Special Investigation Unit Investigator remote jobs

Stripe is a financial infrastructure platform for businesses. Millions of companies-from the world's largest enterprises to the most ambitious startups-use Stripe to accept payments, grow their revenue, and accelerate new business opportunities. Our mission is to increase the GDP of the internet, and we have a staggering amount of work ahead. That means you have an unprecedented opportunity to put the global economy within everyone's reach while doing the most important work of your career. About the team Stripe is both a technology company and a financial services company, and you will need to be comfortable straddling both of those worlds every day. The right person for the role will enjoy dealing with that puzzle, seeking creative solutions and moving quickly, often in the face of ambiguity. The right person for the role will also be comfortable getting their hands dirty by directly working on critical parts of the Americas financial crimes program, as well as being an effective people manager. The Financial Crimes, Compliance, and Risk Oversight (FinCRO) Investigations Management team is responsible for providing second line of defense (2LoD) financial crime risk oversight and coordination over casework, the management of user risk and other investigative oversight responsibilities for Stripe's global operations. The Investigations Management function will take part in local exams, field financial partner inquiries, and respond to law enforcement or other external inquiries. What you'll do We are looking for an Americas Financial Crimes Investigations Lead based in the US. This role focuses on leading a team of investigators and analysts conducting anti-money laundering (AML), counter-terrorist financing (CTF), sanctions, and other financial crimes and regulatory compliance investigations in support of Stripe's growing business. Responsibilities Lead a team of Financial Crime Analysts located across the Americas region (US, Canada, and Latin America) Provide guidance and support to the Americas team, in order to conduct a wide variety of analyses, potentially including: Investigations into money laundering, terrorist financing and other financial crimes and reporting of this activity through Suspicious Activity Reports (SARs) or Suspicious Transaction Reports (STRs) Conduct OFAC and BIS screening ("watchlist") and sanctioned jurisdictions screening (“keyword”) reviews, manually reviewing Stripe merchant accounts, and reviewing investigations work products, as part of Stripe's sanctions program Assessments of customer risks, including KYC and Due Diligence investigations for high risk customers, inclusive of Politically Exposed Persons (PEPs) Management of customer risk to Stripe, including the assessment of user retention and offboarding of users Assist the team in the investigation and response to requests for information from banking and financial partners, including the direct management of financial partner relationships Drive complex intelligence investigations and analytical workstreams, coordinating with Stripe's Complex and Major investigations teams Demonstrate sound judgment and an ability to navigate non-binary, high-risk decisions, and effectively communicate these decisions to the wider team Adhere closely to process while still constantly questioning assumptions, suggesting improvements, and following up implementation of those improvements Effectively and clearly communicate, including with other Stripes, Stripe's users, and Stripe's financial partners Demonstrate ownership of the Americas Financial Crimes program, and constantly seek improvements and accountability both within the team, as well as with our Financial Crimes Operations teams Who you are We're looking for someone who meets the minimum requirements to be considered for the role. If you meet these requirements, you are encouraged to apply. The preferred qualifications are a bonus, not a requirement. Minimum requirements 5+ years experience in investigations, operations, or advisory roles within financial crimes, AML, sanctions, risk, fraud, research, or a related field 2+ years experience leading financial crimes investigation teams of varying size and complexity Investigative expertise and strong knowledge of BSA, AML, US Patriot Act, and OFAC regulations Excellent research and writing skills Ability to synthesize large amounts of information, including transaction data Ability to work efficiently and independently in a fast-paced environment Ability to work cross-functionally with internal stakeholders Preferred qualifications ACAMS, ACAMS CGSS or ACSS Certification Familiarity with evaluating STRs and other regulatory reports to FINTRAC and Canadian Law Enforcement, as well as SAR reporting and regulatory requirements in Brazil. MS Excel experience SQL abilities Familiarity with MacOS and Google products Technical curiosity and an interest in evolving sanctions, AML, or regulatory compliance trends Foreign language fluency, including Spanish or Portuguese

