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.

• Independently conduct extensive and detailed investigations to determine the origin and cause of fires and explosions
• Investigate large loss, large fire loss, multiple claims, and suspected insurance fraud claims
• Investigate sites and provide expert testimony in depositions and trials
• Report assigned cases to requesting parties according to best practices
• Maintain confidential claims files and document relevant facts in claims handling systems
• Keep management informed of developments affecting claims results
• Review investigations and recommend outcomes promptly
• Provide guidance and recommendations to claims leadership and associates on claims resolution
• Develop and maintain relationships with government agencies and private information bureaus
• Identify and interview witnesses and involved persons
• Conclude investigations independently and determine negligence and violations of laws
• Inspect public records, including deeds, mortgages, liens, suits, judgments, and marriage and divorce records
• Maintain technical competency regarding applicable laws, privacy rights, and public-record availability
• Provide investigative guidance to Fire Investigator team members when needed
• Support quality programs and travel as required

Fire investigator determining fire origins and causes for EFI Global’s forensic consulting services

Senior Fire Investigator, IAAI-CFI

Fire Investigator determining fire origins and causes for EFI Global’s forensic consulting services.
Providing defensible findings, expert testimony, and insurance-fraud investigations across Southern California.

• 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.

• 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 suspected insurance fraud involving auto, property, casualty, workers’ compensation, and other personal, commercial, and specialty lines of business.
• Collaborative with internal stakeholders and external partners to evaluate and investigate suspicious insurance transactions (claims, underwriting, policy, etc.), collect evidence, support fraud detection programs, and communicate investigative findings to internal and external partners, regulators, and law enforcement.
• Support fraud detection and investigation by identifying red flags, gathering facts, and documenting evidence in compliance with company policy and legal requirements.
• Review claim files for basic red flags (inconsistencies, late reporting, coverage anomalies, questionable damages, medical billing issues).
• Apply checklists, referral criteria, and scoring tools to determine whether further investigation is warranted.
• Conduct thorough investigations of suspect insurance claims on moderate to high complexity cases with minimal supervision.
• Meticulous attention to detail to ensure accuracy and thoroughness in investigations and ensure efficient and effective investigations are completed using the most appropriate method of investigation through either field, desktop, or combination thereof.
• Evaluate, coordinate, and recommend investigative action plans in collaboration with claims, underwriting, and legal partners.
• Coordinate and monitor outside vendor activity related to assigned SIU investigations.
• Prepare detailed investigative reports for internal decision-making; support referrals to law enforcement or legal action when necessary, and where applicable to state fraud bureaus.
• Stay informed on regulations and statutes as well as internal protocols and procedures.
• Maintain thorough documentation of investigative actions and work products in accordance with accepted SIU operating standards and best practices.
• Serve as a subject matter expert for claims and/or Underwriting Department training on the detection, deterrence, and prevention of fraud.

Investigator II handling insurance fraud investigations for West Bend

Investigator II – Special Investigations Unit, Tennessee, North Carolina, Kentucky, Virginia

Investigator II handling insurance fraud investigations for West Bend, focusing on various personal, commercial, and specialty lines. Collaborating with internal stakeholders and external partners to evaluate and investigate suspicious transactions.

• Investigate suspected insurance fraud involving auto, property, casualty, workers’ compensation, and other personal, commercial, and specialty lines of business.
• Work independently and collaboratively with internal stakeholders and external partners to evaluate and investigate suspicious insurance transactions (claims, underwriting, policy, etc.), collect evidence, support fraud detection programs, and communicate investigative findings to internal and external partners, regulators, and law enforcement.
• Support fraud detection and investigation by identifying red flags, gathering facts, and documenting evidence in compliance with company policy and legal requirements.
• Review claim files for basic red flags (inconsistencies, late reporting, coverage anomalies, questionable damages, medical billing issues).
• Conduct and lead thorough investigations of suspect, high exposure, and complex insurance claims and underwriting/policy concerns, including personal, commercial, and specialty lines of business – including property, auto, workers compensation, and other coverage types.
• Prepare detailed investigative reports for internal decision-making; support referrals to law enforcement or legal action when necessary, and where applicable to state fraud bureaus.
• Maintain thorough documentation of investigative actions and work product in accordance with accepted SIU operating standards and best practices.

