Fugitive investigator jobs near me - 62 jobs

Senior Investigative Analyst The Senior Investigative Analyst (Sr. IA) is a highly dependable position in the Asset Protection Department. The Sr. IA is responsible for reducing shrink through the identification and development of internal/external theft investigations managing the restitution procedures and vendor partnership and supporting background checks adjudication. The Sr. IA needs to be analytical and detail oriented. The role requires the ability to transition from daily tasks to managing ad-hoc requests by the leadership and field team members with agility and speed to meet deadlines. The Sr. IA will maintain a peer mentorship traveling as needed, to visit stores, attended industry conferences as directed, enhance product knowledge, and develop business acumen through such partnerships. In addition, the Sr. IA will assist and support multiple vendor partnerships in the areas of exception-based reporting, restitution, and background checks. The Sr. IA must have strong customer services skills and be able to manage workload to complete tasks with minimal supervision at times. The Sr. IA must be able to analyze data from multiple sources and consistently building new/refining existing reports. The Sr. IA needs to be self-motivated to challenge themselves by developing new skills, leverage emerging technologies, and act as leader within the Asset Protection Operations Team. The Sr. IA needs to be willing to make recommendations or call outs based on the analysis trends and results. The Sr. IA reports to the Senior Manager of Asset Protection Analytics, working a hybrid schedule with a minimum of three days in office per week. Why You Belong Here At Victoria's Secret & Co, you'll join a world-leading specialty retail brand recognized globally for innovation and excellence in lingerie and fashion. You'll work alongside industry leaders to set the standard for what a retail brand can achieve, placing customers at the center of everything we do to create products and experiences that bring them joy. We believe everyone deserves a place where they truly belong. We celebrate individuality and know that your passion, experience, and unique perspective strengthen our team and business. Here, you'll be empowered to perform, grow, and engage through unmatched opportunities to develop your skills, gain real-world experience, and learn from the best in the business. Essential Functions/Core Responsibilities: * Shrink reduction and prevention. * Internal/external case identification and development. * Data/trend analysis (POS, Internal Investigations, RFID, and background checks). * Restitution/collections (reporting, field compliance, and vendor partnerships). * Background check support. * Other duties as assigned. The Sr. IA will work on special projects involving various teams within the Asset Protection Department. The Sr. IA analyst will collaborate with members across the Asset Protection team as well as other cross-functional partners in the company. Click here for benefit details related to this position. Minimum Salary: $58,000.00 Maximum Salary: $76,125.00 VS&Co provides a range of compensation for this role as shown. Your actual salary will be determined by a number of factors, including: your specific skills and experience, geographic region, or other relevant factors. Qualifications Your Experience * 7-10 years of relevant work experience in retail or asset protection. * 5 years' experience conducting retail investigations with a focus on internal/external theft and ORC. * 2 years' experience of managing complex projects and vendor partnerships. * Advanced understanding of POS analysis, inventory systems, case management software, and exception-based reporting. * Experience managing and/or system administration support of AP software. * Proficient in Microsoft Office (i.e., Excel, PowerPoint, Outlook). * Strong team leadership, relationship building cross-functional partnership. * Excellent organizational, verbal, and written communication skills. * Must be able to work onsite Tuesday, Wednesday, and Thursday. * Must be able to travel quarterly to stores for special projects #LI-WM1 We will consider for employment all qualified applicants, including those with arrest records, conviction records, or other criminal histories, in a manner consistent with the requirements of any applicable state and local laws. Please see links: California Fair Chance Act, Los Angeles Fair Chance Initiative for Hiring Ordinance, Philadelphia Fair Chance Law, San Francisco Fair Chance Ordinance, Los Angeles County Fair Chance Ordinance An equal opportunity employer, we do not discriminate in hiring or terms and conditions of employment because of an individual's race, color, religion, gender, gender identity, national origin, citizenship, age, disability, sexual orientation, marital status or any other protected category recognized by state, federal or local laws. We only hire individuals authorized for employment in the United States.

