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Senior Fraud and Abuse Investigator- Remote
Sentara Health 4.9
Remote fraud examiner job
City/State Norfolk, VA Work Shift First (Days) Sentara Health Plan is currently hiring a Senior Fraud and Abuse Investigator- Remote! Status: Full-time, permanent position (40 hours) Work hours: 8am to 5pm EST, M-F Remote opportunities available in the following states: Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming. With travelto Virginia Beach 1x a year.
Overview
Responsible for contributing to in-depth investigations for suspected fraud or abuse with respect to provider, pharmacy, employer, member, and broker interactions involving the full range of products at Sentara Health Plans. Responsible for contributing to the review of the quality of pharmacy, physician, ancillary and hospital based coding in routine desk audits as well as occasional on-site audits. Contribute to the review of reimbursement systems relating to health insurance claims processing and ensures adherence to Optima Health policies and procedures for its various product offerings. Specific progression of responsibility is a follows dependent upon education, certifications, and experience:
Conducts investigation-related training.
Negotiates settlement agreements to resolve disputes.
Maintain current knowledge of relevant laws, regulations and standards.
Updates department policies and procedures and assists in training staff on changes.
Prepares routine department reporting as needed.
Education
Bachelor's Degree REQUIRED; Degree in a related field of study preferred.
Certification/Licensure
Certified Professional Coder REQUIRED (or achieved within 12 months of hire date)
Additional Preferred Qualifications:
Certified Forensic Interviewer (CFI)
Certified Fraud Specialist (CFS)
Certified Professional Coder (CPC) or
Certified in Healthcare Compliance (CHC)
Certified FraudExaminer (CFE) OR Accredited Health Care Fraud Investigator (AHFI) preferred. (Note: Federal Agents who have successfully completed the Federal Bureau of Investigation Training Program (FBITP) - Criminal Investigator Training Program (CITP) would be considered equivalent to the AHFI).
Experience
Minimum 5-8 years of related investigative experience OR 3 - 5 years of related health care investigative experience
Healthcare, Coding, Audit, Investigations, Regulatory, and/or Compliance 5 years REQUIRED -OR- Healthcare Investigation related to Coding, Audit, Regulatory, and/or Compliance 3 years REQUIRED
Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.
Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.
We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services-all to help our members improve their health.
Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.
Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!
We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for Full Time employment is:
$29.21 hour- $48.68/hour. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
To apply, please go to ********************** and use the following as your Keyword Search:JR-92443
Talroo-Health Plan
Keywords: Healthcare, Health Plan, Remote, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming, Bachelor's Degree, Medical Coding, Medical Chart Review, Insurance Billing, Internal/External Audit, Regulatory, Compliance, Claims Investigations, Criminal Investigation, White Collar Crime, Certified Professional Coder (CPC), Certified FraudExaminer (CFE), Accredited Health Care Fraud Investigator (AHFI), Federal Bureau of Investigation Training Program (FBITP) - Criminal Investigator Training Program (CITP); Certified Forensic Interviewer (CFI), Certified Fraud Specialist (CFS), Certified Professional Coder (CPC) or Certified in Healthcare Compliance (CHC), Fraud, Waste, Abuse, Program Integrity, FWA, PI, Professional Writing, Verbal Communication, Time Management, Complex Problem Solving/Critical Thinking, Microsoft Excel and Word, Microsoft Access and Outlook
Benefits: Caring For Your Family and Your Career
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance - $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down - $10,000
• Reimbursement for certifications and free access to complete CEUs and professional development
•Pet Insurance
•Legal Resources Plan
•Colleagues have the opportunity to earn an annual discretionary bonus ifestablished system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission “to improve health every day,” this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
$29.2-48.7 hourly 6d ago
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Fraud and Waste Investigator
Humana 4.8
Fraud examiner job in Columbus, OH
**Become a part of our caring community and help us put health first** The Fraud and Waste Professional 2 conducts investigations of allegations of fraudulent and abusive practices. The Fraud and Waste Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
**Where You Come In**
The Fraud and Waste Professional 2 coordinates investigation with internal and external entities including compliance, internal business partners, and law enforcement. Assembles evidence and documentation to support successful adjudication, where appropriate. Prepares complex investigative and audit reports. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
**What Humana Offers**
We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education
**Use your skills to make an impact**
**WORK STYLE:** Remote anywhere in US, work at home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**WORK HOURS:** Monday-Friday, 8 hours/day, 5 days/week, ideally, associates will work on EST (regardless of their home time zone). Must start between 6AM-9AM (in the employee's time zone), some flexibility might be possible, depending on business needs.
**Required Qualifications - What it takes to Succeed**
+ Bachelor's degree or equivalent work experience
+ Minimum 2 years of investigative and/or claims experience
+ Knowledge of healthcare payment methodologies
+ Strong organizational, interpersonal, and communication skills
+ Inquisitive nature with ability to analyze data to metrics
+ Computer literate (MS Word, Excel, Access)
+ Strong personal and professional ethics
+ Ability to travel up to 5%, to attend trainings and meetings, as required
**Preferred Qualifications**
+ Bilingual in Spanish
+ Bachelor's degree and/or additional degrees and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI).
+ Understanding of healthcare industry, claims processing and investigative process development.
+ Experience in a corporate environment and understanding of business operations
**Additional Information**
**Work at Home Requirements**
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
- Satellite, cellular and microwave connection can be used only if approved by leadership
- Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
**Interview Format**
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$65,000 - $88,600 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 01-22-2026
**About us**
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$65k-88.6k yearly 6d ago
Market Conduct Examiner
Rsm 4.4
Remote fraud examiner job
We are the leading provider of professional services to the middle market globally, our purpose is to instill confidence in a world of change, empowering our clients and people to realize their full potential. Our exceptional people are the key to our unrivaled, culture and talent experience and our ability to be compelling to our clients. You'll find an environment that inspires and empowers you to thrive both personally and professionally. There's no one like you and that's why there's nowhere like RSM.
Market Conduct Examiner
Risk & Regulatory Consulting, LLC
(Regulatory Insurance)
Work from home-any US location
Position Overview
The Market Conduct Examiner will be responsible for performing reviews of major insurance companies' operations, marketing, underwriting, rating, policyholder service, producer licensing, complaint handling and claims handling processes to verify compliance with states' insurance statutes and regulations.
Specific Duties and Responsibilities
(Responsibilities may vary slightly depending on seniority level)
Perform comprehensive, targeted and risk focused market conduct examinations to determine compliance with states' insurance statutes and regulations on behalf of state insurance departments.
Review and assess insurance company's documentation and data to determine compliance with states' insurance statutes and regulations.
Draft examination work papers in an organized manner for supervisory review.
Assist with the preparation of reports, exhibits, and other supporting documentation and schedules that detail a company's compliance with insurance statutes and regulations and recommend solutions.
Submit draft examination reports and other deliverables for supervisory review.
Recommend/document actions to ensure compliance with insurance statutes and regulations.
