Fraud investigator jobs in Bayonne, New JerseyCreate job alerts

The New Jersey Office of Attorney General is looking for a Chief Investigator Law & Public Safety for the New Jersey Division of Consumer Affairs, Bureau of Securities in Newark, NJ. This position will be appointed as a Chief Investigator Law & Public Safety with an annual salary ranging from $106,547.31 to $157,362.71. ABOUT THE DEPARTMENT: The Attorney General has broad oversight of the state’s legal and law enforcement matters. As the head of the Department of Law & Public Safety, the Attorney General supervises a wide range of Divisions, Offices, and Commissions, consisting of over 2,800 sworn law enforcement officers, 600 attorneys, and thousands of other public servants. ABOUT THE DIVISION: The New Jersey Division of Consumer Affairs protects the public from fraud, deceit, misrepresentation and professional misconduct in the sale of goods and services in New Jersey through education, advocacy, regulation and enforcement. The Division pursues its mission through its 51 professional and occupational boards that oversee 720,000 licensees in the state, its Regulated Business section that oversees 60,000 NJ registered businesses, as well as through its Office of Consumer Protection, Bureau of Securities, Charities Registration section, Office of Weights and Measures, and Legalized Games of Chance Control Commission. ABOUT THE SECTION: The New Jersey Bureau of Securities (“Bureau”) is charged with protecting investors from investment fraud, and regulating the securities industry in New Jersey. In addition to bringing investigative and enforcement actions against firms or individuals who violate the New Jersey Uniform Securities Law and Regulations, the Bureau registers securities offered or sold in New Jersey and oversees the firms and individuals selling securities or providing investment advice to New Jersey residents. Through its Investor Education initiative, the Bureau also helps New Jersey residents become informed investors and promotes financial literacy. The Bureau adheres to the philosophy that investor protection begins with prevention. By registering broker-dealers, investment advisers and their agents who conduct business in New Jersey, the Bureau identifies potential problems before they occur. By registering securities, the Bureau requires issuers to provide the disclosures necessary for investors to make informed investment decisions. By conducting broker-dealer and investment adviser examinations, Bureau examiners identify violations and assure that the firms take corrective action to comply with the Uniform Securities Law and Regulations. Finally, by providing Investor Education materials and Check Before You Invest tools, the Bureau assists investors in making informed investment decisions. The Bureau collaborates with law enforcement agencies around the globe – from Scotland Yard to Australia – and its work has garnered national recognition and the respect of fellow prosecutors and regulators throughout the country. ABOUT THE POSITION: Under the supervision of Chief Bureau of Securities will: • Chief Investigator will serve as the Regulatory Chief for the Bureau, • Supervises the Regulatory activities of the Bureau of Securities, • Responsible for the investigative policy and programs, • Administration of confidential and sensitive administrative and regulatory audits;, • Coordinate civil and licensing investigations for the detection of alleged noncompliance with or violation of New Jersey State statutes,, • Administrative codes, or professional rules of conduct for the purpose of consumer protection, • Performs other related duties as assigned or required. REQUIRED QUALIFICATIONS: • Ten (10) years of professional experience in the conduct of civil or criminal investigations related to compliance, enforcement, detection, and surveillance activity, including the preparation of investigative reports, or in the conduct of investigative administrative audits and/or regulatory examinations of records maintained by businesses and organizations, or in the conduct of investigations for the government, the military, consumer protection programs, public advocacy organizations, or the public interest, three (3) years of which shall have been in the administration of investigative programs, initiatives, and regulatory and administrative audits.., • Possession of a bachelor's degree from an accredited college or university; and six (6) years of the above-mentioned professional experience, three (3) years of which shall have been in the administration of investigative programs, initiatives, and regulatory and administrative audits., • Possession of a master's degree in Criminal Justice, Public Administration, Business Administration, or a related field; and five (5) years of the above-mentioned professional experience, three (3) years of which shall have been in the administration of investigative programs, initiatives, and regulatory and administrative audits., • Appointees will be required to possess a driver's license valid in New Jersey. OTHER KEY FACTORS: • All offers of employment are conditional subject to the applicant agreeing to and then passing a background check that may include fingerprinting. BENEFITS: • Appointees may be eligible for a comprehensive benefits package that includes health, dental, and life insurance; a prescription drug plan; and vision care reimbursement. Participation in retirement and deferred compensation plans, as well as flexible spending and health savings accounts may also be available. Eligible employees receive annual paid sick and vacation leave as well as paid State holidays. Positions may offer telework or an Alternate Work Week (AWP) schedule. Benefit eligibility may vary based on job duties, operational needs, and funding. For more information, visit NJDPB. HOW TO APPLY: If qualified, please send a cover letter indicating interest in job vacancy announcement #26-062 and a current resume to the Recruitment Coordinator via email at . For more information, please visit