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

Hours: 40 Pay Details: $72,280 - $117,520 USD TD is committed to providing fair and equitable compensation opportunities to all colleagues. Growth opportunities and skill development are defining features of the colleague experience at TD. Our compensation policies and practices have been designed to allow colleagues to progress through the salary range over time as they progress in their role. The base pay actually offered may vary based upon the candidate's skills and experience, job-related knowledge, geographic location, and other specific business and organizational needs. As a candidate, you are encouraged to ask compensation related questions and have an open dialogue with your recruiter who can provide you more specific details for this role. Line of Business: Financial Crime Risk Management Job Description: Department Overview: Our team currently operates under a primarily offsite work model, employees must be available to come into a TD location for "moments that matter" at a frequency determined by the business. FCRM Investigations is responsible for investigations of complex anti-money laundering, counter-terrorism finance, and insider risk matters resulting from law enforcement referrals, proactive initiatives, 314a/314b, and internal referrals. This Financial Crime Risk Senior Investigator will be a part of the Digital Assets and Cyber Enabled Crime Team. Depth & Scope: Investigates criminal cases ranging from simple to complex in nature Sound knowledge of Bank products, systems, policies and procedures Strong knowledge of criminal investigative techniques, related laws governing collection of evidence, court proceedings and financial/criminal trends Manages programs/projects/ initiatives of low to moderate scope and complexity Expert level professional role requiring in-depth knowledge/expertise in own field of specialty and working knowledge of broader related areas Integrates the broader organizational context into advice and solutions within own area Understands the industry, competition and the factors that differentiate the organization Impacts a range of functional programs across own and related teams Interprets guidelines, standards, policies, and results of analysis to inform decision making at senior levels Builds stakeholder alignment in leading projects and activities Works independently as the senior technical lead and guides others within area of expertise Identifies and leads problem resolution for complex issues at all levels Education & Experience: Undergraduate degree or equivalent work experience 5+ years of experience Preferred Skills: Bachelor's or Master's degree in cybersecurity, cyber crime, intelligence, international studies, criminal justice, forensic accounting, data analytics, or a similar focus. Experience with blockchain analysis and blockchain analytics software such as Chainalysis, TRM Labs, Elliptic, etc. Relevant Industry certifications such as CAMS, CFE, CRC, CISC, TRM-CI, CCAS, etc. Experience conducting intelligence collection or investigations into activities involving cryptocurrency or cyber enabled crime (e.g. Darknet Markets, Ransomware, Money Laundering, Counter Terror Finance, Drug Trafficking, Fraud/Scams, etc.) Strong knowledge of financial crime typologies and AML regulations, including the Bank Secrecy Act (BSA), USA PATRIOT Act, and OFAC requirements Experience leading or supporting investigative projects; strong project management skills a plus. Experience leveraging data analytics to identify trends, anomalies, or support investigative findings related to financial crimes. Strong analytical and problem-solving skills. Ability to work independently and as part of a team, with a high level of integrity and attention to detail. Excellent written and verbal communication skills, with the ability to present findings clearly and concisely. Customer Accountabilities: Conducts a variety of complex investigations, including AML, Sanctions/ABAC and Financial Crime Applies sound methodologies to collect, preserve, and analyze evidence while staying current on global emerging risks and technology threats Assesses and prioritizes files and investigates assigned cases ensuring proper protocols are in place and effectively applied Works effectively with counterparts at other FI's, law enforcement, Non-Profits, and others in government within prescribed protocols to maximize opportunities for information sharing and to reduce TDBFG exposure Conducts investigations in a professional and timely manner Identifies and communicates procedural weaknesses to businesses Identifies industry and typologies risk and trends for respective program areas and shares knowledge with appropriate stakeholders Maintains and establishes working relationships with internal partners (e.g., HR, Employment Standards and Legal etc.,) for investigative purposes Applies sound methodologies to collect, preserve, and analyze digital evidence in accordance with investigative mandate Shareholder Accountabilities: Leads workstream by acting as a project lead for large or complex projects/initiatives in accordance with project management methodologies Evaluates the effectiveness of processes/services and recommends/champions possible enhancements Recommends improvements to escalation processes within the investigative unit and a feedback mechanism to relevant stakeholders Plans and delivers efficient and cost-effective processes that support and promote the implementation of programs Conducts internal and external research projects; supports the development/delivery of presentations/communications to management or broader audience Adheres to enterprise frameworks or methodologies that relate to activities for respective business area(s) Monitors service, productivity and assesses efficiency levels within own function and implements continuous process/performance improvements where opportunities exist Consistently exercises discretion in managing correspondence, information and all matters of confidentiality; escalates issues where appropriate Protects the interests of the organization - identifies and manages risks, and ensures the prompt and thorough resolution of escalated non-standard, high-risk issues Runs analysis at the functional or enterprise level using results to draw conclusions, makes recommendations, assesses the effectiveness of programs/policies/practices Keeps abreast of emerging issues, trends, and evolving regulatory requirements and assesses potential impacts Maintains a culture of risk management and control, supported by effective processes in alignment with risk appetite Employee/Team Accountabilities: Participates fully as a member of the team, supports a positive work environment that promotes service to the business, quality, innovation and teamwork and ensures timely communication of issues/points of interest Shares industry knowledge for own area of expertise and participates in knowledge transfer within the team and business unit Keeps current on emerging trends/developments and grows knowledge of the business, related tools and techniques Participates in personal performance management and development activities, including cross training within own team Keeps others informed and up to date about the status/progress of projects and/or all relevant or useful information related to day-to-day activities Contributes to team development of skills and capabilities through mentorship of others, by sharing knowledge and experiences and leveraging best practices Leads, motivates and develops relationships with internal and external business partners/stakeholders to develop productive working relationships Contributes to a fair, positive and equitable environment that supports a diverse workforce Acts as a brand ambassador for your business area/function and the bank, both internally and/or externally Physical Requirements: Never: 0%; Occasional: 1-33%; Frequent: 34-66%; Continuous: 67-100% Domestic Travel - Occasional International Travel - Never Performing sedentary work - Continuous Performing multiple tasks - Continuous Operating standard office equipment - Continuous Responding quickly to sounds - Occasional Sitting - Continuous Standing - Occasional Walking - Occasional Moving safely in confined spaces - Occasional Lifting/Carrying (under 25 lbs.) - Occasional Lifting/Carrying (over 25 lbs.) - Never Squatting - Occasional Bending - Occasional Kneeling - Never Crawling - Never Climbing - Never Reaching overhead - Never Reaching forward - Occasional Pushing - Never Pulling - Never Twisting - Never Concentrating for long periods of time - Continuous Applying common sense to deal with problems involving standardized situations - Continuous Reading, writing and comprehending instructions - Continuous Adding, subtracting, multiplying and dividing - Continuous The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required. The listed or specified responsibilities & duties are considered essential functions for ADA purposes. Who We Are: TD is one of the world's leading global financial institutions and is the fifth largest bank in North America by branches/stores. Every day, we deliver legendary customer experiences to over 27 million households and businesses in Canada, the United States and around the world. More than 95,000 TD colleagues bring their skills, talent, and creativity to the Bank, those we serve, and the economies we support. We are guided by our vision to Be the Better Bank and our purpose to enrich the lives of our customers, communities and colleagues. TD is deeply committed to being a leader in customer experience, that is why we believe that all colleagues, no matter where they work, are customer facing. As we build our business and deliver on our strategy, we are innovating to enhance the customer experience and build capabilities to shape the future of banking. Whether you've got years of banking experience or are just starting your career in financial services, we can help you realize your potential. Through regular leadership and development conversations to mentorship and training programs, we're here to support you towards your goals. As an organization, we keep growing - and so will you. Our Total Rewards Package Our Total Rewards package reflects the investments we make in our colleagues to help them and their families achieve their financial, physical and mental well-being goals. Total Rewards at TD includes base salary and variable compensation/incentive awards (e.g., eligibility for cash and/or equity incentive awards, generally through participation in an incentive plan) and several other key plans such as health and well-being benefits, savings and retirement programs, paid time off (including Vacation PTO, Flex PTO, and Holiday PTO), banking benefits and discounts, career development, and reward and recognition. Learn more Additional Information: We're delighted that you're considering building a career with TD. Through regular development conversations, training programs, and a competitive benefits plan, we're committed to providing the support our colleagues need to thrive both at work and at home. Colleague Development If you're interested in a specific career path or are looking to build certain skills, we want to help you succeed. You'll have regular career, development, and performance conversations with your manager, as well as access to an online learning platform and a variety of mentoring programs to help you unlock future opportunities. Whether you have a passion for helping customers and want to expand your experience, or you want to coach and inspire your colleagues, there are many different career paths within our organization at TD - and we're committed to helping you identify opportunities that support your goals. Training & Onboarding We will provide training and onboarding sessions to ensure that you've got everything you need to succeed in your new role. Interview Process We'll reach out to candidates of interest to schedule an interview. We do our best to communicate outcomes to all applicants by email or phone call. Accommodation TD Bank is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or any other characteristic protected under applicable federal, state, or local law. If you are an applicant with a disability and need accommodations to complete the application process, please email TD Bank US Workplace Accommodations Program at ***************. Include your full name, best way to reach you and the accommodation needed to assist you with the applicant process.