Must possess knowledge of and provide guidance of insurance laws, rules, and regulations.
Review and analyze new, proposed, or revised laws, regulations, policies, and procedures in order to determine compliance with states' insurance statutes and regulations and interpret their meaning and determine impact to the insurance company.
Analyze reports and records relating to specific and overall operations of insurance companies; prepare clear, complete, concise, and informative compliance reports of condition of insurance companies for supervisory review.
Consistently enhance knowledge of: principles, practices, techniques, and methods of insurance examination and regulations; insurance laws and Insurance Commissioner's rulings; and related Attorney General Opinions and court decisions; insurance company practices; statistical sampling procedures; basic mathematics.
Requirements
Bachelor's Degree in Business, Risk Management, Accounting or Finance; MBA and/or professional certification/s preferred
Minimum of 5+ years insurance experience with a State or Federal agency, insurance company, examination firm or with a public accounting firm as an internal or external auditor, adjuster, compliance professional or examiner.
Insurance industry experience is a must.
Candidates must have completed or are pursuing professional insurance designations such as AIE/CIE, MCM, AIRC, FLMI, CPCU, or CLU.
PC skills, including experience in using software for producing presentations, spreadsheets, and project planning (skilled in TeamMate, ACL/Access, and MS Excel, Word and Power Point).
Demonstrated history of project management experience.
Ability to interact with all levels including executives and senior managers.
Strong interpersonal, presentation, analytical and examination/audit skills.
Excellent organizational skills and the ability to prioritize multiple tasks, projects and assignments using effective time management skills.
Strong written and verbal communication skills are required.
Dynamic/flexible demeanor with exceptional client service skills.
Forward-thinking leader with a collaborative focus who can consult effectively with key constituents and become recognized as a valued resource.
Must be self-motivated, work well independently and possess a sense of urgency.
Skilled in team building and team development.
Flexibility to travel
Risk & Regulatory Consulting, LLC (RRC) was formerly a business segment of RSM US LLP (formerly McGladrey) until 2012 when the separate legal entity was formed. RRC is a strategic business partner with RSM providing actuarial and insurance industry consulting services to RSM clients.
Risk & Regulatory Consulting, LLC (RRC) is a national, leading professional services firm dedicated to providing exceptional regulatory services to clients. With over 100 experienced insurance professionals located in 22 states, we believe RRC is uniquely positioned to serve state insurance departments. We offer services in the following regulatory areas: financial examinations, market conduct examinations, insolvency and receiverships, actuarial services and valuations, investment analysis, reinsurance expertise, market analysis and compliance, and special projects. We are a results oriented firm committed to success that builds long term relationships with our clients.
RRC is managed by seven partners and our practice includes full time professionals dedicated to our regulatory clients. We are focused on listening to your needs and designing customized examination, consulting, and training solutions that address your needs. We bring multiple service lines together to provide superior and seamless service to our clients. We are committed to training our customers and our team. We have developed various comprehensive in house training programs that have been tailored to meet the needs of our regulatory clients. We offer competitive pricing, outstanding experience, credentials and references. RRC is an active participant in the NAIC, SOFE, and IRES.
At RSM, we offer a competitive benefits and compensation package for all our people. We offer flexibility in your schedule, empowering you to balance life's demands, while also maintaining your ability to serve clients. Learn more about our total rewards at **************************************************
All applicants will receive consideration for employment as RSM does not tolerate discrimination and/or harassment based on race; color; creed; sincerely held religious beliefs, practices or observances; sex (including pregnancy or disabilities related to nursing); gender; sexual orientation; HIV Status; national origin; ancestry; familial or marital status; age; physical or mental disability; citizenship; political affiliation; medical condition (including family and medical leave); domestic violence victim status; past, current or prospective service in the US uniformed service; US Military/Veteran status; pre-disposing genetic characteristics or any other characteristic protected under applicable federal, state or local law.
Accommodation for applicants with disabilities is available upon request in connection with the recruitment process and/or employment/partnership. RSM is committed to providing equal opportunity and reasonable accommodation for people with disabilities. If you require a reasonable accommodation to complete an application, interview, or otherwise participate in the recruiting process, please call us at ************ or send us an email at *****************.
RSM does not intend to hire entry level candidates who will require sponsorship now OR in the future (i.e. F-1 visa holders). If you are a recent U.S. college / university graduate possessing 1-2 years of progressive and relevant work experience in a same or similar role to the one for which you are applying, excluding internships, you may be eligible for hire as an experienced associate.
RSM will consider for employment qualified applicants with arrest or conviction records. For those living in California or applying to a position in California, please click here for additional information.
At RSM, an employee's pay at any point in their career is intended to reflect their experiences, performance, and skills for their current role. The salary range (or starting rate for interns and associates) for this role represents numerous factors considered in the hiring decisions including, but not limited to, education, skills, work experience, certifications, location, etc. As such, pay for the successful candidate(s) could fall anywhere within the stated range.
Compensation Range: $56 - $84
$56-84 hourly Auto-Apply 37d ago
Experienced ABL Field Examiner
LCG Advisors 4.2
Remote fraud examiner job
Job DescriptionSalary:
LCG Advisors is looking for an Experienced ABL Field Examiner to work closely with our clients, including large money-center banks such as JP Morgan Chase, Bank of America, Goldman Sachs, and Regions Bank. Our client base includes private equity firms, financial intermediaries, family offices, and accredited investors. Finance jobs in Tampa with LCG offer a wide variety of benefits through a gratifying and rapidly evolving career.
Primary Responsibilities:
Conduct due diligence services, including audit engagements, portfolio reviews, and acquisition due diligence for a wide variety of clients
Perform on-site or remote engagements as contracted by a bank or lender for clients needing lines of credit ranging from under one million dollars or as much as one billion dollars
Conduct audits focused on the companys collateral typically accounts receivable and inventory - by understanding complex concepts or information
Input examination findings into excel templates and produce a comprehensive written report for lenders describing the results and listing findings or exceptions
Perform professional interaction with clients, including calls and meetings
Qualifications:
Strong analytical skills with a willingness to learn new things
Naturally inquisitive on all topics relating to transactions
Excellent verbal and written communication skills
Attention to detail
Ability to meet strict deadlines
Advanced proficiency in Microsoft Office Excel and Word, Monarch, or other data extraction programs
Flexibility for occasional travel
2-4 years of relevant work experience preferred
ABL experience is desired but not required
Competencies:
Verbal Skills: Communicates with a vast vocabulary in a variety of settings and can understand the sophisticated language
Numeric Ability: Proficient with basic numerical equations and is comfortable with complex calculations resulting in accurate and sophisticated conclusions
Fast-Paced: Very active and results-driven with the ability to juggle the demands of several tasks at once
Assertiveness: Enjoys influencing others but is still willing to follow directions from someone else when necessary
Sociability: Comfortable working alone, but willing to collaborate as part of a team when necessary
Decisiveness: Balances timeliness and deliberation but is comfortable making quick decisions when required
Independence: Autonomous yet can accept necessary guidance and instruction
Judgment: Balances objective information and instincts to make decisions
Education:
Bachelors Degree in Accounting or Finance; Masters preferred
Company Benefits:
Competitive Medical Benefits
401(k) plan with employer contributions
Unlimited Paid Time Off
Flexibility to work from home
Paid Family Care Leave
Annual Holiday Retreat
Professional Development
$55k-80k yearly est. 16d ago
Senior Triage Examiner
Insurance Company of The West
Remote fraud examiner job
Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our journey as we strive to transform the insurance carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible.
Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our internal and external communities better everyday! Learn more about why you want to be here!
PURPOSE OF THE JOB
The purpose of this job is to manage new Workers' Compensation losses for the first 10 days of the life of the claim. This job takes necessary steps to assess and summarize new losses, prepare an action plan, set diaries, and reserve the file, all in preparation for assigning the file to an examiner for permanent handling.
ESSENTIAL DUTIES AND RESPONIBILITIES
Administers benefits to injured workers in accordance with statutory and case law as well as pertinent regulations for the first 10 days of the claim.
Represents the Workers' Compensation Department and ICW Group when interacting with injured workers.
Communicates with insureds to obtain information necessary for processing claims.
Contacts and/or interviews injured workers, doctors, medical specialists, attorneys, and employers to get additional information.
Communicates claim activity and processing with the injured worker and insured.
Maintains professional client relationships.
Communicates effectively with other Company departments.
Creates reserves in a timely manner to ensure reserving activities are consistent with company standards and best practices guidelines.
Manages complex claims and approves payment of benefits within higher designated authority level.
Assesses claims fairly and equitably, acting in the best interest of all parties and providing benefits as prescribed by law.
Ensures claim files are properly documented and claims coding is correct.
Refers cases as appropriate to supervisor and management.
Prepares an action plan and set diaries, in preparation for assigning the file to an examiner for permanent handling.
Assists with special projects and development of more junior team members as needed.
SUPERVISORY RESPONSIBILITIES
This role does not have supervisory responsibilities but may mentor and/or train junior team members.
EDUCATION AND EXPERIENCE
High school diploma or general education degree (GED) required. Bachelor's degree from four-year college or university preferred. Minimum of 2-3 years of insurance or claims related experience, or equivalent combination of education and experience required. Minimum 1-2 years of workers' compensation claims experience required.
CERTIFICATES, LICENSES, REGISTRATIONS
California Only
: All examiners must receive certification that meets the minimum standards of training, experience, skill, and further education as required.
California Only:
California Workers' Compensation Claims Administration (WCCA) and Workers' Compensation Claim Professional (WCCP) certifications preferred.
All other jurisdictions:
State Workers' Compensation License as required.
KNOWLEDGE AND SKILLS
Understanding of laws and jurisdictional restraints to manage injuries. Excellent verbal and written communication skills, time management and organizational skills. Requires a high level of attention to detail. Team oriented and a sense of urgency for execution. Able to resolve conflicts fairly and equitably. Problem solving and decision-making ability,
PHYSICAL REQUIREMENTS
Office environment - no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear.
WORK ENVIRONMENT
This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment.
We are currently not offering employment sponsorship for this opportunity
#LI-ET1 #LI-Hybrid
The current range for this position is
$61,979.26 - $97,736.56
This range is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work.
WHY JOIN ICW GROUP?
Challenging work and the ability to make a difference
You will have a voice and feel a sense of belonging
We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match
Bonus potential for all positions
Paid Time Off
Paid holidays throughout the calendar year
Want to continue learning? We'll support you 100%
ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law.
___________________
Job Category
Claims
$62k-97.7k yearly Auto-Apply 22d ago
FCO Fraud Investigative Unit Manager - Vice President
Deutsche Bank 4.9
Remote fraud examiner job
Job Title FCO Fraud Investigative Unit Manager
Corporate Title Vice President
Location Remote work opportunity for candidates living in AZ, CT, DC, FL, GA, IL, MD ,MA, MI, MO, NJ, NY, NC, OH, OR, PA, TN, TX, VA
The anti-financial crime (AFC) team is accountable for protecting Deutsche Bank from financial and reputational losses incurred by financial crimes by assessing, controlling and mitigating risks. The anti-money laundering (AML) Transaction Monitoring Investigations Manager will be responsible for assisting in the development and management of a team of investigators within the Financial Crime Operations (FCO) program, including the associated policies, procedures and controls. The Vice President will also propose procedural enhancements.
What We Offer You
A diverse and inclusive environment that embraces change, innovation, and collaboration
A hybrid working model, allowing for in-office / work from home flexibility, generous vacation, personal and volunteer days
Employee Resource Groups support an inclusive workplace for everyone and promote community engagement
Competitive compensation packages including health and wellbeing benefits, retirement savings plans, parental leave, and family building benefits
Educational resources, matching gift and volunteer programs
What You'll Do
You will lead and manage a team of investigators (Analyst to AVP), overseeing day-to-day case prioritization, staffing capacity, performance development, succession planning, and training guidance
You will oversee, analyze, and investigate high-profile fraud incidents involving wires, checks, ACH transactions, and fraudulent documents, ensuring investigatory best practices and end-to-end transaction monitoring processes are properly executed
You will ensure adherence to regulatory, audit, and compliance requirements by setting deliverables, maintaining Key Operating Procedures (KOPs), monitoring management information (MI) and aging cases/alerts, and addressing internal and external audit inquiries
You will promote continuous analysis by interpreting relevant industry regulations and Compliance policies, ensuring proper control implementation and monitoring; stay current on new rules, regulations, and reputational risks to adjust policies and procedures
You will perform oversight functions in collaboration with monitoring team leads, providing feedback on review focus areas, resolving investigative issues, and serving as a point of contact for escalation of concerns or risks
You will partner with Financial Crimes Operations (FCO) management to identify, escalate, and address open issues representing risk, and support special projects as needed
How You'll Lead
You will manage and develop team performance through ongoing coaching, regular one-on-ones, and clear expectation setting
You will oversee the effective operation of the Fraud Investigations group, ensuring SLAs and regulatory requirements are consistently met
You will collaborate with stakeholders across teams and departments to support the success and integration of the broader function
Skills You'll Need
Bachelor's degree or equivalent work experience, with proven AML investigative experience in a transaction monitoring environment and proven management experience in a comparable environment
Strong knowledge of AML laws and regulations (e.g., USA PATRIOT Act, Fed, SEC, FINRA) and their application to relevant business lines, with experience in Correspondent Banking, Global Markets, and Asset Management preferred
Proficiency with fraud case-management systems (e.g., Actimize, Verafin, Prime) and effective internet research techniques
Advanced Microsoft Word, PowerPoint, and Excel skills, including pivot tables, macros, filtering, and sorting
CFE certification is preferred
Skills That Will Help You Excel
Strong interpersonal, communication (written and verbal), and team-leadership skills, with the ability to guide professionals, manage workloads, and drive task completion
Excellent analytical, judgment, research, and problem-solving skills, with meticulous attention to detail and strong multitasking ability
Effective decision-making and ability to identify, escalate, and communicate issues succinctly to management
Ability to work collaboratively with Infrastructure and other cross-functional groups in a fast-paced environment
Self-motivated team player who can adapt quickly and maintain high effectiveness under changing priorities
Expectations
Deutsche Bank provides reasonable accommodations to candidates and employees with a substantiated need based on disability and/or religion.
