Investigator remote jobs - 83 jobs

Handshake is recruiting Detectives and Criminal Investigator Professionals to contribute to an hourly, temporary AI research project-but there's no AI experience needed. In this program, you'll leverage your professional experience to evaluate what AI models produce in your field, assess content related to your field of work, and deliver clear, structured feedback that strengthens the model's understanding of your workplace tasks and language. The Handshake AI opportunity runs year-round, with project opportunities opening periodically across different areas of expertise. Details The position is remote and asynchronous; work independently from wherever you are. The hours are flexible, with no minimum commitment, but most average 5-20 hrs The work includes developing prompts for AI models that reflect your field, and then evaluating responses. You'll learn new skills and contribute to how AI is used in your field Your placement into a project will be dependent on project availability-if you apply now and can't work on this project, more will be available soon. Qualifications You have at least 4 years of professional experience in one or more of the following types of work. The examples below reflect the types of real-world responsibilities that you might have had in your role that will give you the context needed to evaluate and train high-quality AI models Conduct thorough investigations by collecting and analyzing evidence, interviewing witnesses and suspects, and documenting findings in detailed reports. Secure crime scenes, collaborate with other agencies, and prepare for court proceedings. Engage in surveillance and undercover operations, utilizing specialized equipment and techniques to gather critical information. You're able to participate in asynchronous work in partnership with leading AI labs. Application Process Create a Handshake account Upload your resume and verify your identity Get matched and onboarded into relevant projects Start working and earning Work authorization information F-1 students who are eligible for CPT or OPT may be eligible for projects on Handshake AI. Work with your Designated School Official to determine your eligibility. If your school requires a CPT course, Handshake AI may not meet your school's requirements. STEM OPT is not supported. For more information on what types of work authorizations are supported on Handshake AI.

Job DescriptionBenefits: 401(k) Dental insurance Health insurance Paid time off Vision insurance KENTECH Consulting Inc. is an award-winning background technology and investigations company. We are the creators of innovative platforms such as eKnowID.com, the first consumer background checking system of its kind, and ClarityIQ, a high-tech, high-touch investigative case management system. Our Mission We help the world make clear and informed hiring decisions. Our Values To achieve our mission, our team is guided by the following core values: Customer Focused: We are results-driven and committed to delivering quality outcomes for our clients. Growth Minded: We value continuous learning, collaboration, and industry best practices. Fact Finders: We are passionate about discovery, accuracy, and truth. Community and Employee Partnerships: We believe meaningful impact comes from supporting what our communities and employees care about. The Impact As a small, agile organization, every role at KENTECH directly contributes to our success. This position offers the opportunity to make a measurable impact on public safety, hiring integrity, and the future of background investigations. Position Overview KENTECH Consulting Inc. is seeking a detail-oriented Background Investigator to conduct impartial, fact-based pre-employment investigations for municipal government and law enforcement clients. This is a full-time, W-2 remote position ideal for professionals with strong investigative, research, and writing skills. As a remote investigator, you will analyze applications, conduct interviews, research public records, and produce clear, defensible investigative reports while maintaining the highest standards of confidentiality and accuracy. Key Responsibilities Conduct pre-employment background investigations for law enforcement and government candidates. Review and analyze applications, employment history, criminal records, and public records. Conduct thorough interviews via phone or virtual platforms. Complete criminal history and civil record verifications using public sources. Identify inconsistencies, gaps, or red flags and determine appropriate follow-up actions. Prepare detailed, well-organized investigative reports. Communicate professionally and timely with internal teams and external agency stakeholders. Manage multiple cases simultaneously while meeting required deadlines. Qualifications and Experience Bachelors degree in Journalism, Criminal Justice, Political Science, Pre-Law, Paralegal Studies, or a related field. Five or more years of investigative, journalistic, or related professional experience. Strong interviewing skills, including remote interviews. Excellent analytical thinking and professional writing abilities. Demonstrated ability to handle sensitive and confidential information with discretion. Proficiency in Google Docs, spreadsheets, and investigative or case management tools. Ability to obtain and maintain a Security Clearance, including a Permanent Employee Registration Card (PERC), if required. Ability to obtain and maintain FCRA Certification Ability to meet productivity expectations and manage a consistent investigative workload. Key Soft Skills Strong attention to detail with a focus on accuracy and clarity. High ethical standards and commitment to unbiased investigations. Clear, professional communication skills. Strong investigative mindset with sound judgment. Effective time management and organizational skills. Compensation and Benefits Annual Salary: $45,000 Employment Type: Full-Time, W-2 Benefits Include: Health Insurance Dental Insurance Vision Insurance 401(k) Retirement Plan Apply Now If you are a dedicated investigator who values accuracy, integrity, and meaningful work, we encourage you to apply. KENTECH Consulting Inc. is an equal opportunity employer. We celebrate diversity and are committed to fostering an inclusive and respectful workplace. This is a remote position.

