Top 141 Investigations Jobs in Missouri

Lead SIU Investigator
Centene —Missouri
- $70,100 - $126,200 a year
- Full-time
- Remote
- Master's degree
- High school diploma or GED
- Mentoring
- Paid holidays
- Health insurance
Licensed Private Investigator Kansas City, MO
Direct Insight Services, Inc. —Kansas City, MO
- $20 - $40 an hour
- Part-time
- Remote
- Microsoft Word
- Military
- Computer literacy
Quick Apply
Trade Compliance Specialist
Leonardo DRS —Bridgeton, MO
- $66,049 - $85,864 a year
- Full-time
- Hybrid work
- Mid-level
- Office
- Bachelor's degree
- Paid parental leave
- Health savings account
Legal Investigator
Maune Raichle Hartley French & Mudd, LLC —St. Louis, MO
- $55,000 - $65,000 a year
- Full-time
- Computer literacy
- Mid-level
- Plumbing
- Health savings account
- Paid holidays
Quick Apply
Senior Non-Commissioned Investigator
State of Missouri —Missouri
- $56,872.80 a year
- Full-time
- Research
- Mid-level
- Bachelor's degree
- Health insurance
12d
Investigator, Special Investigations Unit (Meritain Health)
CVS Health —Jefferson City, MO
- $46,988 - $122,400 a year
- Full-time
- Customer service
- Research
- Mid-level
- Health insurance
- Dental insurance
Senior Commissioned Investigator - 1044012
State of Missouri —Kansas City, MO
- $57,000 a year
- Full-time
- Customer service
- 5 years
- Computer literacy
- Health insurance
Contract Investigative Technician
ADC LTD NM —Missouri
- Contract
- Mid-level
Quick Apply
Private Investigator
Digistream Investigations —Missouri
- $18 an hour
- Overtime
- Remote
- Background check
- 21 years or older
- Travel
- Travel reimbursement
- Health insurance
Quick Apply
Senior Commissioned Investigator - Compliance and Investigations Bureau - 7022022
State of Missouri —Cape Girardeau, MO
- $52,077.60 a year
- Full-time
- Customer service
- 5 years
- Computer literacy
- Health insurance
Corporate Ethics & Compliance Investigator
Centene —Missouri
- $107,700 - $199,300 a year
- Full-time
- Remote
- 7 years
- Management
- HIPAA
- Paid holidays
- Health insurance
INVESTIGATOR I
Jackson County, MO —Kansas City, MO
- $28.58 an hour
- Full-time
- Background check
- Pass drug screening
- Mid-level
Senior Commissioned Investigator - 7022032
State of Missouri —Kansas City, MO
- $57,000 a year
- Full-time
- Customer service
- 5 years
- Computer literacy
- Health insurance
Senior Non-Commissioned Investigator-State Board of Registration for the Healing Arts
State of Missouri —St. Louis, MO
- $51,122 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Office
- Health insurance
11d
Senior Commissioned Investigator - 7022013
State of Missouri —Kansas City, MO
- $57,000 a year
- Full-time
- Customer service
- 5 years
- Computer literacy
- Health insurance
Ethics and Compliance Program Consultant
Evergy —Kansas City, MO
- $66,600 - $118,400 a year
- Monday to Friday
- Office
- Analysis skills
- Driver's License
13d
Manager, Sales Investigations
Centene —Missouri
- $87,700 - $157,800 a year
- Full-time
- Remote
- High school diploma or GED
- Fair chance
- 1 year
- Paid holidays
- Health insurance
Investigator
Jackson County, MO —Kansas City, MO
- $22.96 an hour
- Full-time
- 5 years
- Pass drug screening
- High school diploma or GED
Sr. Investigator
State of Missouri —Jefferson City, MO
- $52,077.60 a year
- Full-time
- Office
- Driver's License
- Bachelor's degree
- Health insurance
National Task Force Loss Prevention Investigator
TJX Companies —St. Louis, MO
- $24.10 - $30.70 an hour
- Full-time
- 5 years
- Office
- Travel
- Health savings account
- Paid holidays