The salary range for this position in Jacksonville is $96,000 to $140,850. Actual salaries may be based on a number of factors including, but not limited to, a candidate's skill set, experience, education, work location and other qualifications. Posted salary ranges do not include incentive compensation or any other type of remuneration.
Deutsche Bank Benefits
At Deutsche Bank, we recognize that our benefit programs have a profound impact on our colleagues. That's why we are focused on providing benefits and perks that enable our colleagues to live authenti cally and be their whole selves, at every stage of life. We provide access to physical, emotional, and financial wellness benefits that allow our colleagues to stay financially secure and strike balance between work and home. Click here to learn more!
Learn more about your life at Deutsche Bank through the eyes of our current employees ***************************
The California Consumer Privacy Act outlines how companies can use personal information. If you are interested in receiving a copy of Deutsche Bank's California Privacy Notice please email ****************.
#LI-REMOTE
We strive for a culture in which we are empowered to excel together every day. This includes acting responsibly, thinking commercially, taking initiative and working collaboratively.
Together we share and celebrate the successes of our people. Together we are Deutsche Bank Group.
We welcome applications from all people and promote a positive, fair and inclusive work environment.
Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status or other characteristics protected by law. Click these links to view Deutsche Bank's Equal Opportunity Policy Statement and the following notices: EEOC Know Your Rights; Employee Rights and Responsibilities under the Family and Medical Leave Act; and Employee Polygraph Protection Act.
$96k-140.9k yearly Auto-Apply 33d ago
Sr. Casualty Examiner
Howden 4.0
Remote fraud examiner job
Who are we?
Howden is a global insurance group with employee ownership at its heart. Together, we have pushed the boundaries of insurance. We are united by a shared passion and no-limits mindset, and our strength lies in our ability to collaborate as a powerful international team comprised of 23,000 employees spanning over 56 countries.
People join Howden for many different reasons, but they stay for the same one: our culture. It's what sets us apart, and the reason our employees have been turning down headhunters for years. Whatever your priorities - work / life balance, career progression, sustainability, volunteering - you'll find like-minded people driving change at Howden.
About the role:
DUAL North America, Inc. is seeking a Sr. Claims Adjuster to join its subsidiary group, DUAL Claims Services. This position can be fully remote or hybrid. This individual will handle moderate to high exposure commercial auto and general liability claims involving bodily injury and property damage, with an emphasis on excess exposures.
Essential Functions:
Exercises proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the claim
Understanding and issuance of Reservation of Rights, Denial and general coverage position letters
Interacts extensively with various parties involved in the claim process
Utilize critical thinking and solid judgment to solve problems, make decisions and resolve issues inherent in handling losses, as well as plan and organize activities throughout the claims management process
Successfully negotiate the settlement and disposition of bodily injury and property damage claims; interpret related claims documentation
Documents and communicates all claim activities timely and effectively and in a manner which supports the outcome of the claim file
Handles claims consistent with NBIS client and corporate policies, procedures and "Best Practices", and also in accordance with any statutory, regulatory and ethics requirements
Performs other duties as assigned
Job Requirements (education, experience, skills):
College graduate and/or applicable insurance industry training and/or experience.
Five (5) years of Claims Examiner experience is required; Ten (10) or more years is preferred with a consistent high level of performance and achievement in handling commercial auto and general liability bodily injury and property damage claims.
Excellent oral and written communication skills
Excellent customer service and negotiation skills
Understanding of the unique insurance needs of the market
Exceptional interpersonal skills
Attention to detail
Ability to multitask
Strong organizational skills
Knowledge of MS Office applications, related claims and business software
If you do not meet all the qualifications for this role, we still encourage you to apply, as we are always looking for diverse talent to join our growing team.
What we offer:
A career that you define. Yes, we offer all the usual rewards and benefits - including medical, dental, vision, a wide variety of wellbeing offers, competitive salary, unlimited PTO, 401k with company match, paid volunteer days and more.
We provide an environment where new ideas are encouraged and celebrated, where people who want to have a real hand in our success thrive. We want people who want to make a difference - not just in the workplace, but in the industry and in the wider community.
About DUAL NA:
DUAL is the leading underwriting organization in the US and part of an international insurance organization with operations in 45 countries across the world. DUAL offers commercial property, casualty, financial lines, and personal property insurance products underwritten through several specialized subsidiaries. Since 2013, we have grown to over 500 employees in 14 offices across the US, and we are continuing to grow. DUAL is committed to building a balanced business and contributing to a sustainable world. At DUAL, we believe our people are our greatest assets, espousing entrepreneurialism, and innovation in an environment where new insights are encouraged.
Our culture: People First
Our core values dictate how we live and work. We are a group with independence and people at its heart and we are a home for talent with a unique culture: the biggest small company in the world. The focus on being a People First business has always been at the very heart of the Group; Our vision was to create an independent business with a unique culture and one that would survive and thrive as a business controlled by the people working for it. And finding the most talented and entrepreneurial people to join the Group has been and will continue to be key.
EEO Statement:
We consider our people our chief competitive advantage and as such we treat colleagues, candidates, clients, and business partners with equality, fairness, and respect. DUAL North America provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. DUAL will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
What do we offer in return?
A career that you define. At Howden, we value diversity - there is no one Howden type. Instead, we're looking for individuals who share the same values as us:
Our successes have all come from someone brave enough to try something new
We support each other in the small everyday moments and the bigger challenges
We are determined to make a positive difference at work and beyond
Reasonable adjustments
We're committed to providing reasonable accommodations at Howden to ensure that our positions align well with your needs. Besides the usual adjustments such as software, IT, and office setups, we can also accommodate other changes such as flexible hours* or hybrid working*.
If you're excited by this role but have some doubts about whether it's the right fit for you, send us your application - if your profile fits the role's criteria, we will be in touch to assist in helping to get you set up with any reasonable adjustments you may require.
*Not all positions can accommodate changes to working hours or locations. Reach out to your Recruitment Partner if you want to know more.
Permanent
$51k-73k yearly est. Auto-Apply 60d+ ago
Fraud Investigator
Nymbus, Inc. 4.4
Remote fraud examiner job
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!
$65k-75k yearly 28d ago
Fraud Investigative Lead Supervisor
Open 3.9
Remote fraud examiner job
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
$78k-97k yearly Auto-Apply 42d ago
Fraud Investigator Admin Action
Peraton 3.2
Remote fraud examiner job
Responsibilities
SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.
We are looking to add a Fraud Investigator Admin Action Specialist to our SGS team of talented professionals.
