Senior investigator work from home jobs - 34 jobs

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

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

The Special Investigation Unit (SIU) is a motivated, collaborative team sitting at the intersection of Compliance, Payment Integrity, and Data Infrastructure. The SIU ensures that Clover monitors, identifies and investigates instances of healthcare fraud, waste and abuse (FWA). Come join us as we discover new opportunities to enhance the fight against FWA! As the Senior Investigator, you will play a critical role ensuring that Clover is able to continue to build and scale a compliant, effective FWA audit program. You will work to ensure quality assurance standards and regulatory policy are reflected in our audit practices. You will be joining a fast-growing and fast-moving startup at the intersection of healthcare and technology, where you will have the opportunity to develop both your policy and operational skills. A successful Senior Investigator will have a robust FWA knowledge base and be able to develop, document and execute an effective and efficient FWA audit strategy to identify, audit, track, and report on known or suspected instances of FWA. As a Senior Investigator, you will: Lead development and execution of SIU process improvements to improve the effectiveness and efficiency of our SIU audit processes Identify control opportunities to mitigate FWA Identify possible audit opportunities Implement an effective audit strategy to investigate known or suspected instances of FWA Support annual FWA audit goals Support complex provider conversations around FWA audit findings Prepare response letters to deliver decisions to providers within the regulatory timeframes set forth by the Centers for Medicare & Medicaid Services (CMS). Manage overall audit workload to ensure timely and accurate audit results Act as a FWA subject matter expert Mentor other team members on audit strategies Build strong working relationships with both regulatory and law enforcement agencies, and Communicate effectively while building trust and lasting partnerships both laterally and vertically across multi-discipline teams. Success in this role looks like: By the end of your initial 90 day period, you will have demonstrated a strong understanding of our SIU case flow and are able to effectively navigate through the various Clover systems. By 6 months, you will be working autonomously on cases and provider reviews. Continued success in this position anchors in on developing a deep understanding of the workflows that support our SIU cases and reviews while maintaining regulatory compliance standards. You should get in touch if: You have 5+ years of experience in the healthcare FWA space. You have experience identifying operations and process improvement efforts. You have an understanding of compliance & payer requirements including Medicare regulations. You have knowledge on fraud statutes and regulations You have a Fraud Investigation Certification (CFE, AHFI, etc.) - preferred but not required. Benefits Overview: Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions. Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare. Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location. Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews. Additional Perks: Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities Reimbursement for office setup expenses Monthly cell phone & internet stipend Remote-first culture, enabling collaboration with global teams Paid parental leave for all new parents And much more! About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most. We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare. From Clover's inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences, perspectives, opinions, and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one's identity. All of our employee's points of view are key to our success, and inclusion is everyone's responsibility. #LI-REMOTE Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company. A reasonable estimate of the base salary range for this role is $104,000 to $127,000. Final pay is based on several factors including but not limited to internal equity, market data, and the applicant's education, work experience, certifications, etc. #LI-Remote

Looking for a company that treats associates with respect, understanding, and appreciation? Looking for a company that is passionate about teamwork and the growth of it's associates and communities? That's WEIS! 1002 Weis Remote Road Job Description: ESSENTIAL DUTIES AND RESPONSIBILITIES The associate is responsible for the functions below, in addition to other duties as assigned: Investigate and resolve external theft (Shoplifting, Organized Retail Crime, etc.). Gathers, analyzes, and evaluates intelligence on individuals and groups involved in organizational retail crime. Thoroughly documents information gathered to aid in successful prosecution. Provides guidance to store Asset Protection teams on investigative plans. Operate the store CCTV system. Conduct undercover surveillances. Act as a liaison between Weis Markets and local, state, and federal law enforcement agencies. Refers cases to law enforcement for prosecution. Professionally represent Weis Markets in court hearings and mediations. Effectively manage time and scheduling to best suit the company's needs including evenings, weekends, and occasional overnights. Travel to multiple locations within an assigned area and provide investigative support. Partners with Store Management and associates to best protect the company assets. Supports stores in cases of significant business disruptions (robbery, protests, natural disasters, etc.). SUPERVISORY RESPONSIBILITIES This position does not directly supervise associates. QUALIFICATION REQUIREMENTS To perform this job successfully, the associate must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required: Bachelor's degree (BA/BS) Criminal Justice, Criminology, Business, or related field preferred, plus one (1) year retail loss prevention experience in a retail store environment. RATE OF PAY AND BENEFITS The hourly pay for this position starts at $16.00/hr. and is up to $24.00/hr. Non-Exempt Assistant Department Manager, or Full-time associate Weis Markets offers a competitive salary and comprehensive benefits package such as health plan, dental, vision, flexible spending accounts, short term disability, basic life and AD&D, group whole life with long term care rider, and voluntary insurance such as hospital indemnity, accident and critical illness, 401(k) retirement savings plans, scholarship program and associate discount programs, auto and home insurance, employee assistance program, pet insurance, purchasing power, ID theft protection, legal services, paid time off, sick pay provided the eligibility and criteria specific to the position is met. Weis Markets is an Equal Opportunity Employer: Weis Markets is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of actual or perceived age, sex, sexual orientation, race, color, creed, religion, familial status, ethnicity, national origin, citizenship, disability, marital status, military or veteran status, or any other legally recognized protected basis under federal, state or local laws, regulations or ordinances. Applicants with a disability may be entitled to a reasonable accommodation under terms of the Americans with Disabilities Act and certain state or local laws. A reasonable accommodation is a change in the ways things are normally done which will ensure an equal employment opportunity without imposing undue hardship on Weis Markets.