Job Description Care Access is working to make the future of health better for all. With hundreds of research locations, mobile clinics, and clinicians across the globe, we bring world-class research and health services directly into communities that often face barriers to care. We are dedicated to ensuring that every person has the opportunity to understand their health, access the care they need, and contribute to the medical breakthroughs of tomorrow. With programs like Future of Medicine , which makes advanced health screenings and research opportunities accessible to communities worldwide, and Difference Makers , which supports local leaders to expand their community health and wellbeing efforts, we put people at the heart of medical progress. Through partnerships, technology, and perseverance, we are reimagining how clinical research and health services reach the world. Together, we are building a future of health that is better and more accessible for all. To learn more about Care Access, visit ******************* How This Role Makes a Difference The Sub-Investigator will be responsible for regional travel mixed with remote tele-medicine work to support our clinical research. Care Access is looking for Nurse Practitioners or Physicians Assistants to support clinical trial related activities in states throughout the USA. How You'll Make An Impact Work closely with the Principal Investigator to oversee the execution of study protocols, delegating study related duties to site staff, as appropriate, and ensuring site compliance with study protocols, study-specific laboratory procedures, standards of Good Clinical Practice (GCP), Standard Operating Procedures (SOPs), quality (QA/QC) procedures, OSHA guidelines, and other state and local regulations as applicable Attends and participates in meetings with the director, other managers, and staff as necessary Complies with regulatory requirements, policies, procedures, and standards of practice Read and understand the informed consent form, protocol, and investigator's brochure Be available to see subjects virtually or in-person as dictated by project design, answer their questions, and resolve medical issues during the study visit Sign and ensure that the study documentation for each study visit is completed Perform all study responsibilities in compliance with the IRB approved protocol Review screening documentation and approves subjects for admission to study Review admission documentation and approves subject for randomization Provide ongoing assessment of the study subject/patient to identify Adverse Events Ensure that serious and unexpected adverse events are reported promptly to the Pl Review and evaluates all study data and comments to the clinical significance of any out of range results Perform physical examinations as part of screening evaluation and active study conduct Provide medical management of adverse events as appropriate The Expertise Required Excellent working knowledge of medical and research terminology Excellent working knowledge of federal regulations, good clinical practices (GCP) Ability to communicate and work effectively with a diverse team of professionals Strong organizational skills: Able to prioritize, support, and follow through on assignments Communication Skills: Strong verbal and written communication skills as evidenced by positive interactions with coworkers, management, clients and vendors Team Collaboration Skills: Work effectively and collaboratively with other team members to accomplish mutual goals. Bring positive and supportive attitude to achieving these goals Strong computer skills with demonstrated abilities using clinical trials database, IVR systems, electronic data capture, MS word and excel Ability to balance tasks with competing priorities Critical thinker and problem solver Curiosity and passion to learn, innovate, able to take thoughtful risks and get things done Friendly, outgoing personality; maintain a positive attitude under pressure High level of self-motivation and energy Ability to work independently in a fast-paced environment with minimal supervision Must have a client service mentality Certifications/Licenses, Education, and Experience: Nurse Practitioner or Physician Assistant with 5+ years of clinical experience Currently licensed in good standing in one or more states listed above A minimum of 1 year of relevant work experience as Sub-Investigator (preferred) in a Clinical Research setting How We Work Together Location: This role is 100% on-site at our Memphis, TN clinic. Travel: This is a remote position with less than 10% travel requirements. Occasional planned travel may be required as part of the role. Physical demands associated with this position Include: The ability to use keyboards and other computer equipment. Benefits & Perks Paid Time Off (PTO) and Company Paid Holidays 100% Employer paid medical, dental, and vision insurance plan options Health Savings Account and Flexible Spending Accounts Bi-weekly HSA employer contribution Company paid Short-Term Disability and Long-Term Disability 401(k) Retirement Plan, with Company Match Diversity & Inclusion We work with and serve people from diverse cultures and communities around the world. We are stronger and better when we build a team representing the communities we support. We maintain an inclusive culture where people from a broad range of backgrounds feel valued and respected as they contribute to our mission. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to, and will not be discriminated against on the basis of, race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law. Care Access is unable to sponsor work visas at this time. If you need an accommodation to apply for a role with Care Access, please reach out to: ********************************

