Investigator

• Investigate and analyze complex, multi-discipline coverage and claims referred to the Special Investigation Unit for potential fraud
• Conduct background searches, scene investigations, clinic inspections, recorded statements, witness interviews, and social media searches
• Review and analyze medical notes, bills, and property damage
• Conduct surveillance and create scene reconstructions when needed
• Determine whether fraud can be substantiated and support lawsuits
• Enter SIU claim data into multiple systems
• Review investigations with fraud outcomes and validate whether denial is appropriate
• Update files with investigation outcomes and return files for further handling when fraud is not established or evidence is insufficient
• Conduct online data application searches, research, evaluations, and complex site inspections
• Validate investigative information, follow up on leads, summarize documents, and document claim-file decisions
• Use analytic tools or SIU field intelligence to identify complex claims and support fraud and damages evidence
• Research and respond to complex customer communications, concerns, conflicts, or issues
• Provide work guidance, mentoring, and coaching to less senior employees and the team

SIU Field Investigator investigating suspected insurance fraud for National General, an Allstate insurance company

SIU Field Investigator

SIU Field Investigator investigating suspected insurance fraud for National General, an Allstate insurance company. Conducting field investigations, surveillance, interviews, inspections, and claims analysis across New York.

• Conduct covert, stationary, and mobile surveillance
• Conduct surveillance throughout the investigator's home state and surrounding states
• Record subject activity using a video recording device
• Conduct alive-and-well checks, locates, basic scene investigations, paint sample analysis, EDR, and RCS deployments/retrievals
• Prepare and complete written reports of observations
• Upload video evidence and surveillance reports
• Provide clear reports of activities to the operations team
• Conduct basic claims investigations
• Travel daily within the assigned area or territory

Private investigator conducting insurance surveillance and claims investigations for Advantage Investigations

Field Investigator

Private investigator conducting covert surveillance and claims investigations for Advantage Investigations, an insurance defense investigation firm. Gathering video evidence and reporting claimant activities across Buffalo and surrounding states.

• Conduct comprehensive reviews of medical records and documents supporting claims for providers, suppliers, and pharmacies
• Provide investigative support to the Special Investigations Unit related to coding and billing issues
• Identify potential overpayments and suspected health care fraud and abuse
• Verify service authorizations and documentation against claim information
• Coordinate medical necessity and level-of-care determinations with Medical Directors
• Validate services against CMS and state-specific coverage, limitations, and exclusion guidelines
• Determine code appropriateness using administrative, medical, claim, and financial records
• Develop reports of findings and recommendations
• Communicate complex audit findings in meetings and judicial hearings
• Assist SIU investigators during interviews, discussions, and negotiations
• Perform retrospective and prepayment medical-record reviews
• Investigate provider billing patterns and determine payment based on records, claim history, codes, regulations, and policies
• Prepare findings summaries and recommend next steps for providers
• Identify preventative measures and recommend policy, procedure, and provider-practice changes
• Collaborate with investigators to identify fraud, waste, and abuse using clinical and coding expertise
• Perform other assigned duties and comply with policies and standards

Clinical Investigator reviewing behavioral health claims and detecting fraud for Centene’s healthcare members

Clinical Investigator, Behavioral Health

Clinical Investigator reviewing behavioral health claims and medical records for Centene, a national healthcare solutions provider. Identifying fraud, waste, abuse, overpayments, and billing irregularities for SIU investigations.

• Investigate complex cases involving phishing, blockchain exploits, hacks, terrorism finance, account takeovers, scams, money laundering, ransomware, and other illicit use of blockchain technology.
• Produce insightful reports and deliver them in writing and in briefings to TRM's customers.
• Conduct long-term research on key categories of on-chain crime, turning it into intelligence TRM's partners can act on.
• Support sensitive and complex investigations for TRM's public and private sector partners.
• Proactively identify, build, and manage relationships with industry partners to add new sources of attribution to TRM's pipeline at scale.

Global Investigator at TRM Labs conducting blockchain investigations and analysis

Global Investigator

Global Investigator at TRM Labs conducting blockchain investigations and complex case analyses. Collaborating with teams to provide intelligence solutions for clients in public and private sectors.

• Conduct field-based investigations related to Medicaid fraud, abuse, or non-compliance, aligned with UPIC protocols and state-specific Medicaid rules.
• Interview healthcare providers, beneficiaries, and witnesses to gather key case evidence.
• Analyze Medicaid claims, billing patterns, and supporting documentation to identify irregularities or suspicious activity.
• Prepare detailed investigative reports suitable for law enforcement referrals, overpayment recovery, or administrative actions.
• Collaborate with law enforcement entities, state Medicaid agencies, and CMS stakeholders.
• Maintain and manage documentation and case files in compliance with CMS and contractual standards.
• Represent Purisolve with professionalism and discretion during field engagements and stakeholder communications.