Successfully completes high-quality, sophisticated long term care claims investigations Independently develops and drives a detailed investigative plan Acquires and reviews internal / external documents to support investigative activity and findings Conducts interviews of insureds, caregivers, and other involved parties Handles third party vendor(s) conducting long term care surveillance activities Regularly communicates findings and investigation status to Requesters Produces reports that are accurate and objective Presents case findings and recommendations for further action to department management and Requesters Optimally applies internal case management systems to keep department management updated and to plan / prioritize concurrent assignments Adheres to departmental, company and regulatory timelines, policies, and requirements When applicable, prepares and presents cases for referral to law enforcement, prosecutors, and regulators; provides depositions, grand jury, and court testimony as the need arises Mentors and trains more junior investigators on long term care claim cases and processes Ability to travel on short notice and responds to urgent long term care claim investigations Maintains knowledge of sophisticated investigative techniques, company / external sources of information, changes in the financial services industry as well as applicable laws and regulations impacting long term care claim investigations and other relevant topics Maintains and continuously expands network of professional contacts Plays a major role in the department's fraud awareness training program by developing and delivering appropriate material to employees Attends training sessions, reads pertinent trade journals, actively participates in, and makes presentations to professional organizations and associations Required Qualifications: Bachelor's degree preferably in Criminal Justice or related field required; graduate work a plus 5+ years of proven track record in the investigation profession and/or financial services industry Designations / certifications in relevant subject matter areas a plus (CFE, LTCP, LOMA) Preferred Qualifications: Highly proficient in various computer applications (Microsoft products etc.) Sophisticated written and verbal communication skills Sophisticated analytical skills Sophisticated interviewing skills Ability to work in a dynamic environment Efficient and effective organizational skills Strong presentation skills Foreign language proficiency a plus When you join our team: We'll empower you to learn and grow the career you want. We'll recognize and support you in a flexible environment where well-being and inclusion are more than just words. As part of our global team, we'll support you in shaping the future you want to see. #LI-Remote #LI-JH About Manulife and John Hancock Manulife Financial Corporation is a leading international financial services provider, helping people make their decisions easier and lives better. To learn more about us, visit ************************************************* Manulife is an Equal Opportunity Employer At Manulife/John Hancock, we embrace our diversity. We strive to attract, develop and retain a workforce that is as diverse as the customers we serve and to foster an inclusive work environment that embraces the strength of cultures and individuals. We are committed to fair recruitment, retention, advancement and compensation, and we administer all of our practices and programs without discrimination on the basis of race, ancestry, place of origin, colour, ethnic origin, citizenship, religion or religious beliefs, creed, sex (including pregnancy and pregnancy-related conditions), sexual orientation, genetic characteristics, veteran status, gender identity, gender expression, age, marital status, family status, disability, or any other ground protected by applicable law. It is our priority to remove barriers to provide equal access to employment. A Human Resources representative will work with applicants who request a reasonable accommodation during the application process. All information shared during the accommodation request process will be stored and used in a manner that is consistent with applicable laws and Manulife/John Hancock policies. To request a reasonable accommodation in the application process, contact ************************. Referenced Salary Location USA, Florida - Full Time Remote Working Arrangement Remote Salary range is expected to be between $88,200.00 USD - $152,880.00 USD If you are applying for this role outside of the primary location, please contact ************************ for the salary range for your location. The actual salary will vary depending on local market conditions, geography and relevant job-related factors such as knowledge, skills, qualifications, experience, and education/training. Employees also have the opportunity to participate in incentive programs and earn incentive compensation tied to business and individual performance. Manulife/John Hancock offers eligible employees a wide array of customizable benefits, including health, dental, mental health, vision, short- and long-term disability, life and AD&D insurance coverage, adoption/surrogacy and wellness benefits, and employee/family assistance plans. We also offer eligible employees various retirement savings plans (including pension/401(k) savings plans and a global share ownership plan with employer matching contributions) and financial education and counseling resources. Our generous paid time off program in the U.S. includes up to 11 paid holidays, 3 personal days, 150 hours of vacation, and 40 hours of sick time (or more where required by law) each year, and we offer the full range of statutory leaves of absence. Know Your Rights I Family & Medical Leave I Employee Polygraph Protection I Right to Work I E-Verify Company: John Hancock Life Insurance Company (U.S.A.)

