Top 50 Surveillance investigator Jobs in Pennsylvania

Investigator
Highmark Inc. —Pennsylvania
- $62,700 - $97,200 a year
- Full-time
- Remote
- Nursing
- Writing skills
- HIPAA
8d
Surveillance Investigator
VRC Investigations —Philadelphia, PA
- Clean driving record
- Military
- Computer literacy
- Profit sharing
- Paid training
Quick Apply
Surveillance Investigator
Lemieux & Associates LLC —Scranton, PA
- $25 - $32 an hour
- Part-time
- Bilingual
- Microsoft Word
- Computer literacy
- Flexible schedule
Quick Apply
Surveillance Investigator
Frasco Inc —Pittsburgh, PA
- $18 - $26 an hour
- Weekends as needed
- Clean driving record
- Military
- High school diploma or GED
- Paid training
- Mileage reimbursement
Investigator
Ethos Risk Services —Harrisburg, PA
- $28 - $38 an hour
- Part-time
- Mid-level
- Residential
- Driver's License
- Paid time off
- Referral program
Quick Apply
Surveillance Investigator
Allied Universal® Compliance and Investigations —Allentown, PA
- Weekends as needed
- Microsoft Word
- Military
- Mid-level
- AD&D insurance
- Paid holidays
Quick Apply
Private Investigator - Compliance
Investigative Services LLC. —Lehigh Valley, PA
- $24 - $27 an hour
- Choose your own hours
- Bilingual
- Background check
- Military
- Flexible schedule
Quick Apply
1d
Narcotics Agent Trainee/I/II
Pennsylvania Office of Attorney General —Philadelphia, PA
- $60,506 - $77,447 a year
- Full-time
- Remote
- Military
- Master's degree
- Associate's degree
- Paid holidays
- Health insurance
4d
Surveillance Investigator II
Command Investigations, LLC —Harrisburg, PA
- $25 - $30 an hour
- 8 hour shift
- Microsoft Word
- Clean driving record
- Customer service
- Health insurance
- Dental insurance
Quick Apply
Special Investigator 1, OSIG
Commonwealth of PA —Harrisburg, PA
- $56,541 - $86,022 a year
- Full-time
- Background check
- Writing skills
- Mid-level
- Paid parental leave
- Health insurance
14h
Security Investigator
SeaWorld Parks & Entertainment —Philadelphia, PA
- Part-time
- Background check
- CPR Certification
- Ability to walk for extended periods
Special Agent II
Pennsylvania Office of Attorney General —Harrisburg, PA
- $77,447 a year
- Full-time
- Military
- Mid-level
- Master's degree
- Paid holidays
- Health insurance
Surveillance Agent
Marshall Investigative Group —State College, PA
- $22 - $32 an hour
- Part-time
- Microsoft Word
- 11+ years
- Research
Quick Apply
Surveillance Investigator I - Entry Level
Command Investigations, LLC —Philadelphia, PA
- $20 - $25 an hour
- 8 hour shift
- Microsoft Word
- Background check
- Clean driving record
- Health insurance
- Dental insurance
Quick Apply
Special Agent I/II
Pennsylvania Office of Attorney General —North Huntingdon, PA
- $68,455 - $77,447 a year
- Full-time
- Military
- Mid-level
- Master's degree
- Paid holidays
- Health insurance
7d
Licensed Covert Surveillance Investigator - Full Time - Philadelphia, PA
Meridian Investigative Group, Inc —Philadelphia, PA
- $20 - $30 an hour
- Extended hours
- Microsoft Word
- Computer literacy
- Writing skills
Retail Crime Investigator
Weis Markets —Sunbury, PA
- $17 - $27 an hour
- Weekends as needed
- Remote
- Bachelor of Science
- Mid-level
- Travel
- AD&D insurance
- Disability insurance
Section Director
Pennsylvania Office of Attorney General —Harrisburg, PA
- $91,423 a year
- Full-time
- Military
- Research
- Office
- Paid holidays
- Health insurance
4d
FT Private Investigator - Philadelphia, PA
Delta Group —Philadelphia, PA
- $20 - $30 an hour
- Full-time
- Background check
- 18 years or older
- Clean driving record
- Disability insurance
- Health insurance
Quick Apply
Licensed Covert Surveillance Investigator - Part Time - Harrisburg, PA
Meridian Investigative Group, Inc —Harrisburg, PA
- $20 - $30 an hour
- Extended hours
- Microsoft Word
- Computer literacy
- Writing skills