The Fraud Investigator Admin Action Specialist is responsible for being a Point of Contact for Investigations, MAC and CMS regarding all administrative actions related to investigations.
Review and verify evidence supporting an administrative action as it relates to payment suspensions, revocations, overpayments as well as other administrative actions that can be pursued.
Work with the Investigations, Medical Review and Data teams to ensure that the documentation gathered is sufficient to support an administrative action.
Making administrative action recommendation to Investigations and CMS.
Work with CMS, law enforcement and the Medicare Administrative Contractor throughout the life of the action.
Monitor workload to ensure all actions are taken within the required timeframes set forth in the Program Integrity Manual.
Prepare and submit administrative action packages to CMS and the MACs for approval and processing and speak to the action development.
Ensure that all timelines are followed.
Telework available from any location but must be available during eastern time zone hours.
Qualifications
Basic Qualifications:
4 years with AS/AA; 2 years with BS/BA; 0 years with MS/MA; 6 years with High School diploma/equivalent in lieu degree
Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed to the Program
Strong critical thinking, communication, writing and organizational skills
Experience in developing fraud cases
Strong PC knowledge and skills
Knowledge of Medicare systems
Ability to perform research and draw conclusions
Ability to present issues of concern, citing and interpreting regulatory violations
Ability to organize a case file, accurately and thoroughly document all steps taken
Ability to compose correspondence, reports and letters clearly and concisely.
Ability to communicate effectively, internally and externally
Ability to interpret laws and regulations
Ability to handle confidential material
Ability to report work activity on a timely basis
Ability to work independently and as a member of a team to deliver high quality work
Ability to attend meetings, training, and conferences, overnight travel may be required
US citizenship required
Desirable Qualifications:
The most competitive candidates will have: Medicare fraud investigation and/or Medicare billing background
Investigation
CFE or AHFI certification
Peraton Overview
Peraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world's leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees do the can't be done by solving the most daunting challenges facing our customers. Visit peraton.com to learn how we're keeping people around the world safe and secure.
Target Salary Range $51,000 - $82,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual's experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay. EEO EEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.
$51k-82k yearly Auto-Apply 1d ago
Senior Fraud Investigator
Galileo Financial Technologies 4.3
Remote fraud examiner job
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 **********************************************
The Role
We are seeking a talented and self-motivated Senior Fraud Investigator to support our Fraud Investigations team. This role will be responsible for the training of a team of Fraud Investigators who are responsible for conducting independent reviews and analysis of possible suspicious activity to ensure compliance with regulatory institutions and Galileo policies and procedures. The Senior Fraud Investigator is responsible for conducting holistic reviews of Fraud Investigators' research, documented analysis/findings, and conclusions as it relates to financial crime activity to ensure the utmost quality investigations. This person will assist in the development and guidance of our Fraud Investigative team and report directly to the Senior Manager of Fraud Investigations.
What you'll do:
* Evaluate Fraud or abusive behavior is identified and may warrant a SAR filing. The Senior Fraud Investigator will ensure determinations are appropriate, fully supported, and clearly documented, for fraud claim cases
* Collaborates with other internal SoFi departments, vendors, law enforcement, etc. to resolve issues and works to proactively minimize losses
* Train, coach, develop, and monitor fraud investigations staff to ensure an excellent member experience
* Establishes positive employer-employee relationships, and promotes a high level of employee morale, trust, and integrity
* Develop, maintain, and implement policies/procedures to mitigate and proactively address fraudulent activity
* Conduct team meetings to enhance teamwork ensuring good staff morale
* Knowledge of risk strategies and creation of an open communication forum to iterate policies
* Communicate significant issues to Management; make recommendations when weaknesses are identified
* Respond promptly and exercise exceptional communication skills in an effort to optimize each contact with customers, partners, and external vendors/banks
* Establish and ensure compliance with departmental standards and processes to increase production and accommodate work volumes toward enhanced customer satisfaction
* Foster a culture of accountability, collaboration, speed, innovation, excellence, and a fun work environment while continuously elevating the quality and caliber of our fiscal controls.
* Partner with member-facing teams to ensure there is clear communication and understanding of fraud referrals and policies
* Handle any special projects as assigned by management
* Promote SoFi values in the daily work and management of the team
What you'll need:
* 3+ years of relevant fraud investigation experience in financial services or other related industry
* Minimum of 1 year of managing a team of fraud investigators (Team lead or supervisor)
* Fraud SAR filing experience required
* Proven background in customer service
* Demonstrated ability to communicate effectively with all levels of the organization and across different business lines
* Ability to successfully lead and manage direct reports, including training, mentoring, and counseling
* Strong attention to detail with a focus on quality reviews
* Excellent organizational, verbal, written, and interpersonal skills are required
* Must be able to multitask, adapt well to changing priorities, and effectively prioritize responsibilities to meet critical deadlines
* Ability to work in a fast-paced, demanding, and changing environment; must work well under pressure
* Excellent analytical skills required
Nice to Have:
* Applicable certifications, for example, CFE, CAMS, etc
* Currently participating in peer groups to stay abreast of industry happenings
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.
$34k-53k yearly est. Auto-Apply 13d ago
Construction Defect Examiner
Claim Assist Solutions
Remote fraud examiner job
Parker Loss Consultants, LLC
To know more, visit us at *************************************
Construction Defect Adjuster
Parker Loss Consultants (An Allcat company) is a national provider of specialty claims management services, including Commercial Property, Commercial Liability and Personal lines of business. Our focus is on each client's trust in our ability to pro-actively manage their Large / Complex assignments. We maintain a consistent approach in managing adjuster caseloads to avoid overlooked opportunities and costly mistakes.
What you do:
Manage a caseload of Construction Defect Claims in multiple states.
Manage new loss assignments, reassignments and proper reserve setting.
Be able to perform coverage analysis, responsibilities to defend, tasks to indemnity, and choice of law.
Be able to identify issues that need to be resolved, what methods to use, including a focus on risk transfer and resolutions which create a best outcome.
Familiar with drafting of complex coverage letters, which include reservation of rights, disclaimers and responses to "push back" letters.
Develop legal strategy with counsel and manage Construction Defect litigation consistent with litigation guidelines. This includes both Coverage Counsel and Defense Counsel.
Identify appropriate cases for trial and complete pre-trial reports and trial activities.
What you bring:
You will have 5+ years of litigated Construction Defect claim handling experience with demonstrated roles of increased responsibility and exposure to multiple jurisdictions.
Technical background desired with an emphasis on coverage issue identification and policy interpretation.
Caseload does include handling Home Builder policies which includes WRAP/OCIP, Project Specific and SIR policies.
In-depth knowledge of liability policy language and coverage interpretation.
Work experience in a regulated environment and ability to ensure compliance with company procedures.
College degree
Must have experience working commercial claims (field or desk, but desk preferred),
This will start out as a temporary position with the potential to be a full-time position, dependent upon the workload obtained and the initial success of this program.