The Clinical Investigator monitors service delivery for program integrity through fraud and abuse investigations and audits, including review of claims data, clinical records and reference materials, investigative interviewing, provider education and technical assistance, and monitoring implementation of provider corrective actions. The Investigator reports overpayments and other irregularities and confers with Special Investigations Unit, Senior Management, Chief Compliance Officer and General Counsel as needed. This position will allow the successful candidate to work primarily remote schedule. The candidate must be a resident of North Carolina or reside within 40 miles radius of North Carolina's border. There is no expectation of being in the office routinely, however, the selected candidate will be required to travel to provider sites to conduct audits/investigations in Charlotte, North Carolina up to 3 times per month. Responsibilities & Duties Conduct Audit/Investigations and prepare reports Review allegation(s), conduct preliminary investigation and make disposition recommendations using independent judgment Develop audit/investigation plans and tools based upon alleged non-compliance and data analytics Request and/or collect medical records, personnel records, policies/procedures, compliance plans, and other documents from providers based on audit/investigation plans Systematically and accurately collect, document, and store evidence Conduct post-payment audits of Medicaid and State funded providers to ensure that services are rendered in accordance with established state and federal rules, regulations, policies, and terms of provider contractual agreements with the state Identify inappropriate billing and overpayments Utilize clinical knowledge and experience to determine if documented services were clinically appropriate and/or medically necessary Conduct interviews with provider employees, former employees, recipients of services, and other witnesses Document allegations, investigative activities, and findings in a detailed audit/investigation report Work with the Special Investigations Supervisor and Investigative Team to support investigative activities Assure that individuals served do not pay for health services inappropriately Track allegations of fraud, waste, and abuse in a case management system from referral to final disposition Consult with the Corporate Compliance Unit when potential internal compliance issues are identified Consult on cases Provide clinical guidance to non-clinical staff on documentation obtained from providers Provide guidance to non-clinical staff on Medicaid Clinical Coverage Policies and State Service Definitions and by participating in ad hoc meetings related to clinical regulatory matters Participate in ad hoc meetings related to clinical matters Conduct Regulatory Review/ Research Diligently research clinical policies, administrative code, federal/state laws in order to assess for non-compliance Analyze data Analyze data from a variety of sources, including but not limited to claims, authorizations, credentialing/enrollment, grievances, prior audits/investigations, incarceration records, incident reports, policies/procedures, to inform decision making Utilize various MicroStrategy reports data during the investigation process Analyze claims data to determine if an allegation is supported Analyze claims data during investigations to determine if there are indicators of fraud/abuse other than the allegation received Identify other data sources to review during investigations based on the allegation(s) Provide Case reports/presentations to internal and external stakeholders Present audit/investigation findings and make disposition recommendations using independent judgment to the Chief Compliance and Risk Officer, Senior Director of Program Integrity, Special Investigations Supervisor, and Alliance Compliance Committee Present case