Top 37 Fraud Jobs in Rhode Island

Senior Investigator, Special Investigations Unit (Aetna SIU)
CVS Health —Rhode Island
- $46,988 - $112,200 a year
- Full-time
- Remote
- Research
- Mid-level
- 3 years
- Health insurance
- Dental insurance
1d
Fraud, Waste and Abuse Investigation, Senior Analyst
CVS Health —Rhode Island
- $46,988 - $112,200 a year
- Full-time
- Remote
- Mid-level
- 3 years
- High school diploma or GED
- Health insurance
- Dental insurance
Principal Fraud Protection and Controls Analyst
Fidelity Investments —Smithfield, RI
- Email
- Mid-level
- Office
- Analysis skills
Director, Fraud Risk Oversight
Fidelity Investments —Smithfield, RI
- $110,000 - $222,000 a year
- Full-time
- Office
- Senior level
- Communication skills
- Loan repayment program
- Tuition reimbursement
Senior Manager, Fraud & Claims Quality Control (QC)
Citizens Financial Group —Johnston, RI
- Full-time
- Hybrid work
- Background check
- Office
- 3 years
- Health insurance
- Dental insurance
14d
Payment Network Compliance Analyst (Visa/Mastercard/Discover)
Citizens Financial Group —Johnston, RI
- $86,000 - $101,000 a year
- Full-time
- Background check
- Mid-level
- Office
- Health insurance
- Dental insurance
Surveillance Investigator
Digistream Investigations —Rhode Island
- From $20 an hour
- Weekends as needed
- Remote
- Background check
- 21 years or older
- Travel
- Paid training
- 401(k)
Quick Apply
Product Manager, Fraud & Abuse
CVS Health —Providence, RI
- $92,700 - $203,940 a year
- Full-time
- Mid-level
- 3 years
- Bachelor's degree
- Health insurance
- Dental insurance
Fraud & Claims Call Monitoring Lead
Citizens Financial Group —Johnston, RI
- Full-time
- Background check
- Office
- Analysis skills
- Health insurance
- Dental insurance
14d
Fraud Risk Analytics Sr Analyst
Citizens Financial Group —Johnston, RI
- $79,000 - $95,000 a year
- Full-time
- Background check
- Microsoft Excel
- Office
- Health insurance
- Dental insurance
Fraud Operations Manager
Citizens Financial Group —Riverside, RI
- Full-time
- Background check
- Office
- Criminal background check
- Health insurance
- Dental insurance
9d
VP, Compliance - Card Services & Cash Management
Fidelity Investments —Smithfield, RI
- $125,000 - $258,000 a year
- Full-time
- Bachelor of Science
- Writing skills
- Research
- Loan repayment program
- Tuition reimbursement
RN Clinical Auditor
Neighborhood Health Plan of Rhode Island —Smithfield, RI
- Full-time
- Nursing
- RN License
- Mid-level
- Health insurance
Quick Apply
Investigator
Ethos Risk Services —Providence, RI
- $30 - $35 an hour
- Part-time
- Mid-level
- Residential
- Driver's License
- Paid time off
- Referral program
Quick Apply
Surveillance Investigator
VRC Investigations —Providence, RI
- Clean driving record
- Military
- Computer literacy
- Profit sharing
- Paid training
Quick Apply
As Needed Field Investigator- Coventry, RI
J T Becker & Co Inc —Coventry, RI
- Writing skills
- Mid-level
- Driver's License
- Flexible schedule
Quick Apply
Surveillance Investigator I - Entry Level
Command Investigations, LLC —Providence, RI
- $20 - $25 an hour
- 8 hour shift
- Microsoft Word
- Background check
- Clean driving record
- Health insurance
- Dental insurance
Quick Apply
Operational Risk Manager - Cybersecurity
Citizens Financial Group —Johnston, RI
- $100,000 - $135,000 a year
- Full-time
- Hybrid work
- Microsoft Word
- Background check
- CPA
- Health insurance
- Dental insurance
Surveillance Investigator II
Command Investigations, LLC —Providence, RI
- $25 - $30 an hour
- 8 hour shift
- Microsoft Word
- Background check
- Clean driving record
- Health insurance
- Dental insurance
Quick Apply
Rhode Island, Cranston Surveillance Investigator
Insight Service Group (ISG) —Cranston, RI
- $20 - $27 an hour
- Part-time
- Mid-level
- Analysis skills
- Driver's License
Quick Apply

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Senior Investigator, Special Investigations Unit (Aetna SIU)

CVS Health -
Rhode Island

Apply Now

Job Details

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

fraud jobs in rhode island

Senior Investigator, Special Investigations Unit (Aetna SIU)

Fraud, Waste and Abuse Investigation, Senior Analyst

Principal Fraud Protection and Controls Analyst

Director, Fraud Risk Oversight

Senior Manager, Fraud & Claims Quality Control (QC)

Payment Network Compliance Analyst (Visa/Mastercard/Discover)

Surveillance Investigator

Product Manager, Fraud & Abuse

Fraud & Claims Call Monitoring Lead

Fraud Risk Analytics Sr Analyst

Fraud Operations Manager

VP, Compliance - Card Services & Cash Management

RN Clinical Auditor

Investigator

Surveillance Investigator

As Needed Field Investigator- Coventry, RI

Surveillance Investigator I - Entry Level

Operational Risk Manager - Cybersecurity

Surveillance Investigator II

Rhode Island, Cranston Surveillance Investigator

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