Type of Requisition: Regular Clearance Level Must Currently Possess: None Clearance Level Must Be Able to Obtain: None Public Trust/Other Required: None Job Family: Intelligence Operations and Analysis Job Qualifications: Skills: Evaluate Information, Microsoft Office 365, Research Analysis Certifications: None Experience: 3 + years of related experience US Citizenship Required: No Job Description: Marketplace InvestigatorThe Affordable Care Act (ACA) requires every state to establish a health insurance exchange (also called Health Insurance Marketplace) to facilitate the purchase of health insurance for individuals and small businesses. Through the Center of Program Integrity (CPI), the Centers for Medicare & Medicaid Services (CMS) has strong oversight and internal controls to protect consumers enrolled in the Marketplaces and safeguard taxpayer dollars. CMS develops and enforces rules for insurance agents, brokers, and others who assist with FFM enrollments. The Marketplace Program Integrity Contract (MPIC) is designed to support this oversight. Through research, investigation, and data analysis, the desired outcomes of the MPIC efforts are to prevent, detect, and resolve noncompliance with Marketplace rules, requirements, and laws; recommend administrative actions to CMS; and recommend referrals to law enforcement if potential fraud and abuse is identified.HOW YOU WILL MAKE AN IMPACT:Conducts analysis, research, and outreach in support of an MPIC Team. Research includes review of documents and data; outreach includes interaction with consumers, insurance agents/brokers, and other agencies; analysis includes applying regulations to findings and analysis of data, including enrollment data related to consumer and Agent/Broker activity within the health insurance exchange. Completes and/or supports the preparation of comprehensive reports on the results of analysis and other work completed by team members. Conducts other data analysis and documentation support as needed.Will focus on reviewing documents provided by agent/brokers in response to Marketplace registration/agreement suspension or termination and preparing recommendation based on review conducted. Work collaboratively within a team of ACA policy subject matter experts (SMEs) and data analysts. Actively participate in the development of lead and investigation workflows and required data capture within a case management system. Strictly follow approved Standard Operating Procedures (SOPs) for conducting investigations and provide input into recommendations for SOP updates as needed. Prioritize, evaluate, and analyze information for potential fraud, waste, and abuse (FWA) using data related to consumer enrollments into qualified health plans and/or the associated agents/brokers' compliance with regulations. Analyze and evaluate enrollment data related to consumer and Agent/Broker activity within the Marketplace. As needed, initiate and develop an Investigative Plan of Action (IPOA) and with CMS approval, implement the plan with the support of investigative staff into the potential FWA behavior using various investigative techniques. As needed, initiate and develop a Case Summary report, which summarizes investigative findings. As needed, make administrative recommendations to CMS based on case summary findings. Within a case management and tracking system, comprehensively document in detail all lead and investigative activity. As needed, conduct interviews with complainants and/or consumers and with CMS approval correspond with agents/brokers or other government agencies using CMS-approved template Actively support preparation of comprehensive reports on the status of leads and investigations as required by CMS. As needed, assist in ad-hoc educational and outreach sessions with partners, e.g., CMS, law enforcement, Agent/Brokers, Navigators, etc. Safeguard PII and PHI Infrequent travel may be required WHAT YOU'LL NEED TO SUCCEED Bachelor's degree or equivalent experience in healthcare field that includes 2-4 years' ACA and/or Medicaid-Medicare experience 2+ years' experience with and/or understanding of ACA policies and regulations related to consumer enrollments requirements and Agent/Broker and Navigator responsibilities Frequent work with workgroups to successful completion of goals and milestones Experience reviewing complex data reports Highly organized, ability to multi-task, and meet deadlines Proficient in computer skills, for example Microsoft Office-Word, Excel Requires only limited oversight to conduct work Strong inter-personal and communications skills, both written and oral Experience in conducting telephonic and in-person interviews Ability to conceptualize, solve problems, and draw conclusions Value-Add Experience - Preferred Skills Experience with FWA claims and investigations Location: Remote Residency/background: Must be able to pass a CMS background check, which requires residency in the U.S. for 3 of the last 5 years. GDIT IS YOUR PLACE: 401K with company match Comprehensive health and wellness packages Internal mobility team dedicated to helping you own your career Professional growth opportunities including paid education and certifications Cutting-edge technology you can learn from Rest and recharge with paid vacation and holidays #GDITHealth#healthcarefraud#CMSThe likely salary range for this position is $71,445 - $96,661. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range. Scheduled Weekly Hours: 40 Travel Required: Less than 10% Telecommuting Options: Remote Work Location: Any Location / Remote Additional Work Locations: Total Rewards at GDIT: Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year. Paid leave and paid holidays are prorated based on the employee's date of hire. The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most.We are GDIT. A global technology and professional services company that delivers consulting, technology and mission services to every major agency across the U.S. government, defense and intelligence community. Our 30,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 50 countries worldwide, offering leading capabilities in digital modernization, AI/ML, Cloud, Cyber and application development. Together with our clients, we strive to create a safer, smarter world by harnessing the power of deep expertise and advanced technology.Join our Talent Community to stay up to date on our career opportunities and events at gdit.com/tc. Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans

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

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

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience! The Special Investigations Unit Investigator II investigates and analyzes incidents of suspected fraud, waste, and abuse in accordance with regulatory requirements. The Special Investigations Unit Investigator II is responsible for conducting full investigations to proactively prevent, detect, and correct suspected and identified issues of fraud, waste, and abuse in the health care environment, including reporting to State and/or Federal regulatory agencies. The incumbent makes potential fraud, waste, or abuse determinations by utilizing a variety of sources including data analytics to detect unusual billing. The Special Investigations Unit Investigator II conducts monitoring and supports the Plan's Fraud, Waste and Abuse Program (FWA) to ensure compliance with State and/or Federal contracts, laws, regulations, and guidance set forth by the Centers for Medicare and Medicaid Services (CMS), the United States Health and Human Services Office of the Inspector General (HHS-OIG), the California Department of Managed Health Care (DMHC), and the California Department of Health Care Services (DHCS). Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. * Competitive salary. * Hybrid schedule. * CalPERS retirement. * State of the art fitness center on-site. * Medical Insurance with Dental and Vision. * Life, short-term, and long-term disability options * Career advancement opportunities and professional development. * Wellness programs that promote a healthy work-life balance. * Flexible Spending Account - Health Care/Childcare * CalPERS retirement * 457(b) option with a contribution match * Paid life insurance for employees * Pet care insurance Education & Requirements * Four (4) or more years relevant professional experience in a health care environment, with an emphasis in fraud, waste, and abuse investigations, including Federal and State reporting requirements * Experience in health care fraud investigation, detection, and/or healthcare related specialty including but limited to; Pharmacy, DEM, Mental Health, Behavioral Health, Hospice, Home Health, claims, or claims processing preferred * Bachelor's degree from an accredited institution * In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position * This experience is in addition to the minimum years listed in the Experience Requirements above * Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), or similar certification/licensure preferred Key Qualifications * Strong knowledge of Managed Care, Medi-Cal, and Medicare programs as well as Marketplace * Compliance program principles and practices of managed care. Knowledge of federal and state guidelines as well as ICD, CPT, HCPCS, coding * Excellent verbal and written communication skills with thorough documentation, composing detailed investigative reports and professional internal and external correspondence * Interpersonal and presentation skills to communicate with internal departments and external agencies * Demonstrated analytical, problem solving, and resolution skills * Strong organizational skills and attention to detail. Proficiency in Microsoft Office programs including, but not limited to: Word, Excel, PowerPoint, Outlook, and Access * Demonstrated proficiency in data mining and the use of data analytics to detect fraud, waste, and abuse, including the utilization of pivot tables, formulas, and trending * Proven ability to: * Work independently and collaboratively within a team environment. * Apply knowledge, and address situations appropriately with minimal guidance * Manage multiple projects with competing deadlines and changing priorities * Research, comprehend and interpret various state specific Medicaid, Federal Medicare, and ACA/Exchange laws, rules and guidelines * Identify, research and comprehend medical standards, healthcare authoritative sources and apply knowledge to investigative approach * Minimal physical activity; may include standing, walking, sitting lifting, and pushing and carrying up to 25 lbs Start your journey towards a thriving future with IEHP and apply TODAY! Pay Range * $80,059.20 USD Annually - $106,059.20 USD Annually