Are you ready to embark on a thrilling adventure in the world of covert surveillance? Team 360 Staffing, on behalf of Meridian Investigative Group, is seeking a Covert Surveillance Investigator to join their dynamic Investigative Team. Your mission, should you choose to accept it, is to uncover the truth behind worker’s compensation fraud with stealth and precision. As their covert sleuth, you'll embark on thrilling field surveillance adventures, blending seamlessly into the shadows to gather evidence. Your toolkit includes stationary and mobile surveillance tactics, capturing high-quality video and photographic proof of subjects in action. Crafting comprehensive investigative reports is just the beginning, you'll be uploading your findings into their cutting-edge case management system, readying them for the next thrilling chapter. Job type: Full-time or Part-time Responsibilities: • Conduct covert field surveillance using both stationary and mobile tactics., • Capture top-notch video and photographic evidence of subjects., • Prepare comprehensive investigative reports based on collected intelligence., • Upload findings into our cutting-edge case management system., • Conduct interviews and recorded statements, extracting key insights., • Provide compelling legal testimony when called upon., • Assist in setting up outside surveillance cameras for our Unmanned department. Requirements: • Excellent communication skills, both verbal and written., • Strong ability to gather, compile, and report data., • Capable of providing legal depositions and testimony., • Expertise in evidence gathering and organization., • Knowledge of legal documentation procedures. License/Certification Requirements: • Valid state-issued driver’s license., • Current auto insurance., • Possess an investigator license in the state of operation. Required Equipment: • Reliable vehicle., • Smartphone with access to the app store (Android OS 7 or higher, Apple iOS 11 or higher)., • Laptop computer with Microsoft Word, Windows, and wireless Internet., • Digital video camera with upload capability and accurate time/date stamp. Working Conditions: • Flexible hours with occasional overnight travel, weekend/evening work, and holiday shifts., • Work both indoors and outdoors, embracing various environments and conditions. Physical Requirements: • Ability to sit, stand, walk, and lift up to 50 pounds., • Sharp vision and focus for extended periods., • Moderate exposure to environmental elements. Benefits for Full-time employees: • Weekly Pay & Expense Reimbursement., • Company-paid PI License Renewal., • Vehicle Allowance & Fuel Card., • Cellphone Reimbursement., • Report Writing Pay & Break-Off Time Pay., • Per Diem & 401K with Employer Matching., • Health, Dental, Vision, & Life Insurance., • Accident & Critical Illness Insurance., • Paid Holidays & Time Off. Ready to uncover the truth while enjoying awesome benefits and perks? Apply now to join their elite team of covert operatives! Employment is subject to a background check.

Fraud and Abuse Investigator needed for long-term temporary opportunity. Please have at least 2 years of experience in fraud investigations.

Job Summary: Have you ever thought about becoming a Private Investigator? Are you ready to kick-start your career in a rapidly growing industry? Want to get paid to learn how to investigate fraud and conduct covert surveillance in the real world? Our Full-Time Entry-Level Field Investigator position

Our Special Investigations Unit (SIU) plays a vital role in identifying and mitigating risks associated with fraud and misconduct. We are seeking a meticulous and experienced SIU Investigator to join our team. Insurance Experience: Background in insurance, including workers' compensation, auto, liab

Affirmative Civil Enforcement (ACE) Investigator.CGS is seeking an experienced ACE Investigator with extensive knowledge and skills in investigative techniques and fraud detection to provide assistance for a large Federal agency initiative.CGS brings motivated, highly skilled, and creative people to

Our Special Investigations Unit (SIU) plays a vital role in identifying and mitigating risks associated with fraud and misconduct. We are seeking a meticulous and experienced SIU Investigator to join our team. Key responsibilities as an SIU Investigator include:.