SIU Investigator - CF08BE We're determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals - and to help others accomplish theirs, too. Join our team as we help shape the future. We are seeking a talented Special Investigator to join our Special Investigations Unit (SIU). This position will be based out of the Richmond, VA area. The coverage territory will be all of VA and Northern North Carolina. The ideal candidate for this opportunity will spend 100% of their time traveling within their assigned region to visit loss sites, interview witnesses, conduct recorded statements, take photos, and inspect physical evidence. Additionally, the candidate will investigate all lines of business to include Medical Investigations in Auto, Worker's Compensation, General Liability and Group Benefits as well as Property losses. SIU Investigators work in partnership with claim handlers across all lines of business to investigate suspicious claims. The Field Investigators performing investigations to provide information to the claims handler which will assist in the adjudication of the claim. The mission of the SIU is to contribute to claims accuracy by building fraud awareness and investigating questionable claims. This position will report to the SIU Manager and will be responsible for conducting thorough, timely, efficient and impartial investigations to support the accurate resolution of insurance claims by the Company. Key responsibilities of the role include: - This SIU Investigator will be responsible for assignments in Virginia and the Northern North Carolina areas. - Assignments may include investigations directly referred by the claim staff, or losses reviewed by the field investigator proactively which may be appropriate for SIU Involvement. - The investigator is expected to have face to face interaction with parties to a loss, including insured, claimants, witnesses, experts, and other professionals on a routine basis. - Excellent interpersonal, communication and interview skills are required.- Investigative assignments may include claims with identified suspicious loss indictors, definable inconsistencies, or those which otherwise require a high-level investigative skill and/or local in person presence. - Effective time management skills, proactive execution of investigative plans, and flexibility are necessary to ensure the effectiveness of this position. - The investigator must understand and exhibit appropriate investigative behaviors and methods while conducting investigations, including development of the facts, due diligence around evidence collection and interviews.- The Investigator must be able to effectively communicate investigative findings orally and in writing. - The Investigator will also be responsible for understanding fraud trends within his or her area of responsibility and leverage knowledge gained to SIU analytical resources. - Independently complete investigations in accordance with The Hartford's core performance values and best practices with minimal direction.- Prepare and submit investigative reports detailing and documenting all phases of an investigation to assist in the resolution of the claim.- Recognize intelligence opportunities through active investigations and shares this information within SIU.- Interface with the SIU Community and Law Enforcement; including attendance of NICB and other industry meetings.- Continually enhance investigative skills and understanding of emerging issues impacting property and casualty and group benefit claims.- Provide support to claims partners and other departments within the - Company, which may include identifying training needs; participation in developing and presenting training and mentoring of external business partners and internal staff. QUALIFICATIONS:- Bachelor's Degree preferred.- Minimum of 3 years special investigation insurance experience and/or investigative law enforcement experience required.- Reside roughly within 30 miles of Richmond, VA to cover Virginia and Northern North Carolina.- Solid understanding of SIU or relevant claim processes, practices, and applicable laws and regulations strongly preferred.- Designations in CIFI, FCLS or FCLA are strongly preferred.- Strong interviewing and communication skills (verbal and written).- The ability to work well independently and in a team environment.- Consistent high level of performance and achievement over career span. - Strong critical thinking and analytical skills; ability to make deductions; logical and sequential thinker.- Excellent written and verbal communication and diplomacy skills, inspiring confidence among main customers.- The ability to work well independently and in a team environment.- Consistent high level of performance and achievement over career span. WHAT ELSE CAN YOU TELL ME?- The SIU Investigator is a remote position and will require 100% travel within the assigned territory. The Special Investigator for this opportunity will be based out of the Richmond , VA area. - A cell phone and a wireless laptop is provided for this opportunity. A company car will be provided, and a valid driver's license is required. Compensation The listed annualized base pay range is primarily based on analysis of similar positions in the external market. Actual base pay could vary and may be above or below the listed range based on factors including but not limited to performance, proficiency and demonstration of competencies required for the role. The base pay is just one component of The Hartford's total compensation package for employees. Other rewards may include short-term or annual bonuses, long-term incentives, and on-the-spot recognition. The annualized base pay range for this role is: $87,200 - $130,800 Equal Opportunity Employer/Sex/Race/Color/Veterans/Disability/Sexual Orientation/Gender Identity or Expression/Religion/Age About Us (************************************* | Our Culture (******************************************************* | What It's Like to Work Here (************************************************** | Perks & Benefits (********************************************* Every day, a day to do right. Showing up for people isn't just what we do. It's who we are - and have been for more than 200 years. We're devoted to finding innovative ways to serve our customers, communities and employees-continually asking ourselves what more we can do. Is our policy language as simple and inclusive as it can be? Can we better help businesses navigate our ever-changing world? What else can we do to destigmatize mental health in the workplace? Can we make our communities more equitable? That we can rise to the challenge of these questions is due in no small part to our company values that our employees have shaped and defined. And while how we contribute looks different for each of us, it's these values that drive all of us to do more and to do better every day. About Us (************************************* Our Culture What It's Like to Work Here (************************************************** Perks & Benefits Legal Notice (***************************************** Accessibility Statement Producer Compensation (************************************************** EEO Privacy Policy (************************************************** California Privacy Policy Your California Privacy Choices (****************************************************** International Privacy Policy Canadian Privacy Policy (**************************************************** Unincorporated Areas of LA County, CA (Applicant Information) MA Applicant Notice (******************************************** Hartford India Prospective Personnel Privacy Notice