Job Description ABOUT US: Ethos Risk Services is a leading insurance claims investigation and medical management company, specializing in surveillance and fraud detection. At the forefront, we provide accurate data and actionable insights that translate into better decision-making for our clients. JOB SUMMARY: Our dynamic Ethos team is seeking an Experienced Field Investigator to conduct surveillance and investigative activities to identify potential fraudulent insurance claims. This role involves performing both stationary and mobile surveillance, obtaining video and photographic evidence, and preparing thorough, detailed reports for clients. KEY RESPONSIBILITIES: Case Preparation: Prepare for surveillance assignment by reviewing Ethos' preliminary reports and case information. Field Surveillance: Perform covert surveillance from your vehicle by tracking and capturing high-quality video evidence of surveillance targets. Report Writing: Draft detailed and court-ready investigative reports summarizing activity and key findings. Documentation: Finalize case file by submitting case reports and uploading video footage via personal laptop at the end of the day. Communication: Work closely with the field supervisor and operations teams, receiving regular guidance and mentorship. REQUIREMENTS: Previous Experience: Demonstrated proficiency in covert surveillance techniques, capturing high-quality video footage, and preparing thorough, well-organized investigative reports. Driver's License: Valid driver's license and proof of automobile insurance. Personal Vehicle: A well-maintained vehicle that is always reliable (preferably with tinted windows). Surveillance Equipment: A handheld camcorder with high-quality zoom and a covert camera device. Use of stabilization equipment (gimbals, tripods, etc.) is strongly encouraged. Technology: A reliable laptop, cell phone, and internet service are needed for communication and administrative tasks. Private Investigator License: Active Private Investigator license or willingness to obtain one (where required by state). WORKING CONDITIONS: While we aim to keep assignments within a 2-hour drive of your residence, occasional further travel and overnight stays (covered by the company) may be required Most surveillance cases start at 6:00AM. End time can vary depending on activity and a typical workday can vary from 3-12 hours. Weekends/holidays are common workdays as claimants are more likely to be active. This is an independent role often requiring long hours alone in your vehicle, regardless of weather conditions. Must remain alert with no external distractions, ready to use videography equipment to document subjects. Ethos Risk Services is an equal opportunity employer that does not discriminate on the basis of religious creed, sex, national origin, race, veteran status, disability, age, marital status, color or sexual orientation or any other characteristic. A background check will be conducted, in accordance to the local state law and regulations. Job Posted by ApplicantPro

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

Our team members are at the heart of everything we do. At Cencora, we are united in our responsibility to create healthier futures, and every person here is essential to us being able to deliver on that purpose. If you want to make a difference at the center of health, come join our innovative company and help us improve the lives of people and animals everywhere. Apply today! Job Details Summary: Under the general direction of the Director of Diversion Control Program, supports the Diversion Control Program through investigative research and other duties, as assigned. Primary Duties and Responsibilities: Assists in the implementation and operation of the Diversion Control Program Conducts investigative research via the Internet and public record databases Conducts Customer Due Diligence (DD) and Suspicious Order Monitoring (SOM) Investigations Supports the Diversion Control Analyst in the generation of sales reporting as a result of information requests from state and/or federal regulatory authorities Supports the Diversion Control Analyst in updating the monthly parameter and related OMP maintenance Monitors and adjusts customer OMP parameters, according to Diversion Control Program policy, as required Acts as liaison and maintains contact with Sales and Customer Maintenance departments regarding diversion control concerns, as necessary Acts as liaison with distribution center compliance teams Generates statistical data on a monthly basis, as directed Assists with conducting analysis of customer dispensing reports Assists with conducting targeted, on-site pharmacy visits, as assigned Assists with DC pre-audit preparation and interviews with state and federal regulators Conducts internal associate training on the Diversion Control Program to other ABC business units, as assigned Composes comprehensive written reports relative to investigative analysis Documents all work in a timely and organized fashion for future retrieval purposes Works independently, requiring less oversight from management and offering coaching to Investigator I level team members Willingness to travel up to 25% Perform related duties as assigned Minimum Skills and Qualifications: Requires broad training in fields such as criminal justice, business administration, accountancy, sales, marketing, computer sciences or similar vocations generally obtained through completion of a four (4) year bachelor's degree program or equivalent combination of experience and education Normally requires five (5) + years of directly related and progressively responsible experience Excellent organization and administrative skills Excellent computer skills including Microsoft Office and preferably familiarity with SAP Strong written and verbal communication skills Strong research skills Ability to multi-task What Cencora offers We provide compensation, benefits, and resources that enable a highly inclusive culture and support our team members' ability to live with purpose every day. In addition to traditional offerings like medical, dental, and vision care, we also provide a comprehensive suite of benefits that focus on the physical, emotional, financial, and social aspects of wellness. This encompasses support for working families, which may include backup dependent care, adoption assistance, infertility coverage, family building support, behavioral health solutions, paid parental leave, and paid caregiver leave. To encourage your personal growth, we also offer a variety of training programs, professional development resources, and opportunities to participate in mentorship programs, employee resource groups, volunteer activities, and much more. For details, visit ************************************** Full time Salary Range*$74,000 - 105,820 *This Salary Range reflects a National Average for this job. The actual range may vary based on your locale. Ranges in Colorado/California/Washington/New York/Hawaii/Vermont/Minnesota/Massachusetts/Illinois State-specific locations may be up to 10% lower than the minimum salary range, and 12% higher than the maximum salary range. Equal Employment Opportunity Cencora is committed to providing equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, genetic information, national origin, age, disability, veteran status or membership in any other class protected by federal, state or local law. The company's continued success depends on the full and effective utilization of qualified individuals. Therefore, harassment is prohibited and all matters related to recruiting, training, compensation, benefits, promotions and transfers comply with equal opportunity principles and are non-discriminatory. Cencora is committed to providing reasonable accommodations to individuals with disabilities during the employment process which are consistent with legal requirements. If you wish to request an accommodation while seeking employment, please call ************ or email ****************. We will make accommodation determinations on a request-by-request basis. Messages and emails regarding anything other than accommodations requests will not be returned . Affiliated Companies:Affiliated Companies: AmerisourceBergen Services Corporation