Ethos Risk Services is a leading insurance claims investigation and medical management company, specializing in surveillance and fraud detection. Our dynamic Ethos team is seeking an Experienced Field Investigator to conduct surveillance and investigative activities to identify potential fraudulent

Covert Field Surveillance Investigator. Conduct covert field surveillance via both stationary and mobile surveillance. Conduct covert field surveillance with an emphasis on worker's compensation fraud and insurance fraud.

As a Criminal Investigator, the incumbent of this position will be responsible for investigations involving allegations of suspected violations of criminal statutes as they relate to fraud or corruption in various Department of Education programs.

CGS is seeking a Healthcare Fraud Investigator to provide legal support for a large government project in Nashville, TN. Analyze data for evidence of fraud, waste, and abuse. Minimum three (3) years of professional work experience in healthcare, fraud, or other related investigative field of work.

CGS is seeking a Healthcare Fraud Investigator to provide legal support for a large government project in Nashville, TN. Minimum three (3) years of professional work experience in healthcare, fraud, or other related investigative field of work. Relevant Healthcare Fraud experience including complian

Of course, this is just a sample of the kinds of work this role will require! You should assume that your role will encompass other tasks, too, and that your job duties and responsibilities may change from time to time at Etsy's discretion, or otherwise applicable with local law. If you're intereste

A leading insurance provider is seeking an SIU Field Investigator in New York, New York.

A national healthcare organization seeks a remote RN or LPN to audit medical records and identify billing practices. The ideal candidate should have coding experience and clinical expertise, ideally with a focus on fraud investigations. Applicants should hold an Associate’s Degree in a related fie

Job DescriptionHealthcare 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 We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

A leading insurance company is seeking an experienced SIU Field Investigator for its Special Investigations Unit in New York.

Job Description ABOUT US: Ethos Risk Services is a leading insurance claims investigation and medical management company, specializing in surveillance and fraud detection. At the forefront, we provide accurate data and actionable insights that translate into better decision-making for our clients. JOB SUMMARY: Our dynamic Ethos team is seeking a Special Unit Investigations (SIU) Field Investigator to conduct field investigations, gather and analyze evidence, and produce detailed reports that support claims decisions. You'll work both independently and collaboratively, often traveling to accident scenes, interviewing witnesses, and uploading documentation into our claims system. KEY RESPONSIBILITIES: • Scene Investigations: Conduct thorough on-site investigations of accidents and property losses., • Interviews & Statements: Conduct in-person interviews and obtain accurate, detailed statements from all parties involved., • Online Research: Gather case information through digital sources and background checks., • Report Writing: Draft thorough, detailed investigative reports summarizing findings and observations., • Case Documentation: Conduct in-person interviews and obtain accurate, detailed statements from all parties involved, and retrieve relevant documents to support investigative findings., • Case Management: Track case progress, time, and expenses accurately within Ethos systems., • Fraud Detection: Recognize compensability issues, misrepresentation, and other red flags in claims., • Client Communication: Maintain professional contact with clients and claim handlers throughout the investigation process. QUALIFICATIONS: Education: Associate's or Bachelor's degree in Criminal Justice or a related field preferred. Experience: • Minimum of 2 years of SIU experience with an investigative firm or insurance carrier, working across various lines of business such as liability, auto, and property., • Active Private Investigator license or willingness to obtain one (where required by state)., • A well-maintained and reliable vehicle for exclusive use., • SIU equipment, including a recorder and a high-quality digital camera., • A reliable laptop, cell phone, and internet service are needed for communication and administrative tasks. WORKING CONDITIONS: • While we aim to keep assignments within a 2-hour drive of your residence, occasional further travel and overnight stays (covered by the company) may be required., • Occasional weekend work may be required to align with case demands and or/client requests. Ethos Risk Services is an equal opportunity employer that does not discriminate on the basis of religious creed, sex, national origin, race, veteran status, disability, age, marital status, color or sexual orientation or any other characteristic. A background check will be conducted, in accordance to the local state law and regulations. Job Posted by ApplicantPro