Treliant is a global consulting firm serving banks, mortgage originators and servicers, FinTechs, and other companies providing financial services. We are led by practitioners from the industry and the regulatory community who bring deep domain knowledge to help our clients drive business change and address the most pressing compliance, regulatory, and operational challenges. We provide data-driven, technology-enabled advisory and consulting, implementation, staffing and managed services solutions to the regulatory compliance, risk, financial crimes, and capital markets functions of our clients. Founded in 2005, Treliant is headquartered in Washington, DC, with offices across the United States, London, Belfast, and Łódź, Poland. For more information visit ***************** Treliant is committed to fostering a diverse, equitable and inclusive environment that values and embraces all races, religions, ages, abilities, gender, sexual orientations, ethnicities, languages, nationalities, political parties, socioeconomic groups and other characteristics that inform an individual worldwide view and experiences and systems of beliefs (“the principles”). We believe in championing every voice and ensuring everyone's full potential. We are looking for Financial Crimes Investigators with an expertise in blockchain and cryptocurrencies to join our team for remote, project-based opportunities. Responsibilities While the scope of each project may be different, your duties & responsibilities may include: Conduct thorough Blockchain Tracing investigations into potential financial crimes, including AML, fraud, and sanctions violations. Ensure clients meet regulatory and compliance standards by performing EDD/ CDD checks, KYC assessments and analyzing source of funds. Analyze cryptocurrency transactions and wallet addresses, leveraging blockchain explorers and analytics tools to track illicit activity or suspicious behavior. Draft and submit SARs to relevant authorities Identify and assess potential financial crime risks across all client portfolios, leveraging both traditional and crypto-related financial systems. Work closely with regulatory agencies, and financial institutions to ensure compliance with global anti-money laundering (AML) and counter-financing of terrorism (CFT) regulations. Investigate high-volume or high-value transactions, including cross-border transfers, to identify red flags or signs of illegal activities. Qualifications Strong education background; Bachelor's Degree preferred. 3+ years of experience in Financial Crime; either directly with a bank/financial institution or via a third party providing consulting services. Strong background in AML, CTF or Sanctions, with an understanding of the compliance and regulatory frameworks that apply. Familiarity with cryptocurrency blockchain tracing and blockchian technologies including investigating transactions on blockchain platforms and identifying risks associated with digital assets. Familiarity with blockchain forensics tools such as Chainalysis, Elliptic, or CipherTrace to trace and analyze crypto transactions. Knowledge of global regulatory frameworks for crypto - understanding of evolving cryptocurrency regulations, including FATF's Travel Rule, KYC/AML compliance for digital assets, and the legal landscape around crypto in different regions. Experience in developing risk mitigation strategies for crypto-based financial crimes, including fraud prevention and transaction monitoring in the crypto space. We are committed to being an Equal Opportunity Employer and want to build a diverse, inclusive and authentic workplace. If you are interested in working for Treliant but don't tick all the boxes, we encourage you to apply as you may be the perfect candidate for this or other roles. Benefits Primary Location: Remote Primary Location Salary Range: $50/hr - $60/hr Treliant offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefit package that reflects our commitment to creating a diverse and supportive workplace. In addition to a competitive base salary, candidate is eligible for incentive pay as well as a full range of health benefits, vacation plan, and 401k plan. If you want to be part of a dynamic team of professionals, we invite you to join the team at Treliant. We invest in people, and challenge you to advance your career while achieving your aspirations and goals. Here at Treliant, we pride ourselves on our collaborative team culture, where we embrace diversity of thought and innovation. If you strive for excellence and seek an inclusive environment apply on line treliant.com and follow us on LinkedIn. Right to Work Treliant is not in the position to provide sponsorship for this current position and so applicants must be able to work in the United States without requiring sponsorship. Please note, Treliant receives a high volume of applications for all roles. While we will endeavor to respond to all applicants, this is not always possible. Should you not receive a response to your application within 2 weeks, it is likely that you will have been unsuccessful on this occasion. However, we would like to retain your details on our systems and may contact you should another potentially suitable vacancy arise. Treliant LLC is an Equal Opportunity Employer and does not discriminate on the basis of race, color, national origin, sex, sexual orientation, genetic information, religion, age, disability, or military status in employment or provision of services. When contacted for an interview, an applicant who requires special accommodations due to a disability should notify the office so that proper arrangements can be made.