Who we are At Twilio, we're shaping the future of communications, all from the comfort of our homes. We deliver innovative solutions to hundreds of thousands of businesses and empower millions of developers worldwide to craft personalized customer experiences. Our dedication to remote-first work, and strong culture of connection and global inclusion means that no matter your location, you're part of a vibrant team with diverse experiences making a global impact each day. As we continue to revolutionize how the world interacts, we're acquiring new skills and experiences that make work feel truly rewarding. Your career at Twilio is in your hands. We use Artificial Intelligence (AI) technologies to maintain an efficient, fair and transparent hiring process. Our hiring process is never completely automated, and uses AI in conjunction with our recruiting professionals. See yourself at Twilio Join the team as our next Senior Investigator. About the job This position is needed to lead complex employee and compliance investigations. We are looking for an individual with a strong People investigations background with a focus on discrimination, harassment, retaliation, and Code of Conduct cases for Legal in the NAMER region. The main responsibilities include conducting prompt, thorough, and fair investigations consisting of background research, investigative interviews, and debrief meetings in partnership with Employment Legal, People, ER, and the business. The ideal candidate will be able to clearly communicate complex matters to business stakeholders, deliver high-quality written reports and documentation, and support the effective resolution of workplace concerns. Responsibilities In this role, you'll: Develop and optimize robust investigation standards and disciplinary matrix to ensure transparency, objectivity and consistency throughout the team; Maintain oversight and accountability for investigation case management system, keep improving efficiency and effectiveness; Conduct confidential, fair, thorough and timely internal investigations into allegations of violations of internal policies, including but not limited to bullying, discrimination, harassment, retaliation, and Code of Conduct, and produce comprehensive and clear investigation reports and/or outcomes; Conduct complex, professional interviews, often involving senior management, and prepare investigation summaries, conveying ideas clearly and concisely, both orally and in writing; Assist with the investigation and resolution of other workplace concerns to determine the appropriate approach and to ensure fair and consistent treatment of all employees; Drive the disciplinary procedure in line with the investigation findings, and align with key stakeholders to get to consensus; Monitor and implement corrective action plans to enhance controls and processes; Identify ethics, compliance, and employee relations matters that require improvement, working with our ER leader & various internal groups to amend policies and drive the training and awareness approach accordingly; Participate in the identification and delivery of continuous improvement initiatives to improve the policy framework, increase knowledge within the company; Proactively identify trends and themes to develop strategies that will mitigate risks. Qualifications Twilio values diverse experiences from all kinds of industries, and we encourage everyone who meets the required qualifications to apply. If your career is just starting or hasn't followed a traditional path, don't let that stop you from considering Twilio. We are always looking for people who will bring something new to the table! *Required: 10+ years of Employee Relations / Investigations experience gained as a Human Resource Business Partner (HRBP) role, Employee Relations advisory role, or equivalent experience as an employment attorney practicing employment law; Significant experience working with employment law principles and conducting and advising on investigations; Excellent problem-solving, analytical, and writing skills; Strong communication skills with the ability to manage various stakeholders/programs concurrently; Demonstrated ability to navigate successfully within ambiguity and with multiple priorities in a fast-paced, changing environment; Desired: Data-driven mindset with an eye toward innovation; Working experience in multiple AMER jurisdictions; Experience conducting global investigations outside AMER; Knowledge in employment and labor law; Familiarity with a case management system; Experience with analyzing investigation data. Location This role will be remote, but is not eligible to be hired in CA, CT, NJ, NY, PA, WA. Travel We prioritize connection and opportunities to build relationships with our customers and each other. For this role, you may be required to travel occasionally to participate in project or team in-person meetings. What We Offer Working at Twilio offers many benefits, including competitive pay, generous time off, ample parental and wellness leave, healthcare, a retirement savings program, and much more. Offerings vary by location. Compensation *Please note this role is open to candidates outside of California, Colorado, Hawaii, Illinois, Maryland, Massachusetts, Minnesota, New Jersey, New York, Vermont, Washington D.C., and Washington State. The information below is provided for candidates hired in those locations only. The estimated pay ranges for this role are as follows: Based in Colorado, Hawaii, Illinois, Maryland, Massachusetts, Minnesota, Vermont or Washington D.C. : $141,520 - 176,900. Based in New York, New Jersey, Washington State, or California (outside of the San Francisco Bay area): $149,840 - $187,300. Based in the San Francisco Bay area, California: $166,400 - $208,000. This role may be eligible to participate in Twilio's equity plan and corporate bonus plan. All roles are generally eligible for the following benefits: health care insurance, 401(k) retirement account, paid sick time, paid personal time off, paid parental leave. The successful candidate's starting salary will be determined based on permissible, non-discriminatory factors such as skills, experience, and geographic location. Applications for this role are intended to be accepted until 20th January, 2026, but may change based on business needs. Twilio thinks big. Do you? We like to solve problems, take initiative, pitch in when needed, and are always up for trying new things. That's why we seek out colleagues who embody our values - something we call Twilio Magic. Additionally, we empower employees to build positive change in their communities by supporting their volunteering and donation efforts. So, if you're ready to unleash your full potential, do your best work, and be the best version of yourself, apply now! If this role isn't what you're looking for, please consider other open positions. Twilio is proud to be an equal opportunity employer. We do not discriminate based upon race, religion, color, national origin, sex (including pregnancy, childbirth, reproductive health decisions, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, genetic information, political views or activity, or other applicable legally protected characteristics. We also consider qualified applicants with criminal histories, consistent with applicable federal, state and local law. Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. Additionally, Twilio participates in the E-Verify program in certain locations, as required by law.