Medicaid Investigator focusing on fraud and compliance investigations in Northeast US

Medicaid Investigator – Northeast

Medicaid Investigator focusing on fraud and compliance investigations under NE UPIC contract. Responsible for field investigations and collaborate with law enforcement in the Northeastern US.

• 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

Full Time Private Investigator conducting surveillance and investigations for Advantage Investigations

Full Time Private Investigator conducting surveillance and investigations in Queens, NY for Advantage Investigations. Responsible for covert surveillance and documenting activities to support clients' needs.

Full Time Private Investigator conducting covert surveillance and claims investigations

Full Time Private Investigator at Advantage Investigations conducting covert surveillance and claims investigations. Responsible for obtaining video evidence and providing reports for operations team.

Full Time Private Investigator for Advantage Investigations conducting surveillance and investigations. Responsible for covert activities and delivering accurate reports on findings.

• Conduct database research via the internet and industry databases
• Review and analyze case notes and case instructions to determine pertinent information
• Complete detailed reports on findings within designated turnaround timeframe
• Collaborate with team members to identify accurate databases
• Edit investigative reports for quality and compliance
• Conduct covert surveillance and activity checks for investigations
• Capture and document video footage and complete reports with timestamps
• Maintain strict confidentiality and adhere to legal/ethical guidelines
• Adapt to irregular hours as investigations require
• Attend and testify at hearings when necessary

Hybrid Investigator conducting surveillance and research in Lincoln for Frasco Inc

Hybrid Investigator conducting pre-surveillance research and field surveillance for Frasco Inc in Lincoln, NE. Excellent opportunity for those looking to gain experience in investigations and surveillance.

• 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.

ACE Investigator providing fraud investigation support to federal agency

Civil Enforcement Investigator

ACE Investigator role focused on fraud investigations in healthcare and contracting. Join CGS in innovating government solutions through investigative expertise and collaboration.

• Investigate reports, leads, and escalations involving violent threats, coordinated abuse, and other threats to public safety.
• Use SQL and Codex to query large datasets, analyze user behavior, identify suspicious activity, and uncover novel abuse patterns.
• Utilize Python and Codex to automate investigative workflows, process and analyze data, develop abuse detection methodologies, and improve operational efficiency.
• Develop and refine abuse signals, behavioral indicators, and tracking methodologies that enable scalable detection and enforcement.
• Partner closely with engineering teams to design and improve internal tooling, data pipelines, reporting capabilities, and investigations. Use metrics to evaluate automated workflow efficiency.
• Conduct rapid triage and investigation of urgent escalations, exercising sound judgment in ambiguous situations.
• Communicate investigative findings and recommendations to stakeholders across Policy, Legal, Product, Engineering, and Leadership teams.
• Translate investigative insights into long-term product, policy, and safety improvements.
• Contribute to an on-call rotation supporting time-sensitive investigations and threat assessments.

Abuse Investigator analyzing threats and abusive behaviors on OpenAI’s platform

Abuse Investigator

Abuse Investigator analyzing threats and abusive behaviors on OpenAI’s platform by investigating violent threats and automating data analysis. Collaborating with policy, engineering, and integrity teams on enforcement actions.

• Detect, investigate and disrupt abuse and harm with policy, legal, global affairs, security, and engineering teams via complex datasets
• Develop and iterate on abuse signals and investigative methods, scaling one-off insights to reduce manual effort and expand coverage.
• Build and maintain lightweight technical solutions (e.g., SQL/ Python data pipelines, investigation templates, dashboards, or internal utilities) for investigators focused on specific harm domains.
• Develop a deep understanding of OpenAI’s products, data systems, and enforcement mechanisms, and collaborate with engineering and data teams to improve investigative tooling, data quality, and workflows.
• Communicate investigation findings effectively to internal stakeholders through written briefs, data-backed recommendations, and escalation summaries
• Rotate (in-frequently) into an incident response role that requires rapid threat triaging, investigation, mitigation, sound judgement and concise briefing to senior leadership
• Be someone people enjoy working with
• Proven ability to quickly learn new processes, systems and team dynamics while thriving in ambiguous, rapidly changing, and high-pressure environments.

Technical Abuse Investigator detecting and disrupting malicious use of OpenAI’s platform

Technical Abuse Investigator

Technical Abuse Investigator on the Intelligence and Investigations team at OpenAI. Responsible for detecting and disrupting malicious use of OpenAI’s platform with strong technical fluency.

Investigator jobs in New York

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SIU Field Investigator

Field Investigator

Clinical Investigator, Behavioral Health

Global Investigator

Medicaid Investigator – Northeast

Field Investigator

Field Investigator

Field Investigator

Investigator

Civil Enforcement Investigator

Abuse Investigator

Technical Abuse Investigator