SummaryJob Description Role Summary/Purpose The Investigator will be responsible for leading investigations relating to potential violations of law or other GE Vernova Policies. These investigations may be allegations of Conflict of Interest, Reporting and Recordkeeping violations, Respectful Workplace allegations (harassment/discrimination) or other Compliance areas. The Sr. Compliance Investigator will (1) lead investigations of policy concerns raised through the open reporting system; (2) provide regular updates on investigations to business stakeholders. (3) facilitate cross-training and report-outs with the broader compliance function at GE Vernova This role will report to the Sr. Compliance Investigations Manager - International. in the GE Vernova Compliance function. Essential Responsibilities Lead complex investigations of policy concerns raised through the open reporting system Provide regular updates on the status of cases to business stakeholders. Conduct prompt, thorough and complex investigations, including conducting interviews with concern raisers, witnesses and subjects, assessing risk, reviewing documentation, and making recommendations/corrective actions in the context of an investigation; in partnership with Compliance, L&E and the HR Manager, as appropriate. Prepare high quality written reports of the investigation which provide a clear and logical account of the allegations, investigative work performed, key findings and conclusions, ensuring that the conclusion is evidence based. Provide briefings to senior leaders on investigative matters as required. Maintain client relationships in the face of conflicting demands or directions. Monitor open cases assigned to you to ensure timeline and compliant closure, using established guidelines Conduct investigations outside your immediate region as required Partner with Compliance, Ombuds and other functions to identify and understand investigations trends and corrective actions In partnership with Labor & Employment, understand and apply applicable legal and policy requirements pertaining to the conduct of investigations including in areas involving employee interviews and relevant labor and employment requirements. Qualifications/Requirements Minimum of 7 years' experience in compliance, legal, investigations, audit or Human Resources Language proficiency within region required, and MUST be fluent in English. Highest personal integrity with demonstrated ability to handle confidential matters in a discreet and respectful manner Desired Characteristics Strong preference for candidate with experience in HR related investigations as well as Finance, legal or other regulatory related investigations. Demonstrated ability to make independent decisions, manage conflicting priorities in a fast-paced environment and effectively interface with high-level business and operations leaders. Proven communication, coaching and interpersonal skills with the ability to work effectively with people at all levels of the organization. Ability to support clients in multiple locations Strong analytical and problem-solving skills Process and detail oriented, including strong organization skills Experience driving business solutions through influence and collaboration in a global, matrixed organization Strong written and presentation skills Additional Information GE Vernova offers a great work environment, professional development, challenging careers, and competitive compensation. GE Vernova is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age, disability, protected veteran status or other characteristics protected by law. GE Vernova will only employ those who are legally authorized to work in the United States for this opening. Any offer of employment is conditioned upon the successful completion of a drug screen (as applicable). Relocation Assistance Provided: No #LI-Remote - This is a remote position For candidates applying to a U.S. based position, the pay range for this position is between $150,100.00 and $250,000.00. The Company pays a geographic differential of 110%, 120% or 130% of salary in certain areas. The specific pay offered may be influenced by a variety of factors, including the candidate's experience, education, and skill set.Bonus eligibility: ineligible.This posting is expected to remain open for at least seven days after it was posted on January 26, 2026.Available benefits include medical, dental, vision, and prescription drug coverage; access to Health Coach from GE Vernova, a 24/7 nurse-based resource; and access to the Employee Assistance Program, providing 24/7 confidential assessment, counseling and referral services. Retirement benefits include the GE Vernova Retirement Savings Plan, a tax-advantaged 401(k) savings opportunity with company matching contributions and company retirement contributions, as well as access to Fidelity resources and financial planning consultants. Other benefits include tuition assistance, adoption assistance, paid parental leave, disability benefits, life insurance, 12 paid holidays, and permissive time off.GE Vernova Inc. or its affiliates (collectively or individually, “GE Vernova”) sponsor certain employee benefit plans or programs GE Vernova reserves the right to terminate, amend, suspend, replace, or modify its benefit plans and programs at any time and for any reason, in its sole discretion. No individual has a vested right to any benefit under a GE Vernova welfare benefit plan or program. This document does not create a contract of employment with any individual.