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

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

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

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

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

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

Investigator (2600007S) Organization: Psychology BoardAgency Contact Name and Information: Jennifer Gates, *************************** Unposting Date: Jan 26, 2026, 4:59:00 AMWork Location: Riffe Tower 77 South High Street Concourse Columbus 43215Primary Location: United States of America-OHIO-Franklin County-Columbus Compensation: $27.92/hr Schedule: Full-time Work Hours: 8:00AM-5:00PMClassified Indicator: ClassifiedUnion: OCSEA Primary Job Skill: InvestigationTechnical Skills: InvestigationProfessional Skills: Attention to Detail, Building Trust, Critical Thinking, Listening, Confidentiality Agency Overview Since 1972, the Ohio Board of Psychology has been providing protections to the public through examinations, licensing, education, and investigating complaints and maintaining accountability among Ohio's psychologists, school psychologists licensed for private practice, supervised providers, and applicants for licensure. The Board is responsible for enforcement of ORC Chapter 4732 and OAC Chapter 4732, the Laws and Rules Governing Psychologists and School Psychologists. In addition, the Board became responsible for regulating the practice of Certified Ohio Behavior Analysts with the enactment of ORC 4783 and the promulgation of rules in OAC 4783 effective in January 2014. The Ohio Board of Psychology's greatest responsibility is to protect the well-being and safety of Ohioans who receive or seek psychological or applied behavior analysis services and stopping illegal practice. The Board is comprised of ten members appointed by the governor-seven license holders and three patient advocates. The Board office is staffed by five full-time employees focused on fulfilling the Board's mission and vision and implementing its core values through a strong customer service model.MISSION: The State Board of Psychology ensures Ohioans' access to safe and competent psychological services through examination, licensing, education, and enforcement.VISION: The State Board of Psychology represents excellence and common sense in occupational regulation in the State of Ohio and is a leader among the members of the Association of State and Provincial Psychology Boards.CORE VALUES: The State Board of Psychology and its employees share a set of core values, which are reflected in investigations, licensing, public relations, and policy making.Job DescriptionThe Investigator plays an important part at the Board. In this role, you will be responsible for: • Conducting investigations of complaints and alleged violations of the Ohio Revised Code 4732/4783 and the Ohio Administrative Code 4732/4783.• Interviewing complainants, witnesses, public members, licensees subject to allegations and unlicensed individuals who may be practicing illegally or using titles, terminology and/or techniques restricted by law.• Preparing reports and making recommendations regarding investigation strategy, case status.• Interpreting application of administrative rules, Ohio Revised Code, ethical principles and Psychology Board policy and procedures.• Responding to inquiries from citizens regarding complex and sensitive material related to confidentiality, client rights, mental disorders and occupational standards of care in psychology.• Drafting legal correspondence and documents including case notes, reports, subpoenas, letters, notice of opportunity for hearing letters, consent agreements and adjudication orders.• Preparing confidential investigation reports and recommendations.• Maintaining files and records and conferring with legal personnel. • Requesting and serving Psychology Board subpoenas.• Testifying in administrative hearings on behalf of the Psychology Board and/or criminal hearings on behalf of the Board.• Handling sensitive inquiries received via telephone, in writing, or in person from psychology physicians, legal counsel, consumers and the general public.• Assisting in development of Psychology Board investigative policies, procedures and methods in accordance with related civil service laws.• Entering and maintaining case information in Psychology Board's investigative case tracking database.• Attending and participating in law enforcement seminars and training and serving on committees and task forces. Why Work for the State of OhioAt the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes: Medical Coverage Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period Paid time off, including vacation, personal, sick leave and 11 paid holidays per year Childbirth, Adoption, and Foster Care leave Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more) Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation) *Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.Qualifications30 months of training or 30 months of investigative experience with experience corresponding to type of complaints & alleged violations appearing in job posting/approved position description AND valid driver's license. -OR Completion of associate core program in law enforcement, criminal justice or in academic field commensurate with program area to be assigned per approved Position Description on file AND 12 months of experience conducting investigations and/or inspections AND valid driver's license. -OR 30 months of training or 30 months of experience as Investigator Assistant, 26210 with experience corresponding to type of complaints & alleged violations appearing in job posting/approved position description AND valid driver's license. -OR equivalent of Minimum Class Qualifications for Employment noted above. Job Skills: InvestigationSupplemental InformationWhen completing your application, be sure to clearly describe how you meet the minimum qualifications outlined in this job posting. If you require reasonable accommodation for the application process, please email the Human Resources contact on this posting so arrangements can be made.The final candidate selected for this position will be required to undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position. An individual assessment of an applicant's prior criminal convictions will be made before excluding an applicant from consideration. The Ohio Board of Psychology is an Equal Employment Opportunity Employer and does not discriminate on the basis of race, color, religion, gender, gender identity or expression, national origin (ancestry), military status, disability, age (40 years or older), genetic information, sexual orientation, or caregiver status, in making employment-related decisions about an individual.ADA StatementOhio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.Drug-Free WorkplaceThe State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.

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

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

Hours: 40 Pay Details: $72,280 - $117,520 USD TD is committed to providing fair and equitable compensation opportunities to all colleagues. Growth opportunities and skill development are defining features of the colleague experience at TD. Our compensation policies and practices have been designed to allow colleagues to progress through the salary range over time as they progress in their role. The base pay actually offered may vary based upon the candidate's skills and experience, job-related knowledge, geographic location, and other specific business and organizational needs. As a candidate, you are encouraged to ask compensation related questions and have an open dialogue with your recruiter who can provide you more specific details for this role. Line of Business: Financial Crime Risk Management Job Description: Department Overview: Our team currently operates under a primarily offsite work model, employees must be available to come into a TD location for "moments that matter" at a frequency determined by the business. FCRM Investigations is responsible for investigations of complex anti-money laundering, counter-terrorism finance, and insider risk matters resulting from law enforcement referrals, proactive initiatives, 314a/314b, and internal referrals. This Financial Crime Risk Senior Investigator will be a part of the Digital Assets and Cyber Enabled Crime Team. Depth & Scope: * Investigates criminal cases ranging from simple to complex in nature * Sound knowledge of Bank products, systems, policies and procedures * Strong knowledge of criminal investigative techniques, related laws governing collection of evidence, court proceedings and financial/criminal trends * Manages programs/projects/ initiatives of low to moderate scope and complexity * Expert level professional role requiring in-depth knowledge/expertise in own field of specialty and working knowledge of broader related areas * Integrates the broader organizational context into advice and solutions within own area * Understands the industry, competition and the factors that differentiate the organization * Impacts a range of functional programs across own and related teams * Interprets guidelines, standards, policies, and results of analysis to inform decision making at senior levels * Builds stakeholder alignment in leading projects and activities * Works independently as the senior technical lead and guides others within area of expertise * Identifies and leads problem resolution for complex issues at all levels Education & Experience: * Undergraduate degree or equivalent work experience * 5+ years of experience Preferred Skills: * Bachelor's or Master's degree in cybersecurity, cyber crime, intelligence, international studies, criminal justice, forensic accounting, data analytics, or a similar focus. * Experience with blockchain analysis and blockchain analytics software such as Chainalysis, TRM Labs, Elliptic, etc. * Relevant Industry certifications such as CAMS, CFE, CRC, CISC, TRM-CI, CCAS, etc. * Experience conducting intelligence collection or investigations into activities involving cryptocurrency or cyber enabled crime (e.g. Darknet Markets, Ransomware, Money Laundering, Counter Terror Finance, Drug Trafficking, Fraud/Scams, etc.) * Strong knowledge of financial crime typologies and AML regulations, including the Bank Secrecy Act (BSA), USA PATRIOT Act, and OFAC requirements * Experience leading or supporting investigative projects; strong project management skills a plus. * Experience leveraging data analytics to identify trends, anomalies, or support investigative findings related to financial crimes. * Strong analytical and problem-solving skills. * Ability to work independently and as part of a team, with a high level of integrity and attention to detail. * Excellent written and verbal communication skills, with the ability to present findings clearly and concisely. Customer Accountabilities: * Conducts a variety of complex investigations, including AML, Sanctions/ABAC and Financial Crime * Applies sound methodologies to collect, preserve, and analyze evidence while staying current on global emerging risks and technology threats * Assesses and prioritizes files and investigates assigned cases ensuring proper protocols are in place and effectively applied * Works effectively with counterparts at other FI's, law enforcement, Non-Profits, and others in government within prescribed protocols to maximize opportunities for information sharing and to reduce TDBFG exposure * Conducts investigations in a professional and timely manner * Identifies and communicates procedural weaknesses to businesses * Identifies industry and typologies risk and trends for respective program areas and shares knowledge with appropriate stakeholders * Maintains and establishes working relationships with internal partners (e.g., HR, Employment Standards and Legal etc.,) for investigative purposes * Applies sound methodologies to collect, preserve, and analyze digital evidence in accordance with investigative mandate Shareholder Accountabilities: * Leads workstream by acting as a project lead for large or complex projects/initiatives in accordance with project management methodologies * Evaluates the effectiveness of processes/services and recommends/champions possible enhancements * Recommends improvements to escalation processes within the investigative unit and a feedback mechanism to relevant stakeholders * Plans and delivers efficient and cost-effective processes that support and promote the implementation of programs * Conducts internal and external research projects; supports the development/delivery of presentations/communications to management or broader audience * Adheres to enterprise frameworks or methodologies that relate to activities for respective business area(s) * Monitors service, productivity and assesses efficiency levels within own function and implements continuous process/performance improvements where opportunities exist * Consistently exercises discretion in managing correspondence, information and all matters of confidentiality; escalates issues where appropriate * Protects the interests of the organization - identifies and manages risks, and ensures the prompt and thorough resolution of escalated non-standard, high-risk issues * Runs analysis at the