status updates in individual supervision sessions, unit team meetings, Division meetings (as designated by supervisor), and to NC Department of Justice (as requested) Conduct and participate in Investigation Planning meetings with the Investigation Team Interpret and convey highly technical information to others Provide Technical Assistance/Education Educate providers on the errors identified in the audit and investigation process Recognize when providers can improve through technical assistance (TA) rather than full investigation when FWA is not evident and/or pervasive Recognize quality of care issues in order to make recommendations to appropriate entities/authorities Monitor Provider Action and Follow-Up Document Improper Payment Charts, Statements of Deficiency, provides feedback and technical assistance to providers as needed/requested, and follows up on provider corrective action through the probation process, as applicable Prepare for and participate in provider appeal process and/or court hearings to explain and defend audit/investigation findings Recommend policy, procedure, or process changes Recommends revisions to Alliance Health procedures and policies Minimum Requirements Education & Experience Graduation from an accredited school of Nursing with a Registered Nurse (RN) license and five (5) years relevant post-graduate experience. OR Master's degree in human services/social sciences, health care compliance, analytics, government/public administration, auditing, security management, criminal justice, or pre-law and Five (5) years relevant post-graduate experience. Special Requirement- Current, unencumbered clinical license as an LCSW, LCMHC, LMFT, LCAS, LPA or RN Preferred Health care industry and/or Medicare/Medicaid/Behavioral Health experience and knowledge SIU and/or regulatory compliance work experience National Certified Investigator and Inspector Training (NCIT) Basic and Specialized Knowledge, Skills, & Abilities Knowledge of Health care industry and/or Medicare/Medicaid/Behavioral Health Knowledge of the state and federal Medicaid laws, state and federal criminal and civil fraud laws, regulations, policies, rules, guidelines, service limitations, and various Medicaid programs Knowledge and proficiency in claims adjudication standards & procedures Knowledge of investigative methods and procedures High degree of integrity and confidentiality required handling information that is considered personal and confidential Skill in using Microsoft Office products (such as Word, Excel, Outlook, etc.) Analytical skills and ability to make deductions; logical and sequential thinker Strong verbal and written communication skills. Ability to write clear, accurate and concise rationale in support of findings Ability to manage time, prioritize work, and use problem-solving approaches Ability to interpret contractual agreements, business-oriented statistics medical/administrative services and records Ability to identify resources, gather evidence, analyze raw data and generate reports A general understanding of all major managed care functions in particular as it relates to prior authorization, utilization reviews, grievance management, provider credentialing and monitoring Knowledge of the Alliance Health service benefit plans and network providers Employment for this position is contingent upon a satisfactory background and MVR (Motor Vehicle Registration) check, which will be performed after acceptance of an offer of employment and prior to the employee's start date. Salary Range $77,868 - $99,282/Annually Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity An excellent fringe benefit package accompanies the salary, which includes: Medical, Dental, Vision, Life, Long Term Disability Generous retirement savings plan Flexible work schedules including hybrid/remote options Paid time off including vacation, sick leave, holiday, management leave Dress flexibility

