Head investigator jobs near me - 64 jobs

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.

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

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.)

At Clover Health, we are committed to providing high-quality, affordable, and easy-to-understand healthcare plans for America's seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant, a powerful tool that helps physicians make informed health recommendations. By giving doctors a holistic view of each member's complete health history, we ensure better care at a lower cost-delivering the highest value to those who need it most. The Special Investigation Unit (SIU) is a collaborative team at the crossroads of Compliance, Payment Integrity, and Data Infrastructure, focused on detecting and investigating healthcare fraud, waste, and abuse (FWA). As an Investigator, you'll help scale Clover's FWA audit program, ensuring regulatory compliance and quality assurance. You'll develop and execute effective audit strategies to identify and report suspected FWA, while growing your policy and operational expertise in a fast-paced, tech-driven healthcare environment. As an Investigator, you will: Implement an effective audit strategy to investigate known or suspected instances of FWA. Support complex provider conversations around FWA audit findings. Prepare response letters to deliver information to providers within the regulatory timeframes set forth by the Centers for Medicare & Medicaid Services (CMS). Manage overall audit workload to ensure timely and accurate audit results. Act as a FWA subject matter expert. Collaborate to identify possible audit opportunities. Build strong working relationships with both regulatory and law enforcement agencies. Communicate effectively while building trust and lasting partnerships both laterally and vertically across multi-discipline teams. Support annual FWA goals Success in this role looks like: By the end of your initial 90 day period, you will have demonstrated a strong understanding of our SIU case flow and are able to effectively navigate through the various Clover systems. By 6 months, you will be working autonomously on cases and provider reviews. Continued success in this position anchors in on developing a deep understanding of the workflows that support our SIU cases and reviews while maintaining regulatory compliance standards. You should get in touch if: You have 3+ years of experience in the healthcare FWA space. You have experience identifying operations and process improvement efforts. You have an understanding of compliance & payer requirements including Medicare regulations. You have knowledge on fraud statutes and regulations and preferably hold certifications like CFE, AHFI, or similar. Benefits Overview: Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions. Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare. Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location. Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews. Additional Perks: Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities Reimbursement for office setup expenses Monthly cell phone & internet stipend Remote-first culture, enabling collaboration with global teams Paid parental leave for all new parents And much more! About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most. We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare. From Clover's inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences, perspectives, opinions, and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one's identity. All of our employee's points of view are key to our success, and inclusion is everyone's responsibility. # LI-REMOTE Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company. A reasonable estimate of the base salary range for this role is $83,000 to $125,000. Final pay is based on several factors including but not limited to internal equity, market data, and the applicant's education, work experience, certifications, etc. #LI-Remote

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

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.