Compensation: $45-60 / hour
Location: Remote
Parker Loss Consultants, LLC. is an Equal Opportunity Employer and considers all qualified applicants regardless of race, gender, color, religion, national origin, age, sexual orientation, gender identity, disability, veteran status or other classification protected by law.
#parkerloss
$37k-57k yearly est. Auto-Apply 36d ago
Examiner
LPL Financial 4.7
Remote fraud examiner job
What if you could build a career where ambition meets innovation? At LPL Financial, we empower professionals to shape their success while helping clients pursue their financial goals with confidence. What if you could have access to cutting-edge resources, a collaborative environment, and the freedom to make an impact? If you're ready to take the next step, discover what's possible with LPL Financial.
Job Overview:
Our Examiners are focused on the sales practices of each individual advisor and the books and records requirements of each office to ensure adherence to compliance with all applicable regulations. The Examiner will consult with branch managers, advisors, and support staff and provide direction on maintaining branch offices in accordance with federal and state regulations, FINRA and other SRO regulations and LPL Financial policies and procedures. This is a Tempe, Arizona based position with the requirement for travel and a proximity to a regional airport location.
Responsibilities:
Responsible for independently performing all functions of branch examination, including thorough evaluation of branch activities to assess/monitor compliance with company policies and procedures as well as applicable federal and state laws and regulations (may be onsite or virtual depending on the needs of the business)
Conduct virtual and/or in-person consultations with branch manager, advisors, and support staff
Prepare audit letter based on deficiencies identified during branch examination and provide instructions, both verbally and in writing, to correct deficiencies and operate an office that is in compliance with all regulations
Use all company-provided tools and systems required to perform thorough audit and document findings in detail
Accountable for planning and preparation of pre-audit material, scheduling of exams, travel arrangements, and managing associated expenses
Collaborate with peers and management to streamline processes and create efficiencies for the department
What are we looking for?
The ideal candidate will have a client-first customer service oriented mind-set from a financial background, with strong attention to detail, problem-solving skills, and excellent verbal and written abilities. Candidate will be able to contribute positively to a team-focused environment, driving both growth and innovation.
Requirements:
Possibility of some domestic travel (up to 20%) which will require the carrying of luggage and audit paperwork (approx. lifting at least 40 pounds)
Professional demeanor to represent LPL in a client-facing role and across all levels within and outside the organization
Proficient in Microsoft applications (Word, Excel, Outlook)
Skilled in building relationships and collaborating with business partners
Must have excellent customer service skills, be a consultative partner, and be able to communicate effectively with individuals at various levels, both verbal and written
Ability to proactively identify risk and use sound judgement to know when to "ask the next question" as potential risk areas are found
Take initiative and problem solve in a complex environment
Able to effectively leverage resources and navigate the organization to obtain information and achieve objectives
Proven track record for working independently, meeting job responsibilities, and detail orientation.
Education: Bachelor's degree (B.A./B.S.) or minimum of three years of experience in the financial services industry
Preferences:
FINRA securities registrations (including SIE, Series 7, and Series 24 licenses) preferred
Prior compliance or supervisory experience preferred
#LPL-PA
Pay Range:
$65,508-$109,180/year
Actual base salary varies based on factors, including but not limited to, relevant skill, prior experience, education, base salary of internal peers, demonstrated performance, and geographic location. Additionally, LPL Total Rewards package is highly competitive, designed to support your success at work, at home, and at play - such as 401K matching, health benefits, employee stock options, paid time off, volunteer time off, and more. Your recruiter will be happy to discuss all that LPL has to offer!
Company Overview:
LPL Financial Holdings Inc. (Nasdaq: LPLA) is among the fastest growing wealth management firms in the U.S. As a leader in the financial advisor-mediated marketplace(6) , LPL supports over 32,000 financial advisors and the wealth management practices of approximately 1,100 financial institutions, servicing and custodying approximately $2.3 trillion in brokerage and advisory assets on behalf of approximately 8 million Americans. The firm provides a wide range of advisor affiliation models, investment solutions, fintech tools and practice management services, ensuring that advisors and institutions have the flexibility to choose the business model, services, and technology resources they need to run thriving businesses. For further information about LPL, please visit ************
At LPL, independence means that advisors and institution leaders have the freedom they deserve to choose the business model, services, and technology resources that allow them to run a thriving business. They have the flexibility to do business their way. And they have the freedom to manage their client relationships, because they know their clients best. Simply put, we take care of our advisors and institutions, so they can take care of their clients.
For further information about LPL, please visit ************
Join LPL Financial: Where Your Potential Meets Opportunity
At LPL Financial, we believe that everyone deserves objective financial guidance. As the nation's leading independent broker-dealer, we offer an integrated platform of cutting-edge technology, brokerage, and investment advisor services.
Why LPL?
Innovative Environment: We foster creativity and growth, providing a supportive and responsive leadership team. Learn more about our leadership team here!
Limitless Career Potential: Your career at LPL has no limits, only amazing potential. Learn more about our careers here!
Unified Mission: We are one team on one mission-taking care of our advisors so they can take care of their clients. Learn more about our mission and values here!
Impactful Work: Our size is just right for you to make a real impact. Learn more here!
Commitment to Equality: We support workplace equality and embrace diverse perspectives and backgrounds. Learn more here!
Community Focus: We care for our communities and encourage our employees to do the same. Learn more here!
Benefits and Total Rewards: Our Total Rewards package goes beyond just compensation and insurance. It includes a mix of traditional and unique benefits, perks, and resources designed to enhance your life both at work and at home. Learn more here!
Join the LPL team and help us make a difference by turning life's aspirations into financial realities. Please log in or create an account to apply to this position. Principals only. EOE.
Information on Interviews:
LPL will only communicate with a job applicant directly from ******************** email address and will never conduct an interview online or in a chatroom forum. During an interview, LPL will not request any form of payment from the applicant, or information regarding an applicant's bank or credit card. Should you have any questions regarding the application process, please contact LPL's Human Resources Solutions Center at **************.
EAC12.9.25
$36k-48k yearly est. Auto-Apply 6d ago
Senior Account Fraud QC Investigator
Mercury 3.5
Remote fraud examiner job
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
$38k-59k yearly est. Auto-Apply 2d ago
SIU Investigator - Underwriting & Premium Fraud
CNA Financial Corp 4.6
Fraud examiner job in Westerville, OH
You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential.
Under minimal direction, initiates and manages suspected fraudulent underwriting and insurance premium investigations involving the highest complexity matters. Provides advice, direction, and support to underwriters, auditors, business unit leadership, corporate investigations and other stakeholders across the organization on the detection, investigation, and litigation of suspected underwriting matters.
JOB DESCRIPTION:
Essential Duties & Responsibilities
Performs a combination of duties in accordance with departmental guidelines:
* Leads the detailed analysis and completion of thorough and timely investigations of suspected underwriting fraud by following Best Practice Guidelines and collaborating with business stakeholders.