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.

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: ********************************

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.

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

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.

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

BMV Investigator (2600009D) Organization: Public SafetyAgency Contact Name and Information: Jennifer Pletcher, HCM Sr. Analyst - ********************** Unposting Date: Jan 22, 2026, 4:59:00 AMWork Location: BMV Toledo Inv. Office 1 Maritime Plaza Toledo 43604Primary Location: United States of America-OHIO-Lucas County-Toledo Compensation: $27.92 per hour Schedule: Full-time Work Hours: 8:00 a.m. - 5:00 p.m.Classified Indicator: ClassifiedUnion: OCSEA Primary Job Skill: InvestigationTechnical Skills: Criminology/Criminal JusticeProfessional Skills: Attention to Detail Agency OverviewBureau of Motor VehiclesOversees driver and motor vehicle licensing and registration and continues to make services more convenient, efficient and cost-effective.Job DescriptionOhio Department of Public Safety - Bureau of Motor Vehicles/Investigations District 4 ToledoReport in Location: 1 Maritime Plaza, Toledo, OH 43604Work Hours: Monday - Friday, 8:00 a.m. - 5:00 p.m.Perks of Working for the Ohio Department of Public Safety• Multiple pay increases over the first years of service!• Free Parking!What You'll Do as a BMV Investigator• Independently, or as a lead investigator, conduct criminal investigations related to allegations of fraud, abuse or other violations of ORC, OAC & BMV policy, file criminal charges & enforce Ohio motor vehicle laws & agency guidelines:• Investigate criminal acts (e.g., odometer tampering, forgeries & falsifications, possession of criminal tools, selling motor vehicles without a license, illegally obtained driver licenses, license plates, vehicle registrations & handicap parking permits);• Enforce Ohio motor vehicle laws & agency guidelines;• Locate & contact individuals whose driving &/or registration privileges have been suspended, confiscate driver licenses &/or license plates, interview individuals;• Perform investigations concerning hardship driver license &/or medical restriction cases & submit recommendations;• Participate with law enforcement & other government agencies in investigations & criminal prosecution of violators of motor vehicle laws (e.g., consult with prosecutors, file charges, present investigative case reports as a witness before the Dealer Board & testify in court).Click here to see the full position description 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.QualificationsOption 124 mos. exp. as law enforcement officer; AND valid driver's license.Option 2-Or completion of associate core program in criminology, criminal justice or law enforcement; AND 18 months experience in conducting criminal investigations. (Note: conducting criminal investigations is defined as performing field interviews & interrogation, field surveillance, field information& evidence gathering techniques while conducting investigations involving violations of criminal law(i.e., special emphasis on theft& fraud cases) as well as researching various administrative laws, policies & procedures related to commission of possible criminal offenses); AND valid driver's license.Option 3-Or 24 months experience as a Motor Vehicle Investigator Associate, 24320; AND valid driver's license.-Or equivalent of Minimum Class Qualifications For Employment noted above. Note: Pursuant to Ohio Administrative Code Chapter 4501 users of system shall adhere to policies& guidelines published in NCIC operating manual, CJIS security policy, LEADS operating manual, LEADS security policy, newsletters, & administrative messages from LEADS, all of which are either available on ODPS/LEADS intranet or disseminated to LEADS agencies; pursuant to LEADS, state& national fingerprint-based record checks must be conducted within 30 days of initial employment or assignment of all personnel, having access to LEADS, or to records storage areas containing CCH data; minimum check must include submission of both a State of Ohio BCI& I card & an FBI applicant fingerprint card; both completed applicant fingerprint cards must be submitted by employing agency to State of Ohio Bureau of Criminal Identification & Investigation for processing & forwarding to Federal Bureau of Investigation; record of this check must be kept by employing agency & made available to LEADS upon request; fingerprint card returned by Ohio BCI&I is sufficient documentation. Pursuant to Ohio Administrative Code Chapter 4501 terminal agency shall conduct a complete background investigation of all terminal operators including, but not limited to: an applicant fingerprint card submission to BCI &I & FBI, an inquiry of state& national arrest& fugitive files; terminal agency is required to notify CTO of any applicant's criminal record; existence of a criminal record may result in denial of access. Helpful Tips for Applying:1. Be detailed when describing your current/previous work duties. The more the better!! Don't just write "see attached resume".2. Tailor your application for each position you apply for. You should clearly describe how you meet the minimum qualifications outlined in this job posting.3. Respond to all questions asked. If you do not have the education/training/experience that is being asked, select either "No" or "N/A".Job Skills: InvestigationSupplemental InformationTRAINING AND DEVELOPMENT REQUIRED TO REMAIN IN THE CLASSIFICATION AFTER EMPLOYMENTMust successfully obtain LEADS certification 6 months after employment. Must re-certify in LEADS every two years as mandated by Ohio Administrative Code 4501:2-10-03 (G) (3).UNUSUAL WORKING CONDITIONSRequires travel; may be exposed to angry, hostile, or violent persons; exposed to inclement weather and elements; may work in remote rural or metro areas; may work in high-crime, hazardous &/or unsanitary environments. May conduct surveillance for extended periods of time in extreme temperatures.This position will primarily serve an area that may include (but not limited to) counties such as (Actual county assignments may vary based on coverage needs): Allen, Auglaize, Champaign, Logan, Hancock, and Hardin.This position is essential, meaning the duties this job performs are critical to the continued operations of the Ohio Department of Public Safety during a public safety emergency (OAC 123: 1-46-01 & DAS Directive HR-D-11). This position will be required to report for duty during any public safety emergency. Background Check Information• A BCI/FBI fingerprint check, and background check, may be required on all selected applicants.• A comparative analysis and/or drug-test may be a requirement of the hiring process.To request a disability accommodation, please email ************************* as soon as possible, or at least 48 hours prior to the above referenced testing or interview date so any necessary arrangements may be made in a timely manner. 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.

