Investigator

• Plan and conduct data exfiltration investigations independently
• Produce investigative outcomes and determinations capable of withstanding judicial or administrative scrutiny
• Investigate noncompliance with customer regulatory requirements, company policies and procedures, and violations of law
• Write detailed professional investigative reports
• Conduct employee and challenging subject interviews
• Securely store relevant case artifacts in the Resolver Case Management System
• Collaborate with CI&I members, GSS colleagues, and cross-functional partners
• Provide feedback to Enterprise Services on tools and processes for identifying potential indicators of concern
• Provide cognizant FSOs with investigative details for adverse information reporting involving cleared employees
• Assist the CI&I Investigations Team with other investigations as needed

Counterintelligence investigator protecting RTX aerospace and defense systems from insider data exfiltration

Counter-Intelligence Data Exfiltration Investigator

Counterintelligence investigator protecting RTX aerospace and defense systems from insider data exfiltration. Conducting investigations, interviews, reporting, and threat analysis using UAM, Splunk, and Endpoint DLP.

• Accept assignments from customers for investigation of losses or claims and pursue investigations according to assignment requirements
• Determine the origin and cause of losses or claims and identify potential third-party responsibility for subrogation
• Maintain required client reporting commitments according to EFI procedures
• Promote and market EFI services within the insurance industry and assigned territory
• Liaise between insurance industry representatives and law enforcement/fire service personnel
• Investigate losses or claims involving illegal, fraudulent, or subrogation aspects
• Identify and interview witnesses and involved persons
• Inspect public records, including land deeds, mortgages, liens, suits, judgments, and marriage and divorce records
• Maintain current knowledge of privacy laws and public-record availability to ensure legal and ethical investigations
• Travel as required
• Perform other duties as assigned

Fire Investigator conducting origin-and-cause investigations for EFI Global’s forensic consulting services

Fire Investigator

Fire Investigator conducting origin-and-cause investigations for EFI Global, a forensic engineering and specialty consulting firm. Determining responsibility and delivering defensible findings across Texas.

• 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.

• Conducts investigations into fraud cases
• Coordinates investigative assets and conducts field investigations
• Analyzes fraud schemes and prepares for litigation
• Collaborates with external agencies for documentation gathering
• Provides training and support to other investigators

Investigator handling complex fraud cases for GEICO

Internal Major Case SIU Investigator

Investigator investigating large-scale fraud cases involving multiple jurisdictions for GEICO. Conducting analyses, collaborating with law enforcement, and providing support to other investigators.

• Investigates & analyzes the origin and cause of fire and explosion events
• Collects evidence and documents scenes
• Interviews witnesses and identifies compliance with applicable codes
• Prepares accurate reports and recommendations

Part-Time Fire Investigator analyzing fire and explosion incidents

Fire Investigator, Part Time

Part-Time Fire Investigator focusing on fire and explosion investigations in Texas. Engaging with clients and stakeholders while ensuring compliance with codes and reporting standards.

• Monitor, follow, and videotape subjects as they conduct their day-to-day activities
• Participate in vehicle and foot pursuit of subjects while maintaining cover
• Film subjects in various locations (e.g., grocery stores, sports games)
• Craft pre-surveillance strategies based on case details
• Write detailed reports on observed activities and submit video evidence
• Communicate regularly with team leader regarding setup positions and tactics

Surveillance Investigator for DigiStream Investigations in Texas

Surveillance Investigator

Surveillance Investigator conducting covert investigations and monitoring subjects for DigiStream Investigations. A fast-growing private investigation firm providing evidence for Worker's Compensation and Liability cases in Texas.

• Conduct timely investigations including recorded statements and interviews of claimants, witnesses, and employers.
• Provide timely status updates to case manager and client.
• Timely and clear documentation of the claim files.
• Maintain highest level of confidentiality and professionalism.
• Develop appropriate investigative action plan.
• Ensure accuracy, quality and timeliness of the evidence gathered during an investigation as well as compliance with all applicable laws, legal codes, and governing agencies.
• Provide Claim Adjuster with timely investigation results and document investigative findings.
• Determine whether additional evidence is required including but not limited to accident reports, accident scene reconstructions, witness statements, police reports, expert opinion, etc.
• Provide recommendations and decisions surrounding investigative efforts.
• Perform detailed database queries on SIU investigations to include analysis and organization of critical data to assist during the assigned investigation.
• Be able to evaluate State compliance referrals, as applicable, when questionable or suspicious activity is identified.
• Maintain active membership in professional organizations that provide SIU assistance and resources.
• Establish and maintain relationships with law enforcement, government regulatory agencies and insurance industry personnel assisting when needed or required.

Investigator in a national firm specializing in insurance claims

SIU Investigator

Investigator in Delta Group's Special Investigation Unit focusing on insurance claims. Conducting thorough investigations and collaborating with clients and regulatory agencies.

• Monitoring, following, and videotaping subjects as they conduct their day-to-day activities
• Vehicle and foot pursuit of subjects while maintaining cover
• Activity varies from filming someone at a grocery store to filming them at a sports game
• Crafting pre-surveillance strategies based on the setup location and case details
• Detailed report writing on the activities observed/captured and submission of video evidence
• Regular communication with team leader on setup positions, activity and tactics

Surveillance Investigator conducting investigations for claims defense in Texas

Surveillance Investigator working with DigiStream Investigations on claims-related investigations in Texas. Requires travel and flexible hours with hands-on training provided.

• Assist the Principal Investigator (PI) in overseeing and managing clinical trials conducted at the research site, ensuring adherence to the study protocol, Good Clinical Practice (GCP), ICH guidelines, and all applicable regulatory requirements.
• Provide medical oversight and ensure the safety and well-being of study participants throughout the trial, under the supervision of the PI.
• Perform delegated study-related duties as assigned by the PI, which may include comprehensive patient assessments, physical exams, medical histories, and eligibility screenings.
• Review and interpret eligibility, laboratory results, ECGs, and other diagnostic tests as required by the protocol and under PI supervision.
• Assist the PI in making medical decisions regarding participant care, adverse events, and protocol deviations.
• Ensure accurate, complete, and timely collection and documentation of all study data.
• Communicate effectively with the PI, study team, and, as delegated, with sponsors, Contract Research Organizations (CROs), Institutional Review Boards (IRBs), and regulatory authorities.
• Assist with investigational product accountability, storage, and administration according to protocol.
• Participate in site initiation visits, monitoring visits, audits, and inspections as required.
• Maintain continuous medical education and stay current with advancements in clinical research and relevant therapeutic areas.

Nurse Practitioner or Physician Assistant leading clinical trials at Hawthorne Health.

Sub Investigator, NP/PA-C

Nurse Practitioner or Physician Assistant leading clinical trials at a community-based research site. Ensuring adherence to protocols and participant safety in Conroe, TX.

Sub Investigator leading clinical trials for community-based research site

Sub Investigator leading clinical trials in hybrid position at a community-based research site in McAllen, TX. Seeking NP or PA-C experienced in managing clinical trials.

• 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 supporting a large Federal agency initiative.

Civil Enforcement Investigator

ACE Investigator with expertise in fraud detection and investigative techniques for a Federal agency initiative. Collaborating with attorneys and conducting investigations on various fraud cases.

Investigator jobs in Texas

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Counter-Intelligence Data Exfiltration Investigator

Fire Investigator

Clinical Investigator, Behavioral Health

Internal Major Case SIU Investigator

Fire Investigator, Part Time

Surveillance Investigator

SIU Investigator

Surveillance Investigator

Sub Investigator, NP/PA-C

Sub Investigator, NP/PA-C

Civil Enforcement Investigator