* Develops and executes investigation strategy either independently or in collaboration with underwriting professionals, counsel, experts, insureds, and other stakeholders.
* Manages investigation activities independently and/or coordinates/oversees vendor service partner activities in the field.
* Maintains detailed, accurate and timely case records by following established Best Practices for file documentation and by creating comprehensive reports of investigative findings, and conclusions.
* Makes recommendations for resolution by presenting evidence-based findings and proposing solutions of moderate to complex scope.
* Identifies opportunities and participates in the design and implementation of process or procedural improvements.
* Leads or directs efforts to build and enhance and oversees organizational capabilities by developing and delivering fraud awareness or regulatory compliance training and mentoring SIU staff.
* Leads or directs the preparation of cases for appropriate reporting to outside agencies; leads or directs pursuit of criminal or civil actions through gathering and documenting relevant data, organizing and summarizing facts and testifying on behalf of the company in civil or criminal matters.
* Continuously develops knowledge and expertise related to insurance fraud by keeping current on related law, regulations, trends, and emerging issues and participating in insurance fraud or related professional associations.
May perform additional duties as assigned.
Reporting Relationship
Typically Manager or Director
Skills, Knowledge and Abilities
* Solid knowledge of property and casualty claim handling practices
* Strong technical knowledge of practices and techniques related to investigations and fact finding. For roles focused in an area of specialty (medical provider investigations), strong technical knowledge of respective specialty practices is required.
* Strong interpersonal, oral, and written communication skills; ability to clearly communicate complex issues
* Ability to interact and collaborate with internal and external business partners, including outside agencies
* Ability to work independently, exercise good judgment, and make sound business decisions
* Detail oriented with strong organization and time management skills
* Strong ability to analyze complex, ambiguous matters and develop effective solutions
* Proficiency with Microsoft Office applications and similar business software, and understanding of relational databases information querying techniques
* Ability to adapt to change and value diverse opinions and ideas
* Developing ability to implement change
* Ability to travel occasionally (less than 10%)
Education and Experience
* Bachelor's degree or equivalent professional experience.
* Minimum of three to five years of experience conducting investigations in the area of a) insurance fraud, b) law enforcement, c) civil or criminal litigation, or d) similar field.
* Professional certification or designation related to fraud investigations strongly preferred (e.g., CFE, CIFI, FCLS, FCLA, or similar).
#LI-AR1
#LI-Hybrid
In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com.
CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.
$54k-103k yearly Auto-Apply 34d ago
SIU/Fraud Investigator- Long Term Care
Illumifin
Remote fraud examiner job
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
$39k-61k yearly est. 9h ago
Healthcare Fraud Investigator
Contact Government Services, LLC
Remote fraud examiner job
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
$39k-61k yearly est. Auto-Apply 60d+ ago
External Fraud Investigator
U.S. Bank 4.6
Fraud examiner job in Columbus, OH
At U.S. Bank, we're on a journey to do our best. Helping the customers and businesses we serve to make better and smarter financial decisions and enabling the communities we support to grow and succeed. We believe it takes all of us to bring our shared ambition to life, and each person is unique in their potential. A career with U.S. Bank gives you a wide, ever-growing range of opportunities to discover what makes you thrive at every stage of your career. Try new things, learn new skills and discover what you excel at-all from Day One.
Job DescriptionPartners with their assigned Line of Business, other Risk/Compliance/Audit (RCA) professionals, and RCA Managers to, depending on their function, create, implement, maintain, review or oversee an effective risk management framework. Participates in projects and/or activities that ensure compliance with applicable federal, state, and local laws and regulations. Identifies gaps and inform solutions that minimize losses resulting from inadequate internal processes, systems or human errors. Identifies, responds and/or escalates risks as appropriate. Serves as a functional liaison between the Line of Business and the Lines of Defense.Basic Qualifications
- Bachelor's degree, or equivalent work experience
- Typically, more than two years of applicable experience Preferred Skills/Experience
- Intermediate knowledge of applicable laws, regulations, financial services, and regulatory trends that impact their assigned line of business
- Intermediate understanding of the business line's operations, products/services, systems, and associated risks/controls
- Basic knowledge of Risk/Compliance/Audit competencies
- Strong analytical, process facilitation and project management skills
- Effective presentation, interpersonal, written and verbal communication skills
- Proficient computer navigation skills using a variety of software packages, including Microsoft Office applications and word processing, spreadsheets, databases, and presentations This role requires working from a U.S. Bank location three (3) or more days per week.
If there's anything we can do to accommodate a disability during any portion of the application or hiring process, please refer to our disability accommodations for applicants.
Benefits:
Our approach to benefits and total rewards considers our team members' whole selves and what may be needed to thrive in and outside work. That's why our benefits are designed to help you and your family boost your health, protect your financial security and give you peace of mind. Our benefits include the following:
Healthcare (medical, dental, vision)
Basic term and optional term life insurance
Short-term and long-term disability
Pregnancy disability and parental leave
401(k) and employer-funded retirement plan
Paid vacation (from two to five weeks depending on salary grade and tenure)
Up to 11 paid holiday opportunities
Adoption assistance
Sick and Safe Leave accruals of one hour for every 30 worked, up to 80 hours per calendar year unless otherwise provided by law
Review our full benefits available by employment status here.
U.S. Bank is an equal opportunity employer. We consider all qualified applicants without regard to race, religion, color, sex, national origin, age, sexual orientation, gender identity, disability or veteran status, and other factors protected under applicable law.
E-Verify
U.S. Bank participates in the U.S. Department of Homeland Security E-Verify program in all facilities located in the United States and certain U.S. territories. The E-Verify program is an Internet-based employment eligibility verification system operated by the U.S. Citizenship and Immigration Services. Learn more about the E-Verify program.
The salary range reflects figures based on the primary location, which is listed first. The actual range for the role may differ based on the location of the role. In addition to salary, U.S. Bank offers a comprehensive benefits package, including incentive and recognition programs, equity stock purchase 401(k) contribution and pension (all benefits are subject to eligibility requirements). Pay Range: $66,640.00 - $78,400.00
U.S. Bank will consider qualified applicants with arrest or conviction records for employment. U.S. Bank conducts background checks consistent with applicable local laws, including the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act as well as the San Francisco Fair Chance Ordinance. U.S. Bank is subject to, and conducts background checks consistent with the requirements of Section 19 of the Federal Deposit Insurance Act (FDIA). In addition, certain positions may also be subject to the requirements of FINRA, NMLS registration, Reg Z, Reg G, OFAC, the NFA, the FCPA, the Bank Secrecy Act, the SAFE Act, and/or federal guidelines applicable to an agreement, such as those related to ethics, safety, or operational procedures.
Applicants must be able to comply with U.S. Bank policies and procedures including the Code of Ethics and Business Conduct and related workplace conduct and safety policies.
Posting may be closed earlier due to high volume of applicants.