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.

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

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

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

Job DescriptionBenefits: Competitive salary Flexible schedule Opportunity for advancement Paid time off Field InvestigatorInsurance Fraud Investigator (Auto, Fire, Theft, Workers Comp Field/Desk) Bilingual in Spanish Required (Hybrid Field & Remote) Part-Time (Potential for Full-Time) About the Role Covert Special Investigations is expanding, and were actively seeking skilled and driven investigators to join our team. This is an exciting opportunity for individuals with a background in insurance claims investigations, particularly those involving auto losses, workers compensation, and AOE/COE matters. This is not a surveillance position. We're looking for part-time investigators who may transition into full-time roles based on performance. Whether youre an experienced SIU professional or looking to enter the field of insurance fraud investigations, this role is for you. What You'll Do Investigate complex auto claims: theft, fire, vandalism, staged accidents, jump-ins, and questionable losses Handle workers compensation investigations, including AOE/COE determinations and scene or site inspections Conduct root cause analysis and develop investigative strategies for each unique claim Collect and analyze evidence including police reports, witness interviews, court filings, and surveillance data Write clear, comprehensive, and timely investigative reports Maintain frequent communication with clients and internal teams Follow new leads as they develop and adjust case strategy accordingly Travel as needed, primarily within the specified Metro area and surrounding area What Were Looking For 12+ years in claims, investigations, or SIU (required) Workers Compensation, AOE/COE, or root cause analysis experience (preferred) Bilingual in Spanish (REQUIRED) Background in Auto Physical Damage, Fire & Theft, or Field Investigations (a plus) Strong interpersonal skills and professional communication (written and verbal) Self-motivated and capable of independent time management Team player with a problem-solving mindset Comfortable working under deadlines in a fast-paced environment Tech proficient: able to use laptops, smartphones, apps, and digital documentation tools Associates degree or equivalent experience Requirements Valid Texas Drivers License Reliable, insured personal vehicle Pass criminal background check and qualify for TX DPS Private Investigator Registration Access to investigative tools (e.g., camera, laptop, voice recorder) is helpful but not required Attention to Detail Is a Must Being detail-oriented is one of the most critical traits in an investigator. To evaluate your attention to detail, please visit our websites homepage at ****************** scroll halfway down, and click on the eye watermark. Follow the instructions provided there. Candidates who skip this step will not be considered. Why Join Us? Flexible schedule, mix of remote and fieldwork High-exposure, high-impact investigative assignments Clear path to full-time employment for the right candidate Learn from experienced fraud investigators Supportive and professional team culture Apply Today If you're passionate about uncovering the truth and protecting against fraud, we invite you to apply and join the growing team at Covert Special Investigations. This is a remote position.

PRODIGY INVESTIGATIONS OFFERS TOP PAY FOR SUPERIOR RESULTS! We are seeking experienced Background Investigator candidates throughout the country. This is a remote position. Over the past 43 years, Prodigy Investigations has saved employers and insurance carriers 100's of Millions of Dollars. More than 50,000 employers have trusted Prodigy Investigations to solve big problems fast, close claims quicker, and save more money. Prodigy Investigations is the best choice to refute fraudulent claims. Job duties include, but are not limited to: setup new surveillance cases in database, conduct pre-surveillance research, research locations, backgrounds, and social media profiles, assistance with claims investigations, locates, online investigations, court research, and report writing. This is a fun, dynamic, and exciting career! Every day is unpredictable. Job Duties include: Internet research Social media investigations Locates Vehicle identification Asset Investigations Pre Surveillance Planning Develop address histories New surveillance investigations intake Data entry Driving records License plate searches Pre-employment background checks Court research & public records requests Freedom of Information Act requests Report writing Open Source Intelligence (OSINT)