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health , you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time. Position Summary LOUISIANA RESIDENCY REQUIRED As a Senior Investigator you will conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high profile, those that are complex cases involving or cases involving multiple perpetrators or intricate healthcare fraud schemes. Investigates to prevent payment of fraudulent claims submitted to the Medicaid lines of business Researches and prepares cases for clinical and legal review Documents all appropriate case activity in case tracking system Facilitates feedback with providers related to clinical findings Initiates proactive data mining to identify aberrant billing patterns Makes referrals, both internal and external, in the required timeframe Facilitates the recovery of company and customer money lost as a result of fraud matters Provides on the job training to new Investigators and provides guidance for less experienced or skilled Investigators. Assists Investigators in identifying resources and best course of action on investigations Serves as back up to the Team Leader as necessary Cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud and abuse matters. Demonstrates high level of knowledge and expertise during interactions and acts confidently when providing testimony during civil and criminal proceedings Gives presentations to internal and external customers regarding healthcare fraud matters and Aetna's approach to fighting fraud Provides input regarding controls for monitoring fraud related issues within the business units Required Qualifications LOUISIANA RESIDENCY REQUIRED 3+ years investigative experience in the area of healthcare fraud and abuse matters. Working knowledge of medical coding; CPT, HCPCS, ICD10 Proficiency in Microsoft Office with advanced skills in Excel (must know how to do pivot tables). Strong analytical and research skills. Proficient in researching information and identifying information resources. Strong verbal and written communication skills. Ability to travel up to 10% (approx. 2-3x per year, depending on business needs) Preferred Qualifications Previous Medicaid/Medicare investigatory experience Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations for fraud and abuse. Credentials such as certification from the Association of Certified Fraud Examiners (CFE), or an accreditation from the National Health Care Anti-Fraud Association (AHFI) Knowledge of Aetna's policies and procedures. Knowledge and understanding of complex clinical issues. Competent with legal theories. Strong communication and customer service skills. Ability to effectively interact with different groups of people at different levels in any situation. Education: Bachelor's degree or equivalent experience (3-5 years of working health care fraud, waste and abuse investigations). Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $46,988.00 - $91,800.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ***************************************** We anticipate the application window for this opening will close on: 02/18/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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

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

Responsibilities SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse. We are looking to add a Fraud Investigator Admin Action Specialist to our SGS team of talented professionals. The Fraud Investigator Admin Action Specialist is responsible for being a Point of Contact for Investigations, MAC and CMS regarding all administrative actions related to investigations. Review and verify evidence supporting an administrative action as it relates to payment suspensions, revocations, overpayments as well as other administrative actions that can be pursued. Work with the Investigations, Medical Review and Data teams to ensure that the documentation gathered is sufficient to support an administrative action. Making administrative action recommendation to Investigations and CMS. Work with CMS, law enforcement and the Medicare Administrative Contractor throughout the life of the action. Monitor workload to ensure all actions are taken within the required timeframes set forth in the Program Integrity Manual. Prepare and submit administrative action packages to CMS and the MACs for approval and processing and speak to the action development. Ensure that all timelines are followed. Telework available from any location but must be available during eastern time zone hours. Qualifications Basic Qualifications: 4 years with AS/AA; 2 years with BS/BA; 0 years with MS/MA; 6 years with High School diploma/equivalent in lieu degree Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed to the Program Strong critical thinking, communication, writing and organizational skills Experience in developing fraud cases Strong PC knowledge and skills Knowledge of Medicare systems Ability to perform research and draw conclusions Ability to present issues of concern, citing and interpreting regulatory violations Ability to organize a case file, accurately and thoroughly document all steps taken Ability to compose correspondence, reports and letters clearly and concisely. Ability to communicate effectively, internally and externally Ability to interpret laws and regulations Ability to handle confidential material Ability to report work activity on a timely basis Ability to work independently and as a member of a team to deliver high quality work Ability to attend meetings, training, and conferences, overnight travel may be required US citizenship required Desirable Qualifications: The most competitive candidates will have: Medicare fraud investigation and/or Medicare billing background Investigation CFE or AHFI certification Peraton Overview Peraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world's leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees do the can't be done by solving the most daunting challenges facing our customers. Visit peraton.com to learn how we're keeping people around the world safe and secure. Target Salary Range $51,000 - $82,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual's experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay. EEO EEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.