Job Description Hi, we're Oscar. We're hiring a SIU Coding Auditor to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role The Senior Specialist works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations. You will report to the Manager, SIU Coding Audit. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. Pay Transparency: The base pay for this role in the states of New Jersey and New York is: $65,412 - $85,853 per year. The base pay for this role is: $58,870 - $77,267 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities • Develop a depth of expertise on CPT, HCPCS, and ICD-10 Coding guidelines and other insurance billing submission requirements., • Perform complex audits of assigned medical records and claims on both a prepayment and post payment basis to determine accuracy of claims submitted to Oscar., • Document findings including reference to sources used to support decision making and in a way that can be easily understood by non clinicians or coders., • Create audit report findings, tools, and reference guide that can be used by other team members to communicate findings or more effectively perform similar reviews., • Help draft written communications to providers to convey audit findings., • Participate in educational calls with providers., • Help train new team members., • Develop and document processes to improve the effectiveness of the team., • Compliance with all applicable laws and regulations, • Other duties as assignedQualifications, • 2+ years of coding or auditing experience across multiple specialties is required, • Bachelor's degree or 4+ years of work experience, • Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC) designation or similar certification, • Experience working in production-based environment, • Experience of both outpatient and inpatient auditingBonus Points, • Certified Professional Medical Auditor (CPMA), • Additional certification applicable to this work such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), other coding certifications or similar, • Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity, • Demonstrated experience translating technical jargon to non-technical end users., • Experience working in health insurance specifically with claims processing, billing, reimbursement, or provider contracting., • Experience with HIPAA, data privacy, and/or data security processes At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

Job Description For the past 28 years, Advantage Investigations has been the Nation’s only insurance defense investigation firm that invests in the operational capabilities necessary to produce consistent, high-quality results—ultimately helping our clients "See What’s True." With over 200+ licensed private investigators Nationwide, Advantage uses strategic planning and technology to give our clients greater clarity on a claimant's daily activities. Providing Covert Surveillance, Claims Investigations, Net-Sweep Investigations, Remote Controlled Surveillance, and more, we’re able to save our clients time and money on insurance fraud cases. Advantage Investigations is seeking a Full Time Private Investigator in the Newark, NJ & surrounding areas. The qualified candidate will be responsible for conducting covert surveillance, investigating daily activities, obtaining video evidence, and providing a clear report of all activities for our operations team along with basic claims investigations. As a private investigator, you will be provided with a comprehensive training program, door to door pay, fuel card, vehicle and phone allowance, top-of-the-line equipment, as well as other generous benefits. This position requires daily travel within the investigator’s area/territory. Duties & Responsibilities: • Conducting surveillance including covert, stationery, and mobile, • Conducting surveillance throughout their home state and surrounding states, • Recording subject activity on a video recording device, • Conducting alive and well checks, locates, basic scene investigations, paint sample analysis, EDR, and RCS deployments/retrievals, • Preparing and completing a written report of observations, • Uploading Video Evidence and a surveillance report Qualifications & Requirements: • Current NJ Private Investigator License preferred, • Private Investigator Licenses required – Licensing differs between states, • Previous experience related to surveillance/claims investigations is preferred, • Access to a reliable, suitable surveillance vehicle for day-to-day use, • Valid Driver’s License, • Ability to provide MVR (driving record), • Willingness to travel throughout home state and surrounding states for work, • Varying weekly work schedule includes weekend and holiday availability, • Good oral and written communication skills, • Self-motivated, ability to work independently, • Meet state mandated requirements to obtain and maintain a Private Investigator license multiple states, • Must pass a Drug Screen Compensation: Investigators are paid door to door at an hourly rate commensurate with experience, within $20.00 to $25.00 an hour. Employees are paid on a bi-weekly basis. Company Benefits: • Door to Door hourly pay, • Fuel Card provided, • Monthly Vehicle Allowance, • Monthly Cell Phone Allowance, • Equipment Provided, • Medical, Dental, Vision, and Disability insurance, • Life Insurance and other supplemental options, • Paid Lodging (when applicable), and per diem pay when out of town, • 401(k) – with match, • 2 weeks of PTO (paid time off), • Parental Leave Advantage Investigations is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Job DescriptionOverview Company Overview: Advance Your Career in Insurance Claims with Allied Universal® Compliance and Investigation Services. Allied Universal® Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you're ready to grow with the best, explore a career with us and make a difference. Job Description Allied Universal® is hiring a Special Investigations Unit (SIU) Investigator. Special Investigations Unit (SIU) Specialists investigate claims with red flags that suggest fraudulent behavior In relation to an Insurance claim. The SIU Specialist must use their extensive knowledge of Insurance policies and the components of fraud to determine If claims warrant reporting to the appropriate state agency for prosecution. • Must possess a valid driver's license with at least one year of driving experience, • Candidate must reside in state listed in job posting, • Pay Rate: $32 - $38 / hr RESPONSIBILITIES: • Independently investigate suspected fraudulent insurance claims for a variety of coverage to include workers' compensation, general liability, property and casualty and disability, • Acquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance, • Create and maintain detailed documentation for investigations, file reviews, audits, training tasks, consulting projects, and other assignments as directed, • Produce professional and expert reports, memos, and letters that are clear, concise, and grammatically correct, • Run appropriate database indices if necessary and verify the accuracy of results found, • Must possess one or more of the following:, • Bachelor's degree in Criminal Justice, • High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud, • Ability to be properly licensed as a Private Investigator as required by the state where work Is completed, • Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course, • Minimum of five (5) years of demonstrated experience conducting complex insurance investigations or adjusting complex insurance claims, • Proficient understanding and application of anti-fraud laws, insurance regulations, and compliance standards within their home state and designated regional area., • Proficient in utilizing laptop computers and cell phones., • Special Investigative Unit (SIU) Compliance knowledge, • Ability to type 40+ words per minute with minimum error, • Military experience, • Law enforcement, • Insurance administration experience, • Familiarity with California SIU regulations, • One or more of the following professional industry certifications:, • Certified Fraud Investigator (CFE), • Certified Insurance Fraud Investigator (CIFI), • Fraud Claim Law Associate (FCLA), • Fraud Claim Law Specialist (FCLS), • Certified Protection Professional (CPP), • Associate in Claims (AIC), • Medical, dental, vision, basic life, AD&D, retirement plan and disability insurance, • Seven paid holidays annually, sick days available where required by law If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: . Requisition ID 2026-1556202