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.

We are looking for qualified candidates to join our growing team of professionals. We are Looking for F/T employees who have the ability to work remotely, independently, and who enjoy a good challenge. Applicants must have an extremely flexible work schedule. This is an industry wide requirement as cases often require odd hours, to include early mornings, weekdays, weekends, and evening hours. The Special Investigations Unit (SIU/Claims) Field Investigator conducts recorded statements / interviews, accident scene investigations, online research, and witness canvassing. They recognize compensability issues, misrepresentation, and understanding insurance coverage as it pertains to claims decisions. They identify red flags and follow where the investigation leads them, doing their due diligence to conduct a thorough investigation. EXPERIENCE: Previous SIU experience with an insurance carrier or investigative firm. Former military or law enforcement. Two years' experience in property loss investigations (or adjusting) to include theft, fire, water, wind and vandalism losses. LICENCES/CERTIFICATIONS/INSURANCE Valid state-issued driver's license. May require Notary. SKILLS: A SIU / Claims investigator must possess strong computer and internet skills, as well as strong verbal and written communication skills. They should have excellent analytical and problem-solving skills, listening skills and high attention to details. They should also be persistent and organized. REQUIRED EQUIPMENT: The ideal candidate must own a well-maintained vehicle, a window-based laptop, cell phone, and have a good internet connection. In addition, they should own a Camera, or comparable equipment to obtain photographs and a Recording device to obtain statements. Company info: Ethos Risk Services is an expert in the field of risk mitigation. We help our clients fight back against fraud through the use of our full suite of services. We provide the highest level of security, real-time field updates, and shortened turn-around times. We are a nationwide risk mitigation company seeking private investigators to conduct surveillance for clients who suspect fraudulent insurance claims. * Pay is commensurate with experience. Ethos Risk Services is an equal opportunity employer that does not discriminate on the basis of religious creed, sex, national origin, race, veteran status, disability, age, marital status, color or sexual orientation or any other characteristic protected by law. A background check will be conducted, in accordance to the local state law and regulations.

UPMC Health Plan has an exciting opportunity for a Special Investigations Unit Investigator position. This is a temporary position working Monday through Friday 8:00 a.m. to 4:30 p.m. This is a remote position. Under the direction of the manager, the Special Investigations Unit (SIU) Investigator is responsible for investigating assigned fraud, waste and abuse (FWA) cases, as well as researching and analyzing claims data in order to identify potential FWA. The SIU Investigator is also responsible for maintaining the FWA case system with accurate and detailed investigative activities related to assigned cases. This role includes supporting current SIU staff and manager with investigations and special projects. Responsibilities: * Maintain neat and organized files and electronic databases * Prepare letters, memos, and reports * Financial tracking * Understand and adhere to HIPAA privacy requirements * Proficiency with Microsoft Office products such as Word, Excel, Outlook and PowerPoint. * Perform other duties as assigned * Support all department personnel with duties including but not limited to investigations, audits, and regulatory referrals. * High School Diploma Strongly Preferred. * Post-secondary education is preferred. * One year of administrative support working experience is highly preferred. * Must have proficiency with Microsoft Office Suite: Excel, Word, Outlook and Powerpoint. * Must possess typing skills and working knowledge of word processing, electronic mail/calendar and spreadsheets. * Must possess the ability to learn and effectively use various software programs. * General knowledge and experience with office equipment such as copiers, multi-line phone systems, fax machines and paging systems Preferred Qualification: * Experience in investigations, claims, medical coding, auditing, compliance, risk management and/or data analysis required Licensure, Certifications, and Clearances: * Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran

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

The SIU Audit Investigator supports the compliance related activities of the Special Investigations Unit (SIU) at the Health Plan. This role assists the External Audit Senior Manager with developing, implementing and performing compliance related auditing and monitoring activities at the Health Plan. This includes the identification, investigation and correction of fraudulent and/or abusive billing and coding practices; coordination of recovery of overpayments related to fraudulent and/or abusive billing and coding practices; and providing education related to coding, medical record documentation requirements, healthcare compliance and fraud, waste and abuse to Health Plan staff, vendors and contracted providers/facilities. Providence Health Plan caregivers are not simply valued - they're invaluable. Join our team at Providence Health Plan Partners and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Providence Health Plan welcomes 100% remote work for applicants who reside in the following states: Washington Oregon California Required Qualifications: Bachelor's Degree Or equivalent combination of education and experience. 5 years Coding experience with a healthcare provider, facility or health insurance company. 2 years Fraud and Abuse audit experience in a health insurance company, healthcare provider, facility or other relevant healthcare environment. Project management experience, education program development experience and group presentation experience. Experience in use of data mining software/tools. Preferred Qualifications: Current certification as an Accredited Healthcare Fraud Investigator (AHFI) upon hire. Certification as an Internal Auditor or Healthcare Compliance certification upon hire. Clinical background. Salary Range by Location: California: Humboldt: Min: $29.62, Max: $45.31 California: All Northern California - Except Humboldt: Min: $33.23, Max: $50.84 California: All Southern California - Except Bakersfield: Min: $29.62, Max: $45.31 California: Bakersfield: Min: $28.41 Max: $43.47 Oregon: Non-Portland Service Area: Min: $26.49, Max: $40.52 Oregon: Portland Service Area: Min: $28.41 Max: $43.47 Washington: Western - Except Tukwila: Min: $29.62, Max: $45.31 Washington: Southwest - Olympia, Centralia & Below: Min: $28.41 Max: $43.47 Washington: Tukwila: Min: $29.62, Max: $45.31 Washington: Eastern: Min: $25.28, Max: $38.68 Washington: South Eastern: Min: $26.49, Max: $40.52 Why Join Providence Health Plan? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons.

class:( $data.display Type === 'InputTextArea') ? 'block__field--full-width' : ($data.display Type === 'InputRichText' || $data.name === 'description Ext' || $data.name === 'qualification Ext' || $data.name === 'description Int' || $data.name === 'qualification Int') ? 'block__field--wide-rich-text' : 'block__field--edit'}" id="description Int-container" html: $component.get FieldValue($data)" id="description Int-value" formfieldid="description Int" UPMC Health Plan has an exciting opportunity for a Special Investigations Unit Investigator position. This is a temporary position working Monday through Friday 8:00 a.m. to 4:30 p.m. This is a remote position. Under the direction of the manager, the Special Investigations Unit (SIU) Investigator is responsible for investigating assigned fraud, waste and abuse (FWA) cases, as well as researching and analyzing claims data in order to identify potential FWA. The SIU Investigator is also responsible for maintaining the FWA case system with accurate and detailed investigative activities related to assigned cases. This role includes supporting current SIU staff and manager with investigations and special projects. Responsibilities: + Maintain neat and organized files and electronic databases + Prepare letters, memos, and reports + Financial tracking + Understand and adhere to HIPAA privacy requirements + Proficiency with Microsoft Office products such as Word, Excel, Outlook and PowerPoint. + Perform other duties as assigned + Support all department personnel with duties including but not limited to investigations, audits, and regulatory referrals. + High School Diploma Strongly Preferred. + Post-secondary education is preferred. + One year of administrative support working experience is highly preferred. + Must have proficiency with Microsoft Office Suite: Excel, Word, Outlook and Powerpoint. + Must possess typing skills and working knowledge of word processing, electronic mail/calendar and spreadsheets. + Must possess the ability to learn and effectively use various software programs. + General knowledge and experience with office equipment such as copiers, multi-line phone systems, fax machines and paging systems Preferred Qualification: + Experience in investigations, claims, medical coding, auditing, compliance, risk management and/or data analysis required Licensure, Certifications, and Clearances: + Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran

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

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. We are currently hiring for multiple positions. Candidates for these role must reside in one of the following states: CA, HI, IL, NE, and OH. Position Purpose: Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse. Conduct investigations of potential waste, abuse, and fraud Document activity on each case and refer issues to the appropriate party Perform data mining and analysis to detect aberrancies and outliers in claims Develop new queries and reports to detect potential waste, abuse, and fraud Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions Assist with complex allegations of healthcare fraud Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies Complete various special projects and audits Performs other duties as assigned Complies with all policies and standards Education/Experience: Bachelor's Degree in Business, Criminal Justice, Healthcare, related field or equivalent experience. 1+ years of medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation experience. Pay Range: $55,100.00 - $99,000.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

