Top 44 Certified fraud examiner Jobs in Florida

Senior Investigator, Special Investigations Unit (Aetna SIU)
CVS Health —Florida
- $46,988 - $112,200 a year
- Full-time
- Remote
- Research
- Mid-level
- 3 years
- Health insurance
- Dental insurance
Senior Compliance Investigator
Centene —Florida
- $70,100 - $126,200 a year
- Full-time
- Remote
- Writing skills
- High school diploma or GED
- Fair chance
- Paid holidays
- Health insurance
Financial Intelligence Analyst IV
Navy Federal Credit Union —Pensacola, FL
- $32 - $42 an hour
- Online Application
- Word processing
- Research
- Office
6d
Associate I, Inspector General
Clerk of the Circuit Court & Comptroller, Palm Beach County —West Palm Beach, FL
- $44,047 - $68,519 a year
- Full-time
- Hybrid work
- Background check
- CPA
- Pass drug screening
- Wellness program
- Paid holidays
11d
Senior Investigator, Special Investigations Unit (Aetna SIU) - Must reside in Florida
CVS Health —Plantation, FL
- $46,988 - $102,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Customer service
- Health insurance
- Dental insurance
5d
Associate II, Inspector General
Clerk of the Circuit Court & Comptroller, Palm Beach County —West Palm Beach, FL
- $50,990 - $79,318 a year
- Full-time
- Hybrid work
- Background check
- CPA
- Pass drug screening
- Wellness program
- Paid holidays
11d
Auditor II
Palm Beach County —West Palm Beach, FL
- $76,862 a year
- Monday to Friday
- CPA
- Computer Science
- Mid-level
Auditor I
Collier County Clerk of the Circuit Court and Comptroller —Tamiami, FL
- $66,268 a year
- Full-time
- CPA
- Writing skills
- Basic math
FINANCIAL INVESTIGATOR-CONSUMER PROTECT - 41000562 1 1
The State of Florida —Miami, FL
- $54,524.34 a year
- Extended hours
- Spanish
- Management
- 5 years
- Paid holidays
- Dental insurance
Auditor I
Palm Beach County —West Palm Beach, FL
- $69,950 a year
- Monday to Friday
- CPA
- Computer Science
- Mid-level
Investigator, Special Investigative Unit-must reside in Florida
Molina Healthcare —Florida
- $21.82 - $42.55 an hour
- Full-time
- Anatomy knowledge
- Customer service
- Research
- Health insurance
Counter Threat Finance Analyst (B21 - CENTCOM)
Amentum —Tampa, FL
- $105,000 - $111,000 a year
- Full-time
- 7 years
- Research
- Office
- Employee stock purchase plan
- Paid holidays
Auditor II
Collier County Clerk of the Circuit Court and Comptroller —Tamiami, FL
- $71,676 a year
- Full-time
- CPA
- Writing skills
- Basic math
68900289 - OPS MEDICAL/HEALTH CARE PROGRAM ANALYST
The State of Florida —Miami, FL
- $20 an hour
- Temporary
- Microsoft Word
- Background check
- Microsoft Excel
- Dental insurance
- Vision insurance
Corporate Security Specialist
AD Mortgage —Fort Lauderdale, FL
- Full-time
- Mid-level
- Office
- Finance
- Paid training
- Health insurance
Quick Apply
Due Diligence Analyst Level 3 (Alternative/Hedge Funds)
BankUnited, N. A. —Miami Lakes, FL
- 7 years
- Mid-level
- Office
Senior Auditor (Clerk of the Court and Comptroller)
Miami-Dade County —Miami-Dade County, FL
- $73,201.59 - $124,070.41 a year
- Full-time
- CPA
- Office
- Bachelor's degree
Investigator, Special Investigative Unit Coding-Miami Florida
Molina Healthcare —Florida
- $21.82 - $42.55 an hour
- Full-time
- Anatomy knowledge
- Clinic experience
- Research
- Health insurance
Threat Finance SME
Cherokee Federal —Tampa, FL
- Full-time
- 5 years
- Bachelor of Science
- Finance
- Health insurance
- Dental insurance
9d
SVP, Investigations and Recovery
Bank OZK —Clearwater, FL
- Extended hours
- Microsoft Excel
- Microsoft Outlook
- Writing skills
- Dental insurance
- Paid time off
5d

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certified fraud examiner jobs near florida

Senior Investigator, Special Investigations Unit (Aetna SIU)

CVS Health -
Florida

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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

certified fraud examiner jobs in florida

Senior Investigator, Special Investigations Unit (Aetna SIU)

Senior Compliance Investigator

Financial Intelligence Analyst IV

Associate I, Inspector General

Senior Investigator, Special Investigations Unit (Aetna SIU) - Must reside in Florida

Associate II, Inspector General

Auditor II

Auditor I

FINANCIAL INVESTIGATOR-CONSUMER PROTECT - 41000562 1 1

Auditor I

Investigator, Special Investigative Unit-must reside in Florida

Counter Threat Finance Analyst (B21 - CENTCOM)

Auditor II

68900289 - OPS MEDICAL/HEALTH CARE PROGRAM ANALYST

Corporate Security Specialist

Due Diligence Analyst Level 3 (Alternative/Hedge Funds)

Senior Auditor (Clerk of the Court and Comptroller)

Investigator, Special Investigative Unit Coding-Miami Florida

Threat Finance SME

SVP, Investigations and Recovery

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