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Lead SIU Investigator

Centene -
Missouri

Apply Now

Job Details

Full-time
$70,100 - $126,200 a year

Benefits

Paid holidays
Health insurance
401(k)
Tuition reimbursement
Paid time off

Qualifications

Healthcare financial misconduct investigations
Investigations regulatory compliance
Medicare
Medical law
Managed care
Managed care organization experience
Health insurance policy knowledge
Regulatory legal research
Medicare regulations
Insurance investigations
Centers for Medicare & Medicaid Services (CMS) billing regulations
Medicaid regulations
Medicaid

Full Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

*This is a remote role anywhere within the continental US.*

Position Purpose: Position acts as a subject matter expert in the field of Special Investigations Unit (SIU) investigations. Provides direction and guidance to staff who investigate and remediate compliance and fraud, waste, and abuse related matters; while maintaining an investigative workload of moderate to high complexity. Assists manager on monitoring team caseload and report on metrics.

Provides guidance to team members who investigate and remediate compliance and fraud, waste, and abuse related matters.
Assists manager on monitoring team caseload and report on metrics.
Identifies training needs and develop training aids and step actions.
Provides training and mentoring to team on casework and other SIU activities.
Evaluates and assesses allegations to determine those criteria, including federal and state regulations, Centers for Medicare & Medicaid Services (“CMS”) guidelines, and internal policies, procedures, and standards that are alleged to have been violated.
Conducts and documents interviews investigatory purposes.
Reviews investigative interviews prepared by junior investigators.
Manages caseloads of moderate to high complexity, develops investigative plans for multiple investigations, prioritizing and managing through execution.
Thoroughly documents actions, organizes, and reviews case files.
Consults with management, in-house counsel, and/or senior leadership to resolve difficult or complex issues.
Identifies risks and recommends and communicates remedial actions to mitigate future potential risks.
Performs follow up to ensure remedial and disciplinary measures are implemented appropriately and timely.
Prepares clear and concise investigative plans and reports.
Provides support and guidance to junior investigative staff.
Identifies trends and aberrant activity to generate proactive leads for investigations and analyzes data to detect potentially fraudulent activity.
Attends, actively participates in, and/or leads meetings with various business area managers.
Communicates directly with Federal or State regulators.
Prepares cases for referral to management, government agencies, and law enforcement.
Develops and maintains strong working relationships with associates and regulators.
Testifies in criminal and civil matters.
Participates in and lead special projects as needed.
Performs other duties as assigned.
Complies with all policies and standards.

Education/Experience:

Bachelor's Degree in related field; or Associate's degree with 6 years related experience; or High School Diploma/GED with 7 years related experience. required.
Master's Degree preferred.
5+ years Healthcare fraud-related investigations with audit and risk analysis required.
1+ years Managed care or working with health insurance company required.
In-depth knowledge of government programs, the managed care industry, Medicare, Medicate laws and requirements, federal, state, civil and criminal statutes required.
Reading, analyzing and interpreting State and Federal laws, rules and regulations. Knowledge of community, state and federal laws and resources required.
Knowledge and understanding of managed care claims processing systems and medical claims coding preferred preferred.

Licenses/Certifications:

Accredited Health Care Fraud Investigator (AHFI), Certified Fraud Examiner (CFE) or other industry related certification preferred.

Pay Range: $70,100.00 - $126,200.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Apply Now

Refine Your Search

investigations jobs in missouri

Lead SIU Investigator

Licensed Private Investigator Kansas City, MO

Trade Compliance Specialist

Legal Investigator

Senior Non-Commissioned Investigator

Investigator, Special Investigations Unit (Meritain Health)

Senior Commissioned Investigator - 1044012

Contract Investigative Technician

Private Investigator

Senior Commissioned Investigator - Compliance and Investigations Bureau - 7022022

Corporate Ethics & Compliance Investigator

INVESTIGATOR I

Senior Commissioned Investigator - 7022032

Senior Non-Commissioned Investigator-State Board of Registration for the Healing Arts

Senior Commissioned Investigator - 7022013

Ethics and Compliance Program Consultant

Manager, Sales Investigations

Investigator

Sr. Investigator

National Task Force Loss Prevention Investigator

I want to receive the latest job alert for investigations in missouri

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