$66.6k-78.4k yearly Auto-Apply 6d ago
Bilingual (Spanish) Account Examiner 2 - 20067469
Dasstateoh
Fraud examiner job in Columbus, OH
Bilingual (Spanish) Account Examiner 2 - 20067469 (260000EA) Organization: Workers' CompensationAgency Contact Name and Information: ********************** Unposting Date: Jan 24, 2026, 4:59:00 AMWork Location: William Green Building 30 West Spring Street Columbus 43215-2256Primary Location: United States of America-OHIO-Franklin County-Columbus Compensation: $22.96Schedule: Full-time Work Hours: 8:00 - 5:00Classified Indicator: ClassifiedUnion: OCSEA Primary Job Skill: Accounting and FinanceTechnical Skills: Customer ServiceProfessional Skills: Attention to Detail, Customer Focus, Responsiveness Agency OverviewA Little About Us:With roughly 1,500 employees in seven offices across Ohio, BWC is the state agency that cares for Ohio workers by promoting a culture of safety at work and at home and ensuring quality medical and pharmacy care is provided to injured workers. For Ohio employers, we provide insurance policies to cover workplace injuries and safety and wellness services to prevent injuries. Our Culture:BWC is a dynamic organization that offers career opportunities across many different disciplines. BWC strives to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee work groups, participate in on-line forums and learn about how different perspectives can improve leadership skills.Our Vision:To transform BWC into an agile organization driven by customer success.Our Mission:To deliver consistently excellent experiences for each BWC customer every day.Our Core Values:One Agency, Personal Connection, Innovative Leadership, Relentless Excellence.What our employees have to say:BWC conducts an internal engagement survey on an annual basis. Some comments from our employees include:BWC has been a great place to work as it has provided opportunities for growth that were lacking in my previous place of work.I have worked at several state agencies and BWC is the best place to work.Best place to work in the state and with a sense of family and support.I love the work culture, helpfulness, and acceptance I've been embraced with at BWC.I continue to be impressed with the career longevity of our employees, their level of dedication to service, pride in their work, and vast experience. It really speaks to our mission and why people join BWC and then retire from BWC.If you are interested in helping BWC grow, please click this link to read more, and then come back to this job posting to submit your application!Job DescriptionBWC's core hours of operation are Monday-Friday from 8:00am to 5:00pm, however, daily start/end times may vary based on operational need across BWC departments. Most positions perform work on-site at one of BWC's seven offices across the state. BWC offers flex-time work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. Flex-time schedules are based on operational need and require supervisor approval.
What You'll Be Doing:
· Provides assistance to walk-in customers at the service office front counter.
· Responds to written & telephone inquiries from public & private employers regarding coverage issues.
· Monitors, reviews, & establishes coverage on business accounts for private & public employers.
· Determines if employer is amenable to O.R.C. Section 4123.01 prior to effective date of coverages.
· Examines & processes annual employer payroll reports & processes true-up reporting or amended true-up reporting.
· Identifies & refers audits to the appropriate Auditing Supervisor
· Answers inquiries (verbally &/or written) from government officials, Bureau personnel, & other customers regarding entities, dissolution of corporate entities, payroll processing &/or financial adjustments.
· Attends training &/or meetings as needed.
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.QualificationsTo Qualify, You Must Clearly Demonstrate:
24 mos. exp. in position involving review & processing of claims, collections, billings, payments or review of documents for accuracy, completeness &/or compliance with reporting guidelines, laws or rules with exp. commensurate to duties to be assigned. -Or 16 semester or 24 quarter hours in accounting; 12 mos. exp. in accounting or other fiscal/financial activity. -Or 12 mos. exp. as Accountant/ Examiner 1, 66111, with state government exp. commensurate with duties to be assigned. -Or equivalent of Minimum Class Qualifications for Employment noted above.
Note: Classification may require use of proficiency demonstration to determine minimum class qualifications for employment.
MAJOR WORKER CHARACTERISTICS:Knowledge of accounting; applicable state &/or federal regulations governing documents processed, reviewed &/or prepared*; public relations*. Skill in use of calculator/adding machine, typewriter, video display terminal or personal computer & photocopier*. Ability to apply principles to solve practical, everyday problems; gather, collate & classify information about data, people or things; complete routine forms & prepare standard reports & business correspondence; handle routine & sensitive inquiries from & contacts with other government officials, general public, claimants &/or providers.(*) Developed after employment.Supplemental InformationEEO & ADA Statement:The State of Ohio is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees due to protected classes as defined in applicable federal law, state law, and any effective executive order.The Ohio Bureau of Workers' Compensation is committed to providing access and reasonable accommodation in its employment opportunities pursuant to the Americans with Disabilities Act and other applicable laws. To request reasonable accommodations related to disability, pregnancy, or religion, please contact the ADA mailbox *********************** OCSEA Selection Rights:This position shall be filled in accordance with the provisions of the OCSEA Collective Bargaining Agreement. BWC bargaining unit members have selection rights before non-bargaining unit members. All other applications will only be considered if an internal bargaining unit applicant is not selected for this position.Salary Information:Hourly wage is expected to be paid at step 1 of the pay range associated with the position for candidates who are new employees of the state. Current employees of the state will be placed in the appropriate step based on any applicable union contract and/or requirements of the Ohio Revised Code. Movement to the next step of the pay range (a roughly 4% increase) will occur after six months, assuming job performance is acceptable. Thereafter, an employee will advance one step in the pay range every year until the highest step of the pay range is reached. There may also be possible cost of living adjustments (COLA) and longevity supplements begin after five (5) years of state service.Educational Transcripts:For any educational achievements to be considered during the screening process, you must at least attach an unofficial transcript that details the coursework you have completed.All applicants must submit an Ohio Civil Service Application using the online Ohio Hiring Management System. Paper applications will not be accepted.Background Check:Prior to an offer of employment, the final applicant will be required to sign a background check authorization form and undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position.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.
$23 hourly Auto-Apply 5h ago
Fraud Investigator
Insight Global
Fraud examiner job in Blue Ash, OH
An employer in the Blue Ash/Cincinnati, Ohio area is seeking a detail-oriented and analytical Fraud Investigator to join it's retail grocery Asset Protection team. This role is critical in identifying and mitigating internal fraud and shrink through data analysis and investigative techniques. The ideal candidate will have experience in fraud detection, auditing, or compliance, and a strong ability to interpret complex data sets to uncover patterns of nefarious activity. Using data from the MAX Asset Protection system, the Fraud Investigator will identify suspicious patterns and investigate potential internal fraud. This includes uncovering schemes such as credit card theft, coupon and gift card abuse, and internal shrink related to inventory discrepancies.
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to ********************.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: ****************************************************
Skills and Requirements
- Experience in fraud investigation, auditing, compliance, or data analysis.
- Strong analytical skills and attention to detail, with the ability to interpret complex data sets.
- Proficiency in Excel and data visualization tools.
- Excellent written and verbal communication skills, including the ability to document findings clearly and professionally. - Experience with investigative or case management software
- Retail experience
- Familiarity with retail operations or asset protection systems