WHAT IS THE OPPORTUNITY? Responsible for performing and documenting through root cause analysis on clients' transactions identified through fraud operations and strategy to identify rings, scams, fraudulent activities that impact CNB's clients, and corporate losses. Additionally, the Fraud Investigator will quarterback internal events and investigation activities to strengthen operational processes to reduce fraud risk. WHAT WILL YOU DO? * Perform analysis on clients' transactions identified through the monitoring system that involves various transaction types including but not limited to credit, cash, wire transfers, remote deposit capture and loans. * Conduct and document, timely investigations with well-reasoned and supported decision-making. * Utilize a variety of internal bank systems and external research tools to investigate, research, and prepare documentation related to fraud investigations consistent with the resolution of the investigation and perform root cause analysis to identify solutions to reduce future fraud risk. * Conducts follow-up with line colleagues and clients for any missing or necessary information. * Demonstrate personal excellence including punctuality, integrity, and accountability. * Think critically and exercise independent judgement. * Apply subject matter expertise in the financial services industry to drive improved fraud detection and prevention. * Champion activities across the fraud organization for identified risk events. * Provide escalation support for fraud operations. * Communicate emerging fraud trends across client operations. WHAT DO YOU NEED TO SUCCEED? *Required Qualifications** * Bachelor's Degree or equivalent * Minimum 5 years experience in risk management or fraud related functions * Minimum 5 years experience in fraud investigations *Additional Qualifications* * Must work well in a team environment, as well as independently. * Advanced computer experience required (e.g., MS Word, Outlook and Excel) * Analytical skills, use of good judgment, attention to detail, internet savvy. * Solid understanding of deposit, credit, and money movement transactions and potential fraud attack vectors. * Must have a strong and positive work ethic and follow CNB core values. * Must be flexible and adapt quickly to change. * Must be able to multi-task, adapt well to changing priorities, and meet specific performance goals. * Advanced Knowledge of PC functions in a Windows based environment. * Proficient in Excel and Word. * Effective written and oral communication skills to interact effectively with all levels of bank personnel and clients. * Demonstrated experience in root cause analysis and event management coordination. * CFE and/or CFCI certification desired * Familiarity/proficiency in programming tools such as Snowflake, Python, SAS for data queries desired *WHAT'S IN IT FOR YOU?* *Compensation*Starting base salary: $65,296 - $104,304 per year. Exact compensation may vary based on skills, experience, and location. This job is eligible for bonus and/or commissions. *Benefits and Perks* At City National, we strive to be the best at whatever we do, including the benefits and perks we offer our colleagues including: * Comprehensive healthcare coverage, including Medical, Dental and Vision plans, available the first of the month following start date * Generous 401(k) company matching contribution * Career Development through Tuition Reimbursement and other internal upskilling and training resources * Valued Time Away benefits including vacation, sick and volunteer time * Specialized health and family planning benefits including fertility benefits, and cancer, diabetes and musculoskeletal support programs * Career Mobility support from a dedicated recruitment team * Colleague Resource Groups to support networking and community engagement Get a more detailed look at our ********************************* ABOUT US Since day one we've always gone further than the competition to help our clients, colleagues and communities flourish. City National Bank was founded in 1954 by entrepreneurs for entrepreneurs and that legacy of integrity, community and unparalleled client relationships continues today. City National is a subsidiary of Royal Bank of Canada, one of North America's leading diversified financial services companies. To learn more about City National and our dynamic company culture, visit us at ********************************** *INCLUSION AND EQUAL OPPORTUNITY EMPLOYMENT* City National Bank fosters an inclusive environment where all forms of diversity are valued and leveraged to make us a better company and employer. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, national origin, disability, veteran status or other basis protected by law. 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. *Represents basic qualifications for the position. To be considered for this position, you must at least meet the required qualifications. careers.cnb.com accepts applications on an ongoing basis, until filled. Unless otherwise indicated as fully remote, reporting into a designated City National location is an essential function of the job.

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

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!

Job Details Corporate Office - Boca Raton, FL Fully Remote Full Time DayDescription The SIU department encompasses low to moderately complex claims investigations of suspicious and fraudulent claims investigation. The unit reports information to and coordinates with law enforcement or state fraud bureaus for regulatory compliance and criminal prosecutions. The position is responsible for conducting in-depth field investigations of suspicious property insurance claims that vary in complexity. These investigations may be of suspicious or unlawful activity by policyholders, vendors and others and are conducted in a prompt, expeditious and ethical manner. Essential Functions: Prioritize assignments and conduct necessary field work exercising independent judgment, initiative and decision-making skills. Analyze facts and data, telephonic interviews, and a review of claim documents. Drafting thorough detailed investigative reports to include developing the appropriate investigative action that justifies a proper recommendation to claims adjusters and management. SIU supports its independent IA firms and internal departments, when needed, that may include identifying training needs; participation in developing and presenting training to raise the awareness of potential fraud. Regularly meet with claims management to keep them informed of trends that may have an impact on claims in a specific assigned region/territory. Develop and maintain industry, federal, state, and local government contacts involved in fraud investigation, detection, and prevention. Maintain and pursue technical competency by continuous learning in fraud education with an emphasis on insurance fraud seminars and other company sponsored courses at the direction of the SIU Manager. Attend monthly meeting facilitated by regulatory agencies and other fraud related organizations Conduct Field investigations to include neighborhood canvasses, interviewing vendors, scene photos, business inquiries, asset recovery, etc. Aid our legal team in preparation for litigation or subrogation, skip trace for witnesses, etc. Travel 50% -70% Qualifications Required Education and Experience: Experience in SIU and/or investigative work in property/casualty claims Candidate must possess a professional demeanor characterized by integrity, good character, and mutual respect. Knowledge of Florida Statutes and Administrative Code Excellent verbal and written communication skills. Ability to work independently with minimal supervision Strong interpersonal skills, including experience taking written and oral statements and evidence gathering techniques Strong organizational and time management skills to manage a high volume of assignments. Excellent analytical and problem-solving skills, independently motivated and strong attention to detail. Proficient in MS Office, including Word, Excel, PowerPoint, and Outlook. Preferred Qualifications: Claims Adjusting experience, 620 license a plus Industry certification (CIFI, CFE, FCLS) Experience in criminal justice, investigations, or related field Private Investigator certification is a plus