Senior Investigator handling insurance fraud investigations for West Bend.

Senior Investigator – Special Investigations Unit, Illinois, Indiana, Michigan

Senior Investigator handling insurance fraud investigations across Illinois, Indiana, and Michigan for a top workplace. Collaborating with internal and external partners to evaluate suspicious transactions.

• 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 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.

SIU Investigator conducting investigations for Delta Group's insurance claims

SIU Investigator

SIU Investigator conducting investigations for Delta Group's insurance claims, specializing in Workers’ Compensation. Engaging with claims personnel and government agencies to identify fraud.

Investigator in Delta Group's Special Investigation Unit focusing on insurance fraud

Investigator in Delta Group's Special Investigation Unit focusing on identifying and preventing fraudulent insurance claims. Responsibilities include conducting investigations, interviews, and maintaining documentation for compliance.

SIU Investigator conducting insurance investigations in Chicago area

SIU Investigator conducting insurance claims investigations including fraud prevention and detailed reporting in Chicago area. Essential skills include strong investigative abilities and communication.

• 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.

• Investigate and take action on suspicious fraud and potential AML activity across the entire Moov payment network.
• Monitor transaction activity and alert queues for indicators of fraudulent behavior or money laundering.
• Author detailed investigative reports on suspicious activity and escalate cases to management or regulatory bodies as necessary.
• Maintain accurate case records and documentation throughout the investigation lifecycle.
• Manage daily KYC (Know Your Customer) and KYB (Know Your Business) onboarding activity queues.
• Perform enhanced due diligence on merchants enrolling to use the Moov payment processing platform.
• Conduct in-depth onboarding investigations specific to Card and Banking payment platforms.
• Perform merchant underwriting evaluations as part of the onboarding and ongoing review process.
• Work closely with Moov Support to validate new partners joining the Moov network.
• Assist management with the creation, documentation, and ongoing refinement of FRAML processes and procedures.

Moov FRAML Investigator ensuring compliance in financial services.

Moov FRAML Investigator overseeing fraud investigations and AML compliance for financial services company. Managing onboarding and due diligence for merchant activity in the Moov payment network.

• Receives, analyzes and coordinates fraud and abuse complaints from internal sources (customer services, claims processing, underwriting, professional affairs) and external sources (members, providers, state and federal regulatory agencies, law enforcement), then conducts and coordinates moderately complex investigations with expertise across various case types, participating in post-audit exit interviews where appropriate.
• Provides accurate accounting of recovered funds from audit activities, criminal or civil convictions and settlements, demonstrating continuing success in settlement, recovery and collection activities related to fraudulent activity.
• Maintains continuing education through anti-fraud and legal issue seminars, holds at least one professional credential (CPC, CPC-H or CPC-P), reviews pertinent articles and regulatory requirements, and provides post-audit education to providers to correct discrepancies, and trains new Investigators and other Cambia employees in detection of abusive or fraudulent billing practices.
• Assists with maintenance of audit and investigation files, formulation of company policies addressing loss exposures and solutions, and maintains extensive contact with the provider community in both educational and potentially confrontational or adversarial investigative roles.
• Issues audit findings and prepayment claim determinations, including maintaining clear documentation of the basis of findings and determinations, and maintaining the required professional judgment to support and deliver them independently.
• Represents company at external and internal meetings dealing with fraud and abuse issues and litigation proceedings, testifies in court as required, and develops professional working relationships with various associations and agencies for detection of local and national fraud and abuse schemes.
• Conducts witness and target interviews, identifying and analyzing evidence, examining records to verify document authenticity, preparing and evaluating investigation reports, providing information for affidavit preparation, and maintaining communications with law enforcement and regulatory agencies to present case findings for further investigation, prosecution or administrative remedies.