Job Description Hi, we're Oscar. We're hiring a SIU Investigator to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role: The SIU Investigator identifies and investigates aberrant behavior observed in medical claims data and member enrollment data. You will manage an investigative caseload from case identification through to resolution, including data mining, investigation planning, data analysis, sampling, medical records requests, audit interpretation, overpayment recovery, reporting to regulatory agencies and monitoring ongoing provider behavior. The Senior Analyst will meet metrics set forth related to caseload, turn around times, and other unit-wide goals. You will report into the Investigations Manager, SIU. Work Location: This is a remote position, open to candidates who reside in: Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas and Virginia. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. If you live within commutable distance to our New York City office (in Hudson Square) or our Tempe office (off the 101 at University Ave), you will be expected to come into the office at least three days each week. Otherwise, this is a remote / work-from-home role. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. The base pay for this role in the states of New Jersey and New York is: $72,036 - $94,546 per year. The base pay for this role in all other locations is: $64,832 - $85,092 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities: • Identify and conduct investigations into suspected FWA with high autonomy, • Document findings to include formal investigative reports, tables, graphs, audit logs, and other supporting documentation, • Met metrics to align with caseload, turn around times, and other unit-wide goals, • Continue to monitor providers with substantiated findings to track behavior change, • Participate in the development and presentation of FWA-related education for Oscar teams, • Build evidentiary files for potential recovery, legal action, and/or referrals to appropriate outside agencies, • Compliance with all applicable laws and regulations, • 3+ years of healthcare fraud investigation experience or professional investigation experience with law enforcement agencies, • Bachelor's degree in Criminal Justice or a related field, • Experience with HIPAA, data privacy, and/or data security processes, • Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), or similar At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