National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers' evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products, through a large network of independent insurance agents, as well as directly to consumers. Job Description This job is responsible for investigating and analyzing complex, multi-discipline coverage and claims that have been referred to the special investigation unit (SIU) for potential fraud. This role typically handles a combination of complex attorney represented and unrepresented claims and moderate to complex losses, in which suspicious activity has been identified. The individual performs a thorough investigation including; (1) conducting background searches, scene investigations, and clinic inspections; (2) taking recorded statements; (3) reviewing and analyzing medical notes, bills, and property damage; and (4) conducting witness interviews and social media searches. The individual conducts surveillance on property and/or creates scene reconstructions on some investigations and reviews whether fraud can be substantiated and supports a lawsuit. The individual provides work guidance and direction to less senior employees and provides mentoring and coaching to the team. We're looking to add an SIU Field Investigator to our team in the Memphis, TN area! This is a remote role with field work throughout the Memphis, TN territory. If you bring prior SIU insurance carrier experience or a background in insurance investigations, we'd love to connect with you. Apply today and join our team! Key Responsibilities Enters SIU claim data information into multiple SIU systems Reviews investigations with fraud outcomes to validate whether denial is appropriate Updates files with investigation outcome, and when no fraud or insufficient evidence is found, returns file to MCO for further handling and settlement Conducts complex online data application searches, research, and evaluation Conducts complex site inspections, including body shops, medical clinics, loss locations etc. Conducts thorough investigations of complex that are potentially fraudulent to determine if payment is warranted, including scene investigations and surveillance as needed Validates that the information provided and obtained through investigation is true and accurate and follows up on all possible leads Summarizes documents and enters into claim system notes, documenting a claim file with notes, evaluations and decision-making process Utilizes analytic tools or SIU field intelligence to identify complex claims for investigation and/or for support in the evidence of the fraud and damages Researches and responds to complex customer communications, concerns, conflicts or issues Experience 2 or more years of experience (Preferred) Supervisory Responsibilities This job does not have supervisory duties. #LI-KR1 Compensation Base compensation offered for this role is: SIU Field Adjuster Cons II: $62,100 - $92,700 SIU Field Adjuster Sr Cons I: $68,500 - $104, 100 And is based on experience and qualifications. Total compensation for this role is comprised of several factors, including the base compensation outlined above, plus incentive pay (i.e. commission, bonus, etc.) if applicable for the role. Joining our team isn't just a job - it's an opportunity. One that takes your skills and pushes them to the next level. One that encourages you to challenge the status quo. One where you can shape the future of protection while supporting causes that mean the most to you. Joining our team means being part of something bigger - a winning team making a meaningful impact. Effective July 1, 2014, under Indiana House Enrolled Act (HEA) 1242, it is against public policy of the State of Indiana and a discriminatory practice for an employer to discriminate against a prospective employee on the basis of status as a veteran by refusing to employ an applicant on the basis that they are a veteran of the armed forces of the United States, a member of the Indiana National Guard or a member of a reserve component. For jobs in San Francisco, please click “here” for information regarding the San Francisco Fair Chance Ordinance. For jobs in Los Angeles, please click “here” for information regarding the Los Angeles Fair Chance Initiative for Hiring Ordinance. To view the “EEO Know Your Rights” poster click “here”. This poster provides information concerning the laws and procedures for filing complaints of violations of the laws with the Office of Federal Contract Compliance Programs. To view the FMLA poster, click “here”. This poster summarizing the major provisions of the Family and Medical Leave Act (FMLA) and telling employees how to file a complaint. It is the Company's policy to employ the best qualified individuals available for all jobs. Therefore, any discriminatory action taken on account of an employee's ancestry, age, color, disability, genetic information, gender, gender identity, gender expression, sexual and reproductive health decision, marital status, medical condition, military or veteran status, national origin, race (include traits historically associated with race, including, but not limited to, hair texture and protective hairstyles), religion (including religious dress), sex, or sexual orientation that adversely affects an employee's terms or conditions of employment is prohibited. This policy applies to all aspects of the employment relationship, including, but not limited to, hiring, training, salary administration, promotion, job assignment, benefits, discipline, and separation of employment. National General Holdings Corp., a member of the Allstate family of companies, is headquartered in New York City. National General traces its roots to 1939, has a financial strength rating of A- (excellent) from A.M. Best, and provides personal and commercial automobile, homeowners, umbrella, recreational vehicle, motorcycle, supplemental health, and other niche insurance products. We are a specialty personal lines insurance holding company. Through our subsidiaries, we provide a variety of insurance products, including personal and commercial automobile, homeowners, umbrella, recreational vehicle, supplemental health, lender-placed and other niche insurance products. Companies & Partners Direct General Auto & Life, Personal Express Insurance, Century-National Insurance, ABC Insurance Agencies, NatGen Preferred, NatGen Premier, Seattle Specialty, National General Lender Services, ARS, RAC Insurance Partners, Mountain Valley Indemnity, New Jersey Skylands, Adirondack Insurance Exchange, VelaPoint, Quotit, HealthCompare, AHCP, NHIC, Healthcare Solutions Team, North Star Marketing, Euro Accident. Benefits National General Holdings Corp. is an Equal Opportunity (EO) employer - Veterans/Disabled and other protected categories. All qualified applicants will receive consideration for employment regardless of any characteristic protected by law. Candidates must possess authorization to work in the United States, as it is not our practice to sponsor individuals for work visas. In the event you need assistance or accommodation in completing your online application, please contact NGIC main office by phone at **************.

