Top 15 fraud examiner Jobs in durham nc

Healthcare Fraud Investigator
Ardelle Associates —Raleigh, NC
- $33.31 - $37.72 an hour
- 8 hour shift
- Microsoft Word
- Background check
- Microsoft Excel
- Health insurance
- Dental insurance
Quick Apply
Internal Auditor EHRA
State of North Carolina - State Budget & Management —Wake County, NC
- $64,621 - $117,465 a year
- Full-time
- Hybrid work
- CPA
- Writing skills
- Mid-level
- Flextime
Investigator I
North Carolina Education Lottery —Raleigh, NC
- $51,078 a year
- Full-time
- 5 years
- Research
- Driver's License
- Flexible schedule
Quick Apply
Insurance Company Examiner I
State of North Carolina - Insurance —Wake County, NC
- $45,703 - $69,628 a year
- Online Application
- Hybrid work
- Mid-level
- Office
- Bachelor's degree
- Paid holidays
- Health insurance
9d
Card Fraud and Disputes Manager (Durham)
Latino Community Credit Union —Durham, NC
- Full-time
- Office
- Finance
- Analysis skills
- Disability insurance
- Health insurance
Auditor (Sanctions & Embargoes) – Assistant Vice President
Deutsche Bank —Cary, NC
- $100,000 - $153,000 a year
- Full-time
- Hybrid work
- CPA
- Office
- Finance
- Health insurance
- Work from home
Insurance Company Examiner Manager
State of North Carolina - Insurance —Wake County, NC
- $81,620 - $95,000 a year
- Online Application
- Hybrid work
- CPA
- Office
- Supervising experience
- Paid holidays
- Health insurance
15h
Payments Fraud Manager 1
Deloitte —Raleigh, NC
- $107,600 - $198,400 a year
- Full-time
- 5 years
- Finance
- Bachelor's degree
2d
Capital Projects and Real Estate Advisory Senior
Baker Tilly Advisory Group, LP —Raleigh, NC
- $86,660 - $164,300 a year
- Full-time
- CPA
- Engineering
- 3 years
Quick Apply
Capital Projects Senior Consultant - DBA/PWA
Deloitte —Raleigh, NC
- $110,700 - $218,300 a year
- Full-time
- Bilingual
- CPA
- Up to 50% travel
4d
Sales Executive – Healthcare Fraud, Waste and Abuse (FWA) Investigation Services
CoventBridge Group —United States
- $90,000 - $120,000 a year
- Full-time
- Remote
- Microsoft Outlook
- 5 years
- Writing skills
- Paid training
- Disability insurance

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Senior Investigator - Remote in Ohio
UnitedHealthcare —Columbus, OH
Access to reliable transportation & valid US driver's license. Responsible to conduct investigations which may include field work to perform interviews and…
$60,200 - $107,400 a year
Special Investigator-Health Insurance Fraud (Ohio residency required)
Amerihealth Caritas —Columbus, OH
Valid driver’s license required. Bachelor's degree with a minimum of two years of experience in the healthcare field working in fraud, waste, and abuse…

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Healthcare Fraud Investigator

Ardelle Associates
Raleigh, NC

Quick Apply

Job Details

Full-time | Contract
$33.31 - $37.72 an hour

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance
401(k) matching
Life insurance

Qualifications

Microsoft Word
Microsoft Excel
Medicare
Microsoft Office
Driver's License
Bachelor's degree
Legal drafting
CPT coding
Fraud prevention and detection

Full Job Description

Ardelle Associates is seeking Healthcare Fraud Investigator to support the United States Attorney’s Office, Opioid Civil Division in Raleigh, North Carolina. The investigator will provide investigator services to the USAO Assistant (AUSA) in connection with healthcare fraud matters, with particular emphasis on civil healthcare investigations and litigation pursued under the False Claims Act. These services will include, without limitation:

Duties

Performs a variety of ancillary investigation-related services in direct support of litigation. Support activities include one or more of the following:
Working with the assigned Assistant United States Attorney and/or supervisory attorneys, determines applicable administrative statutory and regulatory law, and identifies possible violations or causes.
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 assist in affixing legal responsibility for litigation, and devises methods for obtaining, preserving, and presenting evidence to greatest effects.
Decides upon most efficacious methods for planning, scheduling, and conducting investigations, and identifies any resources that may be required.
Refers evidence of criminal activities to appropriate criminal investigators or sworn law enforcement office.
Initiates contacts with federal, state, and local officials, and other organizations and individuals related to the subject of investigation, for the purpose of gathering facts, obtaining statements, learning sequences of events, obtaining explanations, and otherwise advancing investigative objectives. Examines books, ledgers, payrolls, cost reports, billing statements, invoices, correspondence, computer data, and other records pertaining to the transactions, events, or allegations under investigation. Establishes and/or verifies relationships among all facts and evidence obtained or presented to confirm authenticity of documents, corroborate witness statements, and otherwise build proof necessary for successful litigation.
Arranges for secure storage, preservation, organization and indexing of voluminous documentary evidence, including electronic storage.
Utilizes laboratories and other forensic services to identify handwriting, fingerprints, questioned documents and substances, sound and video recordings, and other physical evidence. Arranges for secure storage, preservation, organization, and indexing of voluminous documentary evidence.
Conducts in-person and/or telephonic interviews of witnesses. Identifies the need for service of warrants and subpoenas and secures participation of appropriate law enforcement agents in executions of same. Types hand scribed notes from interview discussions.
Reviews, analyzes, and summarizes documents.
Plans and coordinates surveillance of suspects with appropriate law enforcement/investigative agencies. Occasional surveillance activities personally performed occur in locations that are open and accessible to the public where there is little or no risk of physical harm to incumbent or others. The incumbent does not have arrest authority nor is authorized the use of deadly force. “Undercover” work characteristically does not involve physical interaction with the subject or target of a criminal investigation.
Prepares interim and final reports on progress of investigations for use by AUSAs and supervisory attorneys. Includes significant findings and conclusions, recommendations for additional investigative actions, and candid assessments of strengths and weaknesses of witnesses, documentary evidence, or other aspects of case.
Assists in compilation of documents and physical evidence, and creation of charts, graphs, videotapes, and other audio-visual materials for use by AUSAs in motions and at trial. Provides advice to AUSA on selection of witnesses and ensures their attendance through subpoena or otherwise. Testifies in court regarding investigations, as required.
Develops and analyzes evidence that comes from other investigators, analysis and law enforcement officers, and collects information relating to this evidence or legal matters under consideration from appropriate primary and secondary sources. Analysis is for the purposes of clarifying the target or organizations' pattern of operations, to identify information relevant to the legal issues involved and to recommend valuable approaches to the AUSA or other members of the investigative team. Analysis is also for the purpose of developing and refining proof required to assist in determining legal responsibility for violation(s), and for devising methods for effectively obtaining, preserving, and presenting evidence.
Gathers and analyzes facts including statements, timelines, scientific or technical data, for the purpose of advancing prosecutorial objectives. Establishes and/or verifies relationships among all facts and evidence obtained or presented to confirm authenticity of documents, corroborate witness statement, and otherwise build proof necessary for successful litigation.
Provides specialized investigative analysis relevant to HCF matters. Identifies sources of information and multiple variables. Prepares interim and final comprehensive reports on progress of investigations for use by AUSAs, supervisory AUSAs and the investigative team. Includes significant findings and conclusions, recommendations for additional investigative actions, and candid assessments of strengths and weaknesses of witnesses, documentary evidence, or other aspects of the case.

Experience & Education

5 years of healthcare fraud investigation Experience, focusing on Opioid cases
Familiarity with medical , pharmacies or healthcare experience
Thorough knowledge of Medicare reimbursement program, CPT Codes, and common healthcare fraud schemes.
Experience drafting legal processes for obtaining information relevant to ongoing investigations, such as subpoenas, affidavits in support of search warrants, or written discovery requests.
Must have a valid drivers license and dependable vehicle
Experience with MS office products

Must be a US Citizen

Federal background check required before start date.

Ardelle Associates, a veteran-owned company providing Consulting and Support Services to government agencies and contractors. This position offers an opportunity to work in a dynamic environment that values quality service and professionalism. Join us in delivering exceptional legal support services while upholding our commitment to excellence.

Job Types: Full-time, Contract

Pay: $33.31 - $37.72 per hour

Benefits:

401(k) matching
Dental insurance
Health insurance
Life insurance
Paid time off
Vision insurance

Schedule:

8 hour shift

Experience:

Healthcare fraud : 5 years (Required)

Ability to Commute:

Raleigh, NC 27601 (Required)

Ability to Relocate:

Raleigh, NC 27601: Relocate before starting work (Required)

Work Location: In person

Quick Apply

Refine Your Search

fraud examiner jobs in durham nc

Healthcare Fraud Investigator

Internal Auditor EHRA

Investigator I

Insurance Company Examiner I

Card Fraud and Disputes Manager (Durham)

Auditor (Sanctions & Embargoes) – Assistant Vice President

Insurance Company Examiner Manager

Payments Fraud Manager 1

Capital Projects and Real Estate Advisory Senior

Capital Projects Senior Consultant - DBA/PWA

Sales Executive – Healthcare Fraud, Waste and Abuse (FWA) Investigation Services

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