Hours: 40 Pay Details: $72,280 - $117,520 USD TD is committed to providing fair and equitable compensation opportunities to all colleagues. Growth opportunities and skill development are defining features of the colleague experience at TD. Our compensation policies and practices have been designed to allow colleagues to progress through the salary range over time as they progress in their role. The base pay actually offered may vary based upon the candidate's skills and experience, job-related knowledge, geographic location, and other specific business and organizational needs. As a candidate, you are encouraged to ask compensation related questions and have an open dialogue with your recruiter who can provide you more specific details for this role. Line of Business: Financial Crime Risk Management Job Description: Department Overview: The Financial Crime Risk Senior Investigator is required to be a seasoned and detail-oriented subject matter expert in quality control, end to end BSA/AML Investigations of various complexity related to potential money laundering, terrorist financing and other illicit financial crimes, and Regulatory reporting requirements. The role requires the ability to lead, train and mentor teams in conducting thorough investigations, ensuring regulatory compliance, and maintaining high standards of accuracy. Adept at identifying and mitigating financial crime risk, while driving continuous improvement on the AML processes and procedures. Additionally, the Financial Crime Senior Investigator will conduct end to end investigations of various complexity related to potential money laundering, terrorist financing and other illicit financial crimes, by analyzing transactional activity and Know Your Customer (KYC) information, mitigating associated red flags, documenting all appropriate evidence, filing necessary regulatory reports and also including determination of potential relationship exit, on a as needed basis. This role requires a deep understanding of AML regulations, strong writing and analytical skills, and the ability to work collaboratively with internal and external stakeholders. Primarily Offsite: Our team currently operates under a primarily offsite work model, employees must be available to come into a TD location for "moments that matter" at a frequency determined by the business. Candidates that live within a 50-mile radius of a TD AML Hub location is strongly preferred. Depth & Scope: * Investigates criminal cases ranging from simple to complex in nature * Sound knowledge of Bank products, systems, policies and procedures * Strong knowledge of criminal investigative techniques, related laws governing collection of evidence, court proceedings and financial/criminal trends * Manages programs/projects/ initiatives of low to moderate scope and complexity * Expert level professional role requiring in-depth knowledge/expertise in own field of specialty and working knowledge of broader related areas * Integrates the broader organizational context into advice and solutions within own area * Understands the industry, competition and the factors that differentiate the organization * Impacts a range of functional programs across own and related teams * Interprets guidelines, standards, policies, and results of analysis to inform decision making at senior levels * Builds stakeholder alignment in leading projects and activities * Works independently as the senior technical lead and guides others within area of expertise * Identifies and leads problem resolution for complex issues at all levels Education & Experience: * Undergraduate degree or equivalent work experience * 5+ years of experience Customer Accountabilities: * Conducts a variety of complex investigations, including AML, Sanctions/ABAC and Financial Crime * Applies sound methodologies to collect, preserve, and analyze evidence while staying current on global emerging risks and technology threats * Assesses and prioritizes files and investigates assigned cases ensuring proper protocols are in place and effectively applied * Works effectively with counterparts at other FI's, law enforcement, Non-Profits, and others in government within prescribed protocols to maximize opportunities for information sharing and to reduce TDBFG exposure * Conducts investigations in a professional and timely manner * Identifies and communicates procedural weaknesses to businesses * Identifies industry and typologies risk and trends for respective program areas and shares knowledge with appropriate stakeholders * Maintains and establishes working relationships with internal partners (e.g., HR, Employment Standards and Legal etc.,) for investigative purposes * Applies sound methodologies to collect, preserve, and analyze digital evidence in accordance with investigative mandate Shareholder Accountabilities: * Leads workstream by acting as a project lead for large or complex projects/initiatives in accordance with project management methodologies * Evaluates the effectiveness of processes/services and recommends/champions possible enhancements * Recommends improvements to escalation processes within the investigative unit and a feedback mechanism to relevant stakeholders * Plans and delivers efficient and cost-effective processes that support and promote the implementation of programs * Conducts internal and external research projects; supports the development/delivery of presentations/communications to management or broader audience * Adheres to enterprise frameworks or methodologies that relate to activities for respective business area(s) * Monitors service, productivity and assesses efficiency levels within own function and implements continuous process/performance improvements where opportunities exist * Consistently exercises discretion in managing correspondence, information and all matters of confidentiality; escalates issues where appropriate * Protects the interests of the organization - identifies and manages risks, and ensures the prompt and thorough resolution of escalated non-standard, high-risk issues * Runs analysis at the functional or enterprise level using results to draw conclusions, makes recommendations, assesses the effectiveness of programs/policies/practices * Keeps abreast of emerging issues, trends, and evolving regulatory requirements and assesses potential impacts * Maintains a culture of risk management and control, supported by effective processes in alignment with risk appetite Employee/Team Accountabilities: * Participates fully as a member of the team, supports a positive work environment that promotes service to the business, quality, innovation and teamwork and ensures timely communication of issues/points of interest * Shares industry knowledge for own area of expertise and participates in knowledge transfer within the team and business unit * Keeps current on emerging trends/developments and grows knowledge of the business, related tools and techniques * Participates in personal performance management and development activities, including cross training within own team * Keeps others informed and up to date about the status/progress of projects and/or all relevant or useful information related to day-to-day activities * Contributes to team development of skills and capabilities through mentorship of others, by sharing knowledge and experiences and leveraging best practices * Leads, motivates and develops relationships with internal and external business partners/stakeholders to develop productive working relationships * Contributes to a fair, positive and equitable environment that supports a diverse workforce * Acts as a brand ambassador for your business area/function and the bank, both internally and/or externally Physical Requirements: Never: 0%; Occasional: 1-33%; Frequent: 34-66%; Continuous: 67-100% * Domestic Travel - Occasional * International Travel - Never * Performing sedentary work - Continuous * Performing multiple tasks - Continuous * Operating standard office equipment - Continuous * Responding quickly to sounds - Occasional * Sitting - Continuous * Standing - Occasional * Walking - Occasional * Moving safely in confined spaces - Occasional * Lifting/Carrying (under 25 lbs.) - Occasional * Lifting/Carrying (over 25 lbs.) - Never * Squatting - Occasional * Bending - Occasional * Kneeling - Never * Crawling - Never * Climbing - Never * Reaching overhead - Never * Reaching forward - Occasional * Pushing - Never * Pulling - Never * Twisting - Never * Concentrating for long periods of time - Continuous * Applying common sense to deal with problems involving standardized situations - Continuous * Reading, writing and comprehending instructions - Continuous * Adding, subtracting, multiplying and dividing - Continuous The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required. The listed or specified responsibilities & duties are considered essential functions for ADA purposes. Who We Are: TD is one of the world's leading global financial institutions and is the fifth largest bank in North America by branches/stores. Every day, we deliver legendary customer experiences to over 27 million households and businesses in Canada, the United States and around the world. More than 95,000 TD colleagues bring their skills, talent, and creativity to the Bank, those we serve, and the economies we support. We are guided by our vision to Be the Better Bank and our purpose to enrich the lives of our customers, communities and colleagues. TD is deeply committed to being a leader in customer experience, that is why we believe that all colleagues, no matter where they work, are customer facing. As we build our business and deliver on our strategy, we are innovating to enhance the customer experience and build capabilities to shape the future of banking. Whether you've got years of banking experience or are just starting your career in financial services, we can help you realize your potential. Through regular leadership and development conversations to mentorship and training programs, we're here to support you towards your goals. As an organization, we keep growing - and so will you. Our Total Rewards Package Our Total Rewards package reflects the investments we make in our colleagues to help them and their families achieve their financial, physical and mental well-being goals. Total Rewards at TD includes base salary and variable compensation/incentive awards (e.g., eligibility for cash and/or equity incentive awards, generally through participation in an incentive plan) and several other key plans such as health and well-being benefits, savings and retirement programs, paid time off (including Vacation PTO, Flex PTO, and Holiday PTO), banking benefits and discounts, career development, and reward and recognition. Learn more Additional Information: We're delighted that you're considering building a career with TD. Through regular development conversations, training programs, and a competitive benefits plan, we're committed to providing the support our colleagues need to thrive both at work and at home. Colleague Development If you're interested in a specific career path or are looking to build certain skills, we want to help you succeed. You'll have regular career, development, and performance conversations with your manager, as well as access to an online learning platform and a variety of mentoring programs to help you unlock future opportunities. Whether you have a passion for helping customers and want to expand your experience, or you want to coach and inspire your colleagues, there are many different career paths within our organization at TD - and we're committed to helping you identify opportunities that support your goals. Training & Onboarding We will provide training and onboarding sessions to ensure that you've got everything you need to succeed in your new role. Interview Process We'll reach out to candidates of interest to schedule an interview. We do our best to communicate outcomes to all applicants by email or phone call. Accommodation TD Bank is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or any other characteristic protected under applicable federal, state, or local law. If you are an applicant with a disability and need accommodations to complete the application process, please email TD Bank US Workplace Accommodations Program at ***************. Include your full name, best way to reach you and the accommodation needed to assist you with the applicant process.