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

Anthropic's mission is to create reliable, interpretable, and steerable AI systems. We want AI to be safe and beneficial for our users and for society as a whole. Our team is a quickly growing group of committed researchers, engineers, policy experts, and business leaders working together to build beneficial AI systems. About the Role We are looking for a Technical Scaled Abuse Threat Investigator to join our Threat Intelligence team. In this role, you will be responsible for detecting, investigating, and disrupting large-scale misuse of Anthropic's AI systems, including model distillation, account abuse, fraud, scams, and other forms of scaled exploitation. You will combine open-source research with analysis of internal data to understand how sophisticated adversaries gain access to Anthropic systems and conduct abuse at scale. Your work will directly inform our defenses against threat actors who seek to exploit our products for financial gain, competitive advantage, or to cause widespread harm. Important context: In this position you may be exposed to explicit content spanning a range of topics, including those of a sexual, violent, or psychologically disturbing nature. This role may require responding to escalations during weekends and holidays. Responsibilities Detect and investigate large-scale abuse patterns including model distillation, unauthorized API access, account farming, fraud schemes, and scam operations Develop abuse signals and tracking strategies to proactively identify scaled adversarial activity and coordinated abuse networks Conduct technical investigations using SQL, Python, and data science methodologies to analyze large datasets and uncover sophisticated abuse patterns Create actionable intelligence reports on new attack vectors, vulnerabilities, and threat actor TTPs targeting AI systems at scale Utilize investigation findings to implement systematic improvements to our safety approach and mitigate harm Study trends internally and in the broader ecosystem to anticipate how AI systems could be exploited, generating and publishing reports Build and maintain relationships with external threat intelligence partners and information sharing communities Work cross-functionally to build out our threat intelligence program, establishing processes, tools, and best practices Forecast how abuse actors will leverage advances in AI technology and inform safety-by-design strategies You may be a good fit if you Have strong proficiency in SQL and Python with a data science background Have experience with large language models and understanding of how AI technology could be exploited at scale Have subject matter expertise in abusive user behavior detection, fraud patterns, account abuse, or platform integrity Have experience tracking threat actors across surface, deep, and dark web environments Can derive insights from large datasets to make key decisions and recommendations Have experience with threat actor profiling and utilizing threat intelligence frameworks Have strong project management skills and ability to build processes from the ground up Possess excellent communication skills to collaborate with cross-functional teams and present to leadership Strong candidates may also have Experience at a major technology platform working on trust and safety, fraud, or abuse investigations Background in AI safety, machine learning security, or technology abuse investigation Experience building and scaling threat detection systems or abuse monitoring programs Experience with financial crime investigation or fraud analytics Fluency in Mandarin Chinese and/or Russian (speaking, reading, and writing) combined with a nuanced understanding of the geopolitical landscape and cultural context of the respective regions. Active Top Secret security clearance Deadline to apply None. Applications will be reviewed on a rolling basis. The annual compensation range for this role is listed below. For sales roles, the range provided is the role's On Target Earnings ("OTE") range, meaning that the range includes both the sales commissions/sales bonuses target and annual base salary for the role. Annual Salary:$230,000-$290,000 USDLogistics Education requirements: We require at least a Bachelor's degree in a related field or equivalent experience. Location-based hybrid policy: Currently, we expect all staff to be in one of our offices at least 25% of the time. However, some roles may require more time in our offices. Visa sponsorship: We do sponsor visas! However, we aren't able to successfully sponsor visas for every role and every candidate. But if we make you an offer, we will make every reasonable effort to get you a visa, and we retain an immigration lawyer to help with this. We encourage you to apply even if you do not believe you meet every single qualification. Not all strong candidates will meet every single qualification as listed. Research shows that people who identify as being from underrepresented groups are more prone to experiencing imposter syndrome and doubting the strength of their candidacy, so we urge you not to exclude yourself prematurely and to submit an application if you're interested in this work. We think AI systems like the ones we're building have enormous social and ethical implications. We think this makes representation even more important, and we strive to include a range of diverse perspectives on our team. Your safety matters to us. To protect yourself from potential scams, remember that Anthropic recruiters only contact you ******************* email addresses. In some cases, we may partner with vetted recruiting agencies who will identify themselves as working on behalf of Anthropic. Be cautious of emails from other domains. Legitimate Anthropic recruiters will never ask for money, fees, or banking information before your first day. If you're ever unsure about a communication, don't click any links-visit anthropic.com/careers directly for confirmed position openings. How we're different We believe that the highest-impact AI research will be big science. At Anthropic we work as a single cohesive team on just a few large-scale research efforts. And we value impact - advancing our long-term goals of steerable, trustworthy AI - rather than work on smaller and more specific puzzles. We view AI research as an empirical science, which has as much in common with physics and biology as with traditional efforts in computer science. We're an extremely collaborative group, and we host frequent research discussions to ensure that we are pursuing the highest-impact work at any given time. As such, we greatly value communication skills. The easiest way to understand our research directions is to read our recent research. This research continues many of the directions our team worked on prior to Anthropic, including: GPT-3, Circuit-Based Interpretability, Multimodal Neurons, Scaling Laws, AI & Compute, Concrete Problems in AI Safety, and Learning from Human Preferences. Come work with us! Anthropic is a public benefit corporation headquartered in San Francisco. We offer competitive compensation and benefits, optional equity donation matching, generous vacation and parental leave, flexible working hours, and a lovely office space in which to collaborate with colleagues. Guidance on Candidates' AI Usage: Learn about our policy for using AI in our application process

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. Some travel to Massachusetts each quarter. 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: $72,200.00 - $115,500.00 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.

