Top 119 Claims investigator Jobs in Florida

SIU Investigator
Centene —Florida
- $56,200 - $101,000 a year
- Full-time
- Remote
- Mid-level
- Fair chance
- 1 year
- Paid holidays
- Health insurance
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
Auditor/Investigator II
Qlarant —Florida
- $57,512 - $85,839 a year
- Full-time
- Remote
- Mid-level
- Analysis skills
- Bachelor's degree
Quick Apply
Enrollment Representative - Benefit Investigator
BioPlus Specialty Pharmacy —Altamonte Springs, FL
- Computer literacy
- High school diploma or GED
- Computer skills
- 401(k)
Quick Apply
SIU Field Investigator - Brevard County, FL
GEICO —Melbourne, FL
- $32.05 - $49.86 an hour
- Full-time
- 5 years
- Mid-level
- Associate's degree
12d
Senior Field Security Investigator
GEICO —Orlando, FL
- $32.05 - $49.86 an hour
- Full-time
- 5 years
- Senior level
- Associate's degree
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
12d
MEDICAID FRAUD ANALYST II - 41001293 1
The State of Florida —Orlando, FL
- $57,783.18 a year
- Research
- Analysis skills
- Bachelor's degree
- Paid holidays
- Dental insurance
13d
Entry-Level Investigator
Ethos Risk Services —Palm Bay, FL
- $20 - $26 an hour
- Weekends as needed
- Computer literacy
- Writing skills
- No experience needed
- Paid training
- Mileage reimbursement
Quick Apply
3d
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
Fraud Investigator I
Space Coast Credit Union —Miramar, FL
- $28.13 - $29.79 an hour
- Hybrid work
- Pass drug screening
- Mid-level
- Office
- Health savings account
- Disability insurance
Quick Apply
13d
MEDICAL DISABILITY EXAMINER - 64004787
The State of Florida —Jacksonville, FL
- $41,738.88 - $78,418.23 a year
- Weekends as needed
- Background check
- Basic math
- Pass drug screening
- Paid holidays
- Disability insurance
3d
Regulatory Analyst - Remote
University of Miami —Miami, FL
- Full-time
- Remote
- Databases
- Bachelor's degree
- Continuous improvement
- Health insurance
- Dental insurance
SIU Investigator - Miami, FL
Delta Group —Miami, FL
- $30 - $40 an hour
- Per diem
- Microsoft Outlook
- Organizational skills
- Senior level
Quick Apply
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
Seeking Sharp Minds: Investigator | Miami, FL & Surrounding Areas | Must Have Class C – Private Investigator License
Alliance Risk Group —Miami, FL
- $25 - $30 an hour
- Part-time
- Mid-level
- Office
- Analysis skills
Quick Apply
MEDICAL DISABILITY EXAMINER - 64005290
The State of Florida —Tallahassee, FL
- $41,739.88 - $78,418.23 a year
- Weekends as needed
- Background check
- Basic math
- Pass drug screening
- Paid holidays
- Disability insurance
3d
SIU Desk Investigator - Miami
AssuranceAmerica —Florida
- Full-time
- Customer service
- Mid-level
- Office
Certified Professional Coder, Special Investigations Unit (Aetna SIU)
CVS Health —Florida
- $43,888 - $93,574 a year
- Full-time
- Remote
- Microsoft Excel
- Research
- Mid-level
- Health insurance
- Dental insurance
6d
SIU Investigator
Loyalty MGA LLC —Casselberry, FL
- $45,000 - $65,000 a year
- Spanish
- English
- High school diploma or GED
- Health insurance
- Dental insurance
Quick Apply
5d

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claims investigator jobs near florida

SIU Investigator

Centene -
Florida

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Job Details

Full-time
$56,200 - $101,000 a year

Benefits

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

Qualifications

Healthcare financial misconduct investigations
Data mining
Health data analysis
Bachelor's degree in business
Mid-level
Suspicious activity investigations