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

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 Title: Healthcare Fraud Investigator Employer: Cameo Consulting Group, LLC Contract Type: Full-Time, Contract Position Clearance Required: Must be able to obtain and maintain required DOJ security clearance Travel: Occasional local and out-of-district travel may be required Job Summary Cameo Consulting Group, LLC is seeking an experienced Healthcare Fraud Investigator to provide investigative support for civil healthcare fraud prosecutions on behalf of the U.S. Department of Justice. The investigator will work closely with Assistant U.S. Attorneys (AUSAs) to review, analyze, and develop healthcare fraud cases in compliance with federal Medicare and Medicaid regulations. Key Responsibilities Review, sort, and analyze complex data using Microsoft Excel and other software tools. Examine financial records, legal documents, and regulatory filings to identify evidence of fraud, waste, and abuse. Prepare detailed spreadsheets of financial transactions (e.g., check spreads). Develop healthcare fraud case referrals that meet USAO litigation standards. Evaluate referrals to determine need for additional evidence and plan investigative approaches. Advise attorneys on case merits, liability, damages, and potential defenses. Assist in witness interviews and prepare written summaries. Support development of new referrals through collaboration with federal, state, and local agencies. Assist in training and preparation of informational materials related to healthcare fraud. Perform other related duties as assigned within scope. Qualifications Education: Bachelor's degree or higher in Criminal Justice, Finance, Project Management, or a related field. Experience: Minimum of 3 years of professional experience in healthcare fraud investigation, healthcare compliance, or a related investigative field. Experience with federal healthcare programs (Medicare/Medicaid) strongly preferred. Proficiency in Microsoft Excel and data analysis tools required. Skills & Abilities: Strong analytical, research, and report-writing skills. Ability to interpret complex legal and regulatory documents. Excellent communication and collaboration skills. High ethical standards and ability to handle confidential information. Ability to work independently and under the direction of AUSAs. Contract Requirements & Conditions Must complete DOJ ethics training and Cybersecurity Awareness Training (CSAT) upon hire. Must adhere to all DOJ security, confidentiality, and conduct standards. Work schedule follows federal holidays and government office closures. Travel reimbursements in accordance with Federal Travel Regulations (FTR). Replacement of key personnel requires prior government approval. How to Apply Interested candidates should submit a resume and cover letter detailing relevant experience and qualifications. Resumes should clearly demonstrate education, experience, security clearance status (if applicable), and training relevant to healthcare fraud investigation. About Cameo Consulting Group, LLC Cameo Consulting Group, LLC is a small business providing specialized investigative and legal support services to federal agencies. This position is part of a awarded contract supporting the U.S. Attorney's Office in combating healthcare fraud. Cameo Consulting Group, LLC is an equal opportunity employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or protected veteran status. Health, Insurance & Financial Security Medical Insurance: Premium options with cost-sharing between the company and employee. 100% Employer-Paid Insurance: Cameo fully covers premiums for Dental, Vision, Basic Life, and Accidental Death & Dismemberment (AD&D) insurance. Disability Insurance: Options for both short-term and long-term disability coverage. 401(k) Retirement Plan: A plan to help employees save for the future. Flexible Spending Accounts (FSA): Pre-tax accounts for eligible healthcare and dependent care expenses. Paid Time Off & Work-Life Balance Federal Holidays: Paid time off for 11 federal holidays per year. Paid Time Off (PTO) / Sick Leave: A combined bank of paid leave for vacation, personal time, and illness. Other Leave: Paid time off for bereavement and jury duty. Employee Assistance Program (EAP): Confidential counseling and support services for personal or work-related challenges. Where We Work Program: A flexible work policy that may include a mix of hub office work, work-from-home, and fully remote roles, depending on the position. Professional Growth & Additional Perks Tuition Reimbursement: Financial support for continued education and degree programs. Continuous Training: Access to training programs for professional development. Employee Referral Bonus: A cash bonus for referring successful candidates. Shopping Discounts: Access to an employee discount program for various retailers and services. Cameo Consulting Group, LLC is an EEO Employer - M/F/Disability/Protected Veteran Status View all jobs at this company