SIU Investigator conducting investigations into fraud and abuse allegations

Special Investigations Unit Investigator II – III

SIU Investigator conducting investigations into fraud and abuse allegations for Cambia Health Solutions. Perform audits and provide investigative support while educating others on fraud prevention.

• Accountable for complete investigation of claims suspected of fraud
• Responsible for investigating claims that have indicators of potential misrepresentation
• Investigations may include examination of documents, files, interviewing witnesses, and coordinating forensic work
• Occasionally required to testify in court proceedings in person or remotely, and complete sworn affidavits
• Acts as a liaison for the Claims Staff in fraud training, awareness, and investigation
• Proactively reviews files to identify potentially questionable claims
• Engages in learning opportunities to build knowledge of personal lines claims
• Provides input for continuous development of SIU and Claims best practices
• Interacts and communicates effectively with customers, peers, vendors, and managers

SIU Investigator II investigating claims suspected of fraud for an insurtech company

SIU Investigator II

SIU Investigator II investigating automobile injury and property damage claims suspected of fraud. Supporting the claims team with thorough investigations, while leveraging technology in an insurtech environment.

• Accountable for complete investigation of claims suspected of fraud.
• Acts as a Liaison for the Claims Staff in fraud training, awareness, and investigation.
• Proactively reviews files to identify potentially questionable claims.
• Engages in learning opportunities to build knowledge of personal lines claims, court decisions impacting the claims function, current guidelines in claims function, and policy changes and modifications.
• Provides input for continuous development of SIU and Claims best practices.
• Interacts and communicates effectively with customers, peers, vendors, and managers.
• Provides technical claims recommendations in an effort to improve case outcomes.
• Recommends potential product developments and process improvements.

SIU Investigator ensuring fair investigations for an innovative insurtech company

SIU Investigator I

SIU Investigator at Root Insurance, enforcing fundamental fairness in insurance investigations. Utilizing technology and data to improve claims experiences in a flexible work environment.

• Investigate fire events to determine origin, cause, and responsibility
• Accepts assignments from customers for investigation of losses or claims
• Determines the origin and cause of the loss/claim
• Maintains required reporting commitments to client in accordance with EFI’s standard procedures
• Serves as a liaison between the insurance industry and law enforcement/fire service personnel
• Investigates losses/claims with illegal, fraudulent or subrogation aspects
• Identifies and interviews all witnesses or involved persons
• Develops necessary knowledge and expertise required to conduct thorough inspection of available public records
• Maintains up-to-date information regarding existing laws pertaining to rights of privacy and availability of public records

Fire Investigator responsible for determining origin and cause of fire events

Fire Investigator responsible for investigating fire events and determining origin and cause. Work includes liaising with clients and maintaining legal compliance in investigations.

• 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.

• Transcribe data to files in a complaint handling system.
• Open new files, link files together, and enter approved investigation data.
• Transfer complaint data into regulatory reports for submission.
• Run queries of upcoming regulatory reports needed for regulatory agencies.

Complaints Handling Investigator for medical devices company transcribing complaint data.

Complaints Handling Investigator – Entry Level

Complaints Handling Investigator transcribing data to regulatory reports for a medical devices company. Requires communication skills and experience with software programs.

Investigator jobs in United States

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Counter-Intelligence Data Exfiltration Investigator

Senior Fire Investigator, IAAI-CFI

Fire Investigator

SIU Field Investigator

Field Investigator

Clinical Investigator, Behavioral Health

Investigator II – Special Investigations Unit, Tennessee, North Carolina, Kentucky, Virginia

Senior Investigator – Special Investigations Unit, Illinois, Indiana, Michigan

Global Investigator

SIU Investigator

SIU Investigator

SIU Investigator

Internal Major Case SIU Investigator

Investigator

Special Investigations Unit Investigator II – III

SIU Investigator II

SIU Investigator I

Fire Investigator

Medicaid Investigator – Northeast

Complaints Handling Investigator – Entry Level