Background Investigator - Independent Contractor/1099 Federal Background Investigations Division 1FORCE is currently seeking to engage with experienced Contractors and federally credentialed Background Investigators to conduct personnel security background investigations in a contractor capacity in support of our client's contracts with the federal government. We have work nationwide and if you currently hold credentials on a federal personnel security background investigations contract (or have held government credentials in the last 2 years), we want to partner to provide immediate, weekly work opportunities. DUTIES & RESPONSIBILITIES: Complete record searches. Conduct face-to-face interviews to elicit information about applicants seeking federal positions, contract positions or positions within the military. Obtain factual information from a variety of personal and record sources to produce a report of investigation, containing all pertinent facts, of an individual's background and character, in accordance with agency guidelines and instructions. Investigators work from home, set their own schedules, and work independently. Self-motivated, highly independent, and prepared to work non-traditional hours (i.e., evenings and weekends). POSITION REQUIREMENTS: Federally credentialed and experienced investigators will have met the background investigations national training standards and have 12 months or more of consecutive experience performing executive branch investigations. Superior organizational and time management skills. Excellent communication skills in both oral and written formats. Strong computer and typing skills for composing narrative reports of investigation in FWS and utilizing PIPS or other federally supported case management/reporting system. Sufficient E&O liability, car insurance and personal insurance. **All candidates must be a US Citizen and be able to obtain a TOP SECRET level security clearance.

Investigator External Audit Special Investigations Unit \*Remote* The SIU Audit Investigator supports the compliance related activities of the Special Investigations Unit (SIU) at the Health Plan. This role assists the External Audit Senior Manager with developing, implementing and performing compliance related auditing and monitoring activities at the Health Plan. This includes the identification, investigation and correction of fraudulent and/or abusive billing and coding practices; coordination of recovery of overpayments related to fraudulent and/or abusive billing and coding practices; and providing education related to coding, medical record documentation requirements, healthcare compliance and fraud, waste and abuse to Health Plan staff, vendors and contracted providers/facilities. Providence Health Plan caregivers are not simply valued - they're invaluable. Join our team at Providence Health Plan Partners and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. _Providence Health Plan welcomes 100% remote work for applicants who reside in the following states:_ + Washington + Oregon + California Required Qualifications: + Bachelor's Degree Or equivalent combination of education and experience. + 5 years Coding experience with a healthcare provider, facility or health insurance company. + 2 years Fraud and Abuse audit experience in a health insurance company, healthcare provider, facility or other relevant healthcare environment. + Project management experience, education program development experience and group presentation experience. + Experience in use of data mining software/tools. Preferred Qualifications: + Current certification as an Accredited Healthcare Fraud Investigator (AHFI) upon hire. + Certification as an Internal Auditor or Healthcare Compliance certification upon hire. + Clinical background. Salary Range by Location: California: Humboldt: Min: $29.62, Max: $45.31 California: All Northern California - Except Humboldt: Min: $33.23, Max: $50.84 California: All Southern California - Except Bakersfield: Min: $29.62, Max: $45.31 California: Bakersfield: Min: $28.41 Max: $43.47 Oregon: Non-Portland Service Area: Min: $26.49, Max: $40.52 Oregon: Portland Service Area: Min: $28.41 Max: $43.47 Washington: Western - Except Tukwila: Min: $29.62, Max: $45.31 Washington: Southwest - Olympia, Centralia & Below: Min: $28.41 Max: $43.47 Washington: Tukwila: Min: $29.62, Max: $45.31 Washington: Eastern: Min: $25.28, Max: $38.68 Washington: South Eastern: Min: $26.49, Max: $40.52 Why Join Providence Health Plan? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons. About Providence At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. Requsition ID: 405395 Company: Providence Jobs Job Category: Internal Audit Job Function: Finance Job Schedule: Full time Job Shift: Multiple shifts available Career Track: Business Professional Department: 5018 COMPLI PAYMENT INTEGRITY OR REGION Address: CA Oakland 540 23rd St Work Location: Providence House Oakland-Oakland Workplace Type: Remote Pay Range: $See Posting - $See Posting The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.