Top 30 Medical fraud investigator Jobs in North Carolina

Senior Investigator, Special Investigations Unit (Aetna SIU)
CVS Health —North Carolina
- $46,988 - $112,200 a year
- Full-time
- Remote
- Research
- Mid-level
- 3 years
- Health insurance
- Dental insurance
13d
Investigator, Special Investigations Unit (Aetna SIU)
CVS Health —Raleigh, NC
- $43,888 - $93,574 a year
- Full-time
- Microsoft Word
- Spanish
- Microsoft Excel
- Health insurance
- Dental insurance
6d
Senior Compliance Investigator
Centene —North Carolina
- $70,100 - $126,200 a year
- Full-time
- Remote
- Writing skills
- High school diploma or GED
- Fair chance
- Paid holidays
- Health insurance
Investigator, Special Investigations Unit (Meritain Health)
CVS Health —Raleigh, NC
- $46,988 - $122,400 a year
- Full-time
- Customer service
- Research
- Mid-level
- Health insurance
- Dental insurance
5d
Investigative Specialist
State of North Carolina - Insurance —Wake County, NC
- $43,267 - $55,000 a year
- Online Application
- Writing skills
- Office
- Administrative experience
- Paid holidays
- Health insurance
4d
Clinical Research Associate, Full Service
5PY IQVIA RDS Inc. —Durham, NC
- $47,400 - $169,300 a year
- Full-time
- Microsoft Excel
- Computer literacy
- English
12d
FT Private Investigator - Charlotte, NC
Delta Group —Charlotte, NC
- $20 - $30 an hour
- Full-time
- Remote
- Background check
- 18 years or older
- Clean driving record
- Disability insurance
- Health insurance
Senior Trade Compliance Investigator
Honeywell —Charlotte, NC
- $101,000 - $126,000 a year
- Full-time
- Hybrid work
- 5 years
- Office
- Finance
- Health savings account
- Paid holidays
Senior QA Auditor - GCP Audits
IQVIA —Durham, NC
- $75,400 - $188,600 a year
- Full-time
- Up to 50% travel
- 5 years
- Word processing
CRA 1, IQVIA Biotech
IQVIA —Durham, NC
- $71,900 - $145,300 a year
- Full-time
- Bachelor's degree
- Travel
- Communication skills
Medical Science Liaison Immunology - Admilparant (NC)
Bristol-Myers Squibb —Raleigh, NC
- $166,090 - $201,262 a year
- Email
- Hybrid work
- Medicine
- English
- Mid-level
- Paid holidays
- Disability insurance
Clinical Research Associate, IQVIA Biotech
IQVIA —Durham, NC
- $71,900 - $169,300 a year
- Full-time
- Bachelor's degree
- Travel
- Experience equivalent to degree accepted
Clinical Research Associate 2, IQVIA
IQVIA —Durham, NC
- $71,900 - $189,000 a year
- Full-time
- Microsoft Excel
- Computer literacy
- English
FSP Contract Negotiator
IQVIA —Durham, NC
- $49,200 - $157,100 a year
- Full-time
- Databases
- Presentation skills
- Bachelor's degree
7d
Project Manager II
IQVIA —Durham, NC
- $57,000 - $142,700 a year
- Full-time
- Mid-level
- Analysis skills
- Bachelor's degree
1d
Associate Director Medical Science Liaison - East
IQVIA —Raleigh, NC
- $230,000 - $280,000 a year
- Weekends as needed
- 6 years
- Up to 50% travel
- Doctor of Philosophy
5d
Senior Site Contracts Associate, IQVIA Biotech
IQVIA —Durham, NC
- $62,800 - $157,100 a year
- Full-time
- Mid-level
- 3 years
- Bachelor's degree
9d
Medical Director, Rheumatologist
IQVIA —Durham, NC
- $154,900 - $431,500 a year
- Full-time
- Remote
- Medicine
- Doctoral degree
- BC/BE
Clinical Data Strategist
IQVIA —Durham, NC
- $86,500 - $216,000 a year
- Full-time
- Computer science
- Computer Science
- Customer service
Medical Director, Cardiology
IQVIA —Durham, NC
- $154,900 - $431,500 a year
- Full-time
- Remote
- Medicine
- 5 years
- BC/BE

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medical fraud investigator jobs near north carolina

Senior Investigator, Special Investigations Unit (Aetna SIU)

CVS Health -
North Carolina

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Job Details

Full-time
$46,988 - $112,200 a year
13 days ago

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance

Qualifications

Healthcare financial misconduct investigations
Customer communication
Spreadsheets
Research
Suspicious activity investigations
HCPCS
Insurance investigations
Productivity software

Full Job Description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

As a Senior Investigator you will conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high profile, those that are complex cases involving or cases involving multiple perpetrators or intricate healthcare fraud schemes.

Investigates to prevent payment of fraudulent claims submitted to the Medicaid lines of business
Researches and prepares cases for clinical and legal review
Documents all appropriate case activity in case tracking system
Facilitates feedback with providers related to clinical findings
Initiates proactive data mining to identify aberrant billing patterns
Makes referrals, both internal and external, in the required timeframe
Facilitates the recovery of company and customer money lost as a result of fraud matters
Provides on the job training to new Investigators and provides guidance for less experienced or skilled Investigators.
Assists Investigators in identifying resources and best course of action on investigations
Serves as back up to the Team Leader as necessary
Cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud and abuse matters.
Demonstrates high level of knowledge and expertise during interactions and acts confidently when providing testimony during civil and criminal proceedings
Gives presentations to internal and external customers regarding healthcare fraud matters and Aetna's approach to fighting fraud
Provides input regarding controls for monitoring fraud related issues within the business units

Required Qualifications

3+ years investigative experience in the area of healthcare fraud and abuse matters.

Working knowledge of medical coding; CPT, HCPCS, ICD10
Experience with Microsoft Office with advanced skills in Excel (must know how to do pivot tables).
Ability to travel up to 10% (approx. 2-3x per year, depending on business needs)

Preferred Qualifications

Previous Medicaid/Medicare investigatory experience
Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations for fraud and abuse.
Credentials such as certification from the Association of Certified Fraud Examiners (CFE), or an accreditation from the National Health Care Anti-Fraud Association (AHFI)
Knowledge of Aetna's policies and procedures.
Knowledge and understanding of complex clinical issues.
Competent with legal theories.
Strong communication and customer service skills.
Ability to effectively interact with different groups of people at different levels in any situation.
Strong analytical and research skills.
Proficient in researching information and identifying information resources.
Strong verbal and written communication skills.

Education:

Bachelor's degree or equivalent experience (3+ years of working health care fraud, waste and abuse investigations).

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$46,988.00 - $112,200.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 08/01/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Apply Now

Refine Your Search

medical fraud investigator jobs in north carolina

Senior Investigator, Special Investigations Unit (Aetna SIU)

Investigator, Special Investigations Unit (Aetna SIU)

Senior Compliance Investigator

Investigator, Special Investigations Unit (Meritain Health)

Investigative Specialist

Clinical Research Associate, Full Service

FT Private Investigator - Charlotte, NC

Senior Trade Compliance Investigator

Senior QA Auditor - GCP Audits

CRA 1, IQVIA Biotech

Medical Science Liaison Immunology - Admilparant (NC)

Clinical Research Associate, IQVIA Biotech

Clinical Research Associate 2, IQVIA

FSP Contract Negotiator

Project Manager II

Associate Director Medical Science Liaison - East

Senior Site Contracts Associate, IQVIA Biotech

Medical Director, Rheumatologist

Clinical Data Strategist

Medical Director, Cardiology

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