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Investigator

Highmark Inc. -
Pennsylvania

Apply Now

Job Details

Full-time
$62,700 - $97,200 a year
8 days ago

Qualifications

Data mining
Medical claims processing
Health insurance policy knowledge
Coding for hospital billing
Technical Proficiency
Negotiation
Data extraction

Full Job Description

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job is responsible for developing and maintaining an anti-fraud program which includes development and delivery of training and filing of Fraud Plans and Reports. The incumbent is responsible for conducting investigations of organizational or functional activities related to alleged fraud, waste and abuse perpetrated by providers, members, facilities, pharmacies, groups and/or employees of the organizations and Subsidiaries. The incumbent is responsible for interviews which might include providers and members and may be conducted onsite or offsite. The incumbent is also responsible for the field investigative work necessary to complete a review of a special project, potential fraud, waste and abuse case, conducting the initial investigations and coordinating the recovery/savings of money related to fraud, waste and abuse. The incumbent must be able to testify in a court of law, prepare cases for referral to various federal, state and local law enforcement entities and work with those agencies through closure of the case. Conduct audits for proactive and investigative purposes to comply with internal audit and regulatory requirements.

ESSENTIAL RESPONSIBILITIES

Performs investigations into potential and existing provider and member fraud, waste and abuse activities. Identifies parties involved by reviewing inquiries and complaints against providers, members, facilities, pharmacies, groups, and/or employees of Highmark and Subsidiaries. Conduct Interviews with providers, members or any other individual(s) necessary to complete an assigned investigation or special project. Determines the scope of the allegation or special project by assembling the necessary information, statistics, policies and procedures, licensure information, doctors’ agreements, contract, etc.
Develop and maintain annual anti-fraud program which includes facilitating fraud training and fraud awareness day, as well as filing annual fraud plans and reports according to state regulations. Responsible for updating annually the changes in insurance laws with regard to lines of business
Coordinates data extracts by assessing multiple databases both internally and externally. Takes action to prevent further improper payments. Forwards case to the Credentialing and/or Medical Review Committee, law enforcement and regulatory agencies.
Responsible for completing all necessary field (externally) investigative work for resolution or alleged fraud/waste and abuse cases or special projects.
Provides advisory support as needed to internal and external law enforcement and regulatory agencies, Credentialing or Medical Review Committee.
Engages in delivery of audit results and overpayment negotiations. Responsible for recovery/ savings of misappropriated funds paid by Highmark and affiliated companies and work with Finance to ensure proper recording the financial statements.
Conduct audits for proactive and investigative purposes to comply with internal audit and regulatory requirements. Audits consist of contract, commissions, surveillance, workers’ compensation and IME. In addition, this position will complete Office of Foreign Asset Control (OFAC) to ensure payments are not issued to unauthorized parties.

EDUCATION

Required

Bachelor's Degree in Accounting, Finance, Business Administration, Nursing, IT or Related Field

Substitutions

6 years of related and progressive experience in lieu of Bachelor's degree

Preferred

Master's Degree in Fraud, Forensics Accounting, Business or related field

EXPERIENCE

Required

3 years of relevant, progressive experience in the health insurance industry and/or healthcare fraud investigations

Preferred

1 year in Financial Analysis in an acute care hospital or health insurance setting
1 year in professional billing, facility Patient Financial Services, HIM, Internal Audit, Professional/Facility Reimbursement or Provider Contracting

LICENSES or CERTIFICATIONS

Required

None

Preferred (any of the following)

Certified Fraud Examiner (CFE)
Certified Professional Coder (CPC)
Certified Outpatient Coder (COC)

SKILLS

Must have knowledge of provider facility payment methodology, claims processing systems and coding and billing proficiency
Must have understanding of technical and financial aspects of the health insurance industry
Strong personal computer skills, along with the ability to use fraud/abuse data mining tools are required
Must possess excellent communication skills and be detailed oriented
Strong written and oral communication skills
Strong relationship building skills
Client focused with strong business acumen
Self-starter with the ability to work under pressure independently and as part of a team
Ability to think strategically and act proactively to create strong trust and confidence with business units

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$62,700.00

Pay Range Maximum:

$97,200.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

For accommodation requests, please contact HR Services Online at [email protected]

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

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