LOCATION: Remote -must live in North Carolina or within 40 miles of the NC border. This position is remote, but the applicant must be able to travel to Vaya's Offices or within Vaya's Catchment area as needed . GENERAL STATEMENT OF JOB The Special Investigator works under the direct supervision of the SIU Manager. The Special Investigator is responsible for identification, investigation and prevention of healthcare fraud, waste and abuse within the Vaya Health Network of contracted providers. The Special Investigator will develop investigative summary reports and make applicable referrals to the NC Division of Health Benefits, and recommendations as necessary to providers associated with investigation findings/outcomes. ESSENTIAL JOB FUNCTIONS Investigative Activities: Utilize established Vaya procedures to conduct inquiries and investigations into complaints, allegations, and referrals regarding suspected Fraud, Waste or Program Abuse Review healthcare claims to determine if provider payments were rendered in accordance with rules, regulations, service definition, service utilization, and contractual requirements Determine correct coding, billing, documentation, delivery of services and potential violations of federal and/or state regulation or Medicaid guidelines Perform reviews (desk, virtual, and/or on-site)interview providers, members, and stakeholders, and review medical records to verify compliance with program policies and/or standards of health care, appropriateness of services or medical necessity Prepare reports and exhibits from the findings of provider investigations and develop recommendations or intervention strategies to correct or prevent abusive practices, including proposals to recover inappropriately paid moneys or to suspend or terminate program participation. Refer suspected fraud cases to the DHB Office of Compliance and Program Integrity Administrative Activities: Participate in both informal and formal appeal processes, defending their decisions before a Vaya reconsideration panel, hearing officers and/or administrative law judges Provide litigation testimony as applicable Work in conjunction with various regulatory bodies Propose new fraud prevention edits for automated claims/billing system when new fraudulent schemes are discovered Support Activities: Other duties including technical assistance and provider education may be assigned based upon need, area of expertise, special interests and availability of resources. KNOWLEDGE, SKILLS, & ABILITIES Knowledge of healthcare service definitions, service documentation, and service utilization requirements An intermediate level of knowledge of Local, State and Federal laws and regulations pertaining to insurance and/or healthcare services Possess comprehensive knowledge of fraud investigative procedures and judicial processes relating to fraud prosecutions Excellent decision-making abilities to determine the appropriate course of action during investigations and subsequent follow-up Ability to prepare detailed and comprehensive reports, to present facts clearly, and to instruct others in new methods and procedures; Excellent written communication skills for correspondence, case documentation and report writing Extensive oral and written communication with providers, state and federal regulatory agencies, licensing entities, independent contractors, and members Present investigative findings with regulatory violations citations and ability to accurately describe scheme(s) to defraud Medicaid Intermediate or better proficiency with Microsoft Word, Microsoft Outlook, and Excel and ability to adapt to new technologies and platforms Ability to work autonomously, exercising sound judgment and problem resolution skills Ability to establish appropriate and respectful relationships/partnerships with persons with a wide range of ethnicities and abilities EDUCATION & EXPERIENCE REQUIREMENTS Associate degree in Compliance, analytics, government/public administration, auditing, security management or pre-law, psychology, social work, arts, science or a related human service field. Bachelor's degree preferred. Must have three (3) years of experience in compliance, healthcare, or fraud investigation unit. Preferred work experience: Four years of Medicaid Behavioral Health and/or physical health service delivery Preferred Licensure/Certification: Qualified Professional, Accredited Healthcare Fraud Investigator, Certified Fraud Examiner, or Certified Professional Coder preferred. PHYSICAL REQUIREMENTS: Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading. Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers. Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time. Mental concentration is required in all aspects of work. RESIDENCY REQUIREMENT: The person in this position is required to reside in North Carolina or within 40 miles of the North Carolina border. SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation. DEADLINE FOR APPLICATION: Open Until Filled APPLY: Vaya Health accepts online applications in our Career Center, please visit ****************************************** Vaya Health is an equal opportunity employer.

McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a SIU Coder, to join in leading the organization forward. MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA). MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members. Learn more about McLaren Health Plan at ********************************* Position Overview: The Special Investigations Unit (SIU) Coder supports lines of business from McLaren Health Plan, Inc., McLaren Health Plan Community, and McLaren Health Advantage (McLaren) and is responsible for performing medical claims and records reviews to assist in investigations, ensuring compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. The SIU Coder works in collaboration with a team of SIU Auditors to review records and claims as part of the ongoing audits of the SIU department. The SIU Coder serves as the subject matter expert for all coding activities and collaborates with other departments within McLaren on payment integrity and provider education. This position is fully remote. Qualifications: Required: * Associate's Degree in Health Information Management, Healthcare Business Services, or equivalent program with emphasis in coding or High School diploma with two (2) years of related experience. * Certified Medical Coder (CPC, RHIT, or RHIA). * Two (2) years of hands-on experience in ICD-10-CM and AMA diagnostic coding (with a preference for program integrity coding) and ICD-10 and AMA coding guidelines with the ability to interpret complex medical documentation accurately. * Two (2) years of coding experience on multiple specialties. Preferred: * Five (5) years coding and/or coding and billing experience. * Two (2) years' experience assisting with SIU audits. * Managed Care experience. Additional Information * Schedule: Full-time * Requisition ID: 26000572 * Daily Work Times: 8:30 am - 5:00 pm * Hours Per Pay Period: 80 * On Call: No * Weekends: No