for jobs in NYC and certain features may qualify it as an AEDT. As part of the evaluation process we provide Covey with job requirements and candidate submitted applications. We began using Covey Scout for Inbound on January 22, 2024. [Please see the independent bias audit report covering our use of Covey for more information.] #LI-AR1

Healthcare Fraud Investigator Employment Type: Full-Time, Mid-Level Department: Litigation Support CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project in Nashville, TN. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently, accurately, and under pressure, and be enthusiastic about learning and applying knowledge to provide excellent litigation support to the client. 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. Responsibilities will Include:- Review, sort, and analyze data using computer software programs such as Microsoft Excel.- Review financial records, complex legal and regulatory documents and summarize contents, and conduct research as needed. Preparing spreadsheets of financial transactions (e.g., check spreads, etc.).- Develop HCF case referrals including, but not limited to:- Ensure that HCF referrals meet agency and USAO standards for litigation.- Analyze data for evidence of fraud, waste and abuse.- Review and evaluate referrals to determine the need for additional information and evidence, and plan comprehensive approach to obtain this information and evidence.- Advise the HCF attorney(s) regarding the merits and weaknesses of HCF referrals based upon applicable law, evidence of liability and damages, and potential defenses, and recommend for or against commencement of judicial proceedings.- Assist the USAO develop new referrals by ensuring a good working relationship with client agencies and the public, and by assisting in HCF training for federal, state and local agencies, preparing informational literature, etc. - Assist conducting witness interviews and preparing written summaries. Qualifications:- Four (4) year undergraduate degree or higher in criminal justice, finance, project management, or other related field.- Minimum three (3) years of professional work experience in healthcare, fraud, or other related investigative field of work.- Proficiency in Microsoft Office applications including Outlook, Word, Excel, PowerPoint, etc.- Proficiency in analyzing data that would assist in providing specific case support to the Government in civil HCF matters (E.g., Medicare data, Medicaid data, outlier data).- Communication skills: Ability to interact professionally and effectively with all levels of staff including AUSAs, support staff, client agencies, debtors, debtor attorneys and their staff, court personnel, business executives, witnesses, and the public. Communication requires tact and diplomacy.- U.S. Citizenship and ability to obtain adjudication for the requisite background investigation.- Experience and expertise in performing the requisite services in Section 3.- Must be a US Citizen.- Must be able to obtain a favorably adjudicated Public Trust Clearance.Preferred qualifications:- Relevant Healthcare Fraud experience including compliance, auditing duties, and other duties in Section 3.- Relevant experience working with a federal or state legal or law enforcement entity. #CJ

llumifin provides third party administration and technology services to individual and group insurers. The company blends insurance industry knowledge, technology leadership and operational execution to prepare insurers for the digital future. illumifin is a diverse, passionate and empowered team of insurance specialists committed to the growth and success of its customers. With illumifin, there's a brighter future A SIU/Fraud Investigator is responsible for working with multiple business units on coordination, identification, mitigation, and reporting of incidents and risks related to anti-fraud activities. Conducts and/or assists with investigative tasks Reviews referrals of potential fraud, waste, and abuse from both auto-detection programs and from claims organization, as assigned Coordinates and performs investigations with oversight of lead investigator Prepares responses for suspected or alleged fraud Works closely with cross-functional leaders to ensure appropriate resolution, accurate reporting and tracking to meet client specific service level agreements Participates as a subject matter expert during client implementations, audits and system or process development Complies with state and federal laws to meet client contractual requirements Conducts effective research, analysis, and accurate documentation for reporting to clients and illumifin's leadership Schedules surveillance once approved by the client Conducts continuing education to Claims staff May conduct phone calls or basic interviews with witnesses, as assigned Assists with administration tasks relating to Fraud Services Department, as assigned Assists with client and department reporting Interfaces with claimants, providers and clients Conducts telephonic interviews of members, providers, and/or additional witnesses to gather information to support investigation Other duties as assigned

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.