Job DescriptionAffirmative Civil Enforcement (ACE) InvestigatorEmployment Type: Full-Time, Experienced Department: Legal Services CGS is seeking an experienced ACE Investigator with extensive knowledge and skills in investigative techniques and fraud detection to provide assistance for a large Federal agency initiative. CGS brings motivated, highly skilled, and creative people together to solve the government’s most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities. Skills and attributes for success:- The investigator will generate new investigations, and to continue with ongoing investigation and civil actions involving fraud in areas such as healthcare, contracting, and grants, as well as other fraud and abuse of federal public funds and programs.- Regularly meets with the ACE attorneys and with designated agency personnel for the purpose of generating fraud investigations.- Performs a variety of ancillary investigations-related services in direct support of any assigned fraud- Utilizes electronic databases such as public records, property records, business records, and other government-maintained databases, to identify documents, witnesses and other physical evidence.- Prepares reports on progress of investigations for use by AUSAs and supervisory attorneys. These reports may include significant findings and conclusions, analyses of information located in electronic databases, presentations, recommendations for additional investigative actions and candid assessments of strengths and weaknesses of witnesses, documentary evidence, or other aspects of a case.- Examines books, ledgers, payrolls, cost reports, billing statements, invoices, correspondence, computer data, and other records pertaining to the transactions, events, or allegations under investigation.- Performs sophisticated analyses of large-scale hard-copy and electronic data, such as health care claims data, financial transaction data, accounting records, or bank records to develop investigative leads and to determine their potential relevance to the allegations at issue.- Gathers and analyzes facts including witness statements, timelines, and scientific or technical data for the purpose of advancing investigative objectives. Establishes and verifies relationships between facts and evidence obtained or presented to confirm authenticity of documents, to corroborate witness statements, and to otherwise build proof necessary for successful litigation or settlement.- Develops and analyzes evidence and collects information relating to such evidence, or other legal matters under consideration, from appropriate primary and secondary sources. Performs analysis to clarify the target suspect's or organization's pattern of operations, to identify information relevant to the legal issues involved, and to recommend valuable approaches to the AUSAs or other members of the investigative team. Develops and refines proof required to assist in determining legal responsibility for violations.- Assists ACE AUSAs with in-person and/or telephonic interviews of witnesses, depositions, and sworn witness examinations.- Assists with the preparation and service of subpoenas for documentary materials, interrogatory answers, or witness testimony in connection with ACE investigations.- Develops an understanding of all applicable federal, state, or local laws to the extent necessary to make sound decisions on direction and scope of investigations. Determines proof required to affix responsibility for violations, and devise methods for obtaining, preserving, and presenting evidence to the greatest effect.- Assists with determining the most efficacious methods for planning, scheduling, and conducting investigations, and identifies any resources that may be required.- Performs other related ACE investigator duties as assigned and within scope.- Attends meetings and trainings as may be required and appropriate. Qualifications:- Computer Skills: Applicant shall have the ability to use MS Word, MS Excel, MS Outlook, MS Access, and other databases as well as Adobe Acrobat Professional. Experience with working on document review/management platforms such as Relativity, with analyzing spreadsheets of claims data, and with utilizing docketing software is a plus.- Ability to review and understand the import of a wide variety of documents, both legal and non-legal, including Motions and Briefs.- Ability to think independently and to develop investigative strategies in response to the needs of a specific case.- Communication skills are extremely important. Applicant shall work and interact professionally and effectively with all levels of staff.- Ability to meet established deadlines and work as a team player in a professional office.- Skill in meeting and dealing with people in a courteous and tactful manner. Our Commitment:Contact Government Services (CGS) strives to simplify and enhance government bureaucracy through the optimization of human, technical, and financial resources. We combine cutting-edge technology with world-class personnel to deliver customized solutions that fit our client’s specific needs. We are committed to solving the most challenging and dynamic problems. For the past seven years, we’ve been growing our government-contracting portfolio, and along the way, we’ve created valuable partnerships by demonstrating a commitment to honesty, professionalism, and quality work. Here at CGS we value honesty through hard work and self-awareness, professionalism in all we do, and to deliver the best quality to our consumers mending those relations for years to come. We care about our employees. Therefore, we offer a comprehensive benefits package.- Health, Dental, and Vision- Life Insurance- 401k- Flexible Spending Account (Health, Dependent Care, and Commuter)- Paid Time Off and Observance of State/Federal Holidays Contact Government Services, LLC is an Equal Opportunity Employer. Applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Join our team and become part of government innovation! Explore additional job opportunities with CGS on our Job Board: more information about CGS please visit: or contact:Email: #CJ We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.