Top 751 Investigator Jobs in Pennsylvania

Senior Investigator, Special Investigations Unit (Aetna SIU)
CVS Health —Pennsylvania
- $46,988 - $112,200 a year
- Full-time
- Remote
- Research
- Mid-level
- 3 years
- Health insurance
- Dental insurance
Corporate Ethics & Compliance Investigator
Centene —Pennsylvania
- $107,700 - $199,300 a year
- Full-time
- Remote
- 7 years
- Management
- HIPAA
- Paid holidays
- Health insurance
DHS Case Reviewer
Information Systems & Networks Corporation —Slippery Rock, PA
- $75,000 - $85,000 a year
- Remote
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
1d
Auditor/Investigator II
Qlarant —Pennsylvania
- $57,512 - $85,839 a year
- Full-time
- Remote
- Mid-level
- Analysis skills
- Bachelor's degree
Quick Apply
Older Adult Protective Services Investigator I
Philadelphia Corporation for Aging —Philadelphia, PA
- $71,723.00 - $85,423.24 a year
- Weekends as needed
- Hybrid work
- Clean driving record
- Adults
- Office
- Paid holidays
- Disability insurance
Quick Apply
Investigator II
The School District Of Philadelphia —Philadelphia, PA
- $71,717 - $92,980 a year
- Full-time
- Management
- Word processing
- Mid-level
Quality Management Coordinator
St. Edmonds Home for Children —Bryn Mawr, PA
- From $65,000 a year
- Full-time
- 5 years
- Mid-level
- Driver's License
(Senior) Medical Science Liaison - Mid Atlantic-North (DC, MD, DE, NJ, PA)
BioNTech AG —Philadelphia, PA
- $146,300 - $234,100 a year
- Full-time
- Background check
- Medicine
- Microsoft Office
- Health savings account
- AD&D insurance
Associate Attorney- Relocation Required
Parnall Law —Pittsburgh, PA
- $200,000 - $400,000 a year
- Full-time
- 5 years
- Senior level
- Paid holidays
- Disability insurance
Quick Apply
Director, Investigational Drug Section
START Center for Cancer Research —Pittsburgh, PA
- Microsoft Excel
- Quality control
- Travel
- Disability insurance
- Health insurance
Quick Apply
Operations Manager - ICF
Elwyn —Elwyn, PA
- On call
- Clean driving record
- Microsoft Excel
- Microsoft Outlook
- Paid training
- Health insurance
Quick Apply
Quality Management Coordinator
Archdiocese of Philadelphia —Bryn Mawr, PA
- Full-time
- 5 years
- Mid-level
- Driver's License
12d
Behavior Analysis
Green Woods Charter School —Philadelphia, PA
- From $50,000 a year
- Part-time
- School experience
- Classroom
- Mid-level
- Health savings account
- Health insurance
Quick Apply
3d
Oilfield Roving Security Detail; $15hr; In/around Houston, PA
LPS Services LLC —Canonsburg, PA
- $15 an hour
- Part-time
- Pass drug screening
- Office
- Driver's License
Quick Apply
6d
Retail Crime Investigator
Weis Markets —State College, PA
- $18 - $20 an hour
- Weekends as needed
- Background check
- Bachelor of Science
- Bachelor's degree
- Health savings account
- Health insurance
Quick Apply
23h
Crisis Investigation Specialist
County of Venango —Franklin, PA
- $27.48 an hour
- Full-time
- Pass drug screening
- Adults
- English
- Health savings account
- Health insurance
Quick Apply
Casualty Field Investigator
CUSTARD INSURANCE ADJUSTERS —Pittsburgh, PA
- $50,086.78 - $60,319.57 a year
- Full-time
- Mid-level
- Office
- Analysis skills
- Health savings account
- Health insurance
Quick Apply
Field Investigator
CUSTARD INSURANCE ADJUSTERS —Philadelphia, PA
- $50,000 - $65,000 a year
- Full-time
- Customer service
- Mid-level
- Office
- Health savings account
- Health insurance
Quick Apply
Residential Program Manager- York, PA
AIMED —Dallastown, PA
- Full-time
- Background check
- 18 years or older
- CPR Certification
- Paid training
- Health insurance
Quick Apply
13d
Infusion Nurse
START Center for Cancer Research —Pittsburgh, PA
- Monday to Friday
- Microsoft Excel
- Vital signs
- RN License
- Disability insurance
- Health insurance
Quick Apply

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Senior Investigator, Special Investigations Unit (Aetna SIU)

CVS Health -
Pennsylvania

Apply Now

Job Details

Full-time
$46,988 - $112,200 a year

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

investigator jobs in pennsylvania

Senior Investigator, Special Investigations Unit (Aetna SIU)

Corporate Ethics & Compliance Investigator

DHS Case Reviewer

Auditor/Investigator II

Older Adult Protective Services Investigator I

Investigator II

Quality Management Coordinator

(Senior) Medical Science Liaison - Mid Atlantic-North (DC, MD, DE, NJ, PA)

Associate Attorney- Relocation Required

Director, Investigational Drug Section

Operations Manager - ICF

Quality Management Coordinator

Behavior Analysis

Oilfield Roving Security Detail; $15hr; In/around Houston, PA

Retail Crime Investigator

Crisis Investigation Specialist

Casualty Field Investigator

Field Investigator

Residential Program Manager- York, PA

Infusion Nurse

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