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

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.

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values - honesty, integrity, loyalty and service - define how we treat each other and our members. Be part of what truly makes us special and impactful. The Opportunity As a dedicated Corporate Investigator Senior, you will under minimal supervision, conducts complex investigations regarding corporate policy violations, workplace violence, fraud, collusion, and other criminal matters within or against USAA. Builds relationships with peer partners and leadership to educate all levels of the enterprise about internal threats and fraud. Participates in the development and implementation of internal fraud or threat issues as an innovative team resource. Reviews laws, regulations and current events for business impact. We offer a flexible work environment that requires an individual to be in the office 4 days per week. This position can be based in one of the following locations: San Antonio, TX, Phoenix, AZ, or Tampa, FL. Relocation assistance is not available for this position. What you'll do: Applies advanced knowledge of the business, its products, procedures and processes. Maintains knowledge of specific company policies, laws and regulations, and best practices in the investigative field. Serves as a resource to less experienced team members. Utilizes highly sophisticated investigative tools and techniques. Conducts complex and high priority investigations on external/internal fraud, collusion, corporate policy violations, workplace violence and other criminal matters within or against USAA. Conducts interviews and/or interrogations, gathers information and analyzes data in support of the investigative process. Contributes to completion of the work product by organizing investigative results, preserving evidence and presenting the facts to disprove or substantiate the allegation for the necessary employment decisions. As needed assists others regarding case preparation and coordinating a Incident Management Team (IMT) meeting for case briefing/presentation. Provides written and/or oral briefings of high profile cases to management and/or members of the Executive Management group. Develops and maintains relationships with law enforcement agencies and other institutions to ensure the corporation is informed of potential risks. Assists with the development of the CI HouseCall, work place violence policy, standards, guidelines and procedures to ensure ongoing effective maintenance of the USAA safe workplace program. Conducts learning sessions (CI HouseCalls) by business need regarding internal investigations, fraud, workplace violence issues, harassment, and corporate policy violations. Provides key stakeholders and partners with comprehensive case report for the disposition decision of an employee or contract employee. Performs all other tasks as assigned. Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures. What you have: Bachelor's degree; OR 4 years of related experience (in addition to the minimum years of experience required) may be substituted in lieu of degree. 6 or more years relevant experience in corporate fraud investigations, risk mitigation, Federal, State, local, or Military Law Enforcement with interviewing skills. Knowledge of the Bank Secrecy Act, USA Patriot Act, Sarbanes Oxley Act of 2002, other applicable laws and regulations, company policies and best practices in the investigative field. Excellent communication skills utilizing all available channels, with the ability to collaborate and execute among cross-functional teams, including all levels of the organization and with external law enforcement agencies. Ability to use Microsoft Office applications. Ability and willingness to travel 25% of the time. What sets you apart: Advanced Certifications and Specialized Training in relevant fields such as Certified Fraud Examiner (CFE), Certified Forensic Interviewer (CFI), Certified Threat Manager (CTM), or other specialized investigation certifications. Demonstrated ability to independently manage high-risk, high-visibility investigations, including evidence collection, interviews, and analysis. Strong understanding of investigative best practices, confidentiality, and experience partnering effectively with Legal, HR, Compliance, and external counsel. US military experience through military service or a military spouse/domestic partner [optional] Compensation range: The salary range for this position is: $93,770.00 - $168,790.00. USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.). Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors. The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job. Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals. For more details on our outstanding benefits, visit our benefits page on USAAjobs.com. Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting. USAA 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, disability, or status as a protected veteran.

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.

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

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.