functional or enterprise level using results to draw conclusions, makes recommendations, assesses the effectiveness of programs/policies/practices * Keeps abreast of emerging issues, trends, and evolving regulatory requirements and assesses potential impacts * Maintains a culture of risk management and control, supported by effective processes in alignment with risk appetite Employee/Team Accountabilities: * Participates fully as a member of the team, supports a positive work environment that promotes service to the business, quality, innovation and teamwork and ensures timely communication of issues/points of interest * Shares industry knowledge for own area of expertise and participates in knowledge transfer within the team and business unit * Keeps current on emerging trends/developments and grows knowledge of the business, related tools and techniques * Participates in personal performance management and development activities, including cross training within own team * Keeps others informed and up to date about the status/progress of projects and/or all relevant or useful information related to day-to-day activities * Contributes to team development of skills and capabilities through mentorship of others, by sharing knowledge and experiences and leveraging best practices * Leads, motivates and develops relationships with internal and external business partners/stakeholders to develop productive working relationships * Contributes to a fair, positive and equitable environment that supports a diverse workforce * Acts as a brand ambassador for your business area/function and the bank, both internally and/or externally Physical Requirements: Never: 0%; Occasional: 1-33%; Frequent: 34-66%; Continuous: 67-100% * Domestic Travel - Occasional * International Travel - Never * Performing sedentary work - Continuous * Performing multiple tasks - Continuous * Operating standard office equipment - Continuous * Responding quickly to sounds - Occasional * Sitting - Continuous * Standing - Occasional * Walking - Occasional * Moving safely in confined spaces - Occasional * Lifting/Carrying (under 25 lbs.) - Occasional * Lifting/Carrying (over 25 lbs.) - Never * Squatting - Occasional * Bending - Occasional * Kneeling - Never * Crawling - Never * Climbing - Never * Reaching overhead - Never * Reaching forward - Occasional * Pushing - Never * Pulling - Never * Twisting - Never * Concentrating for long periods of time - Continuous * Applying common sense to deal with problems involving standardized situations - Continuous * Reading, writing and comprehending instructions - Continuous * Adding, subtracting, multiplying and dividing - Continuous The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required. The listed or specified responsibilities & duties are considered essential functions for ADA purposes. Who We Are: TD is one of the world's leading global financial institutions and is the fifth largest bank in North America by branches/stores. Every day, we deliver legendary customer experiences to over 27 million households and businesses in Canada, the United States and around the world. More than 95,000 TD colleagues bring their skills, talent, and creativity to the Bank, those we serve, and the economies we support. We are guided by our vision to Be the Better Bank and our purpose to enrich the lives of our customers, communities and colleagues. TD is deeply committed to being a leader in customer experience, that is why we believe that all colleagues, no matter where they work, are customer facing. As we build our business and deliver on our strategy, we are innovating to enhance the customer experience and build capabilities to shape the future of banking. Whether you've got years of banking experience or are just starting your career in financial services, we can help you realize your potential. Through regular leadership and development conversations to mentorship and training programs, we're here to support you towards your goals. As an organization, we keep growing - and so will you. Our Total Rewards Package Our Total Rewards package reflects the investments we make in our colleagues to help them and their families achieve their financial, physical and mental well-being goals. Total Rewards at TD includes base salary and variable compensation/incentive awards (e.g., eligibility for cash and/or equity incentive awards, generally through participation in an incentive plan) and several other key plans such as health and well-being benefits, savings and retirement programs, paid time off (including Vacation PTO, Flex PTO, and Holiday PTO), banking benefits and discounts, career development, and reward and recognition. Learn more Additional Information: We're delighted that you're considering building a career with TD. Through regular development conversations, training programs, and a competitive benefits plan, we're committed to providing the support our colleagues need to thrive both at work and at home. Colleague Development If you're interested in a specific career path or are looking to build certain skills, we want to help you succeed. You'll have regular career, development, and performance conversations with your manager, as well as access to an online learning platform and a variety of mentoring programs to help you unlock future opportunities. Whether you have a passion for helping customers and want to expand your experience, or you want to coach and inspire your colleagues, there are many different career paths within our organization at TD - and we're committed to helping you identify opportunities that support your goals. Training & Onboarding We will provide training and onboarding sessions to ensure that you've got everything you need to succeed in your new role. Interview Process We'll reach out to candidates of interest to schedule an interview. We do our best to communicate outcomes to all applicants by email or phone call. Accommodation TD Bank is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or any other characteristic protected under applicable federal, state, or local law. If you are an applicant with a disability and need accommodations to complete the application process, please email TD Bank US Workplace Accommodations Program at ***************. Include your full name, best way to reach you and the accommodation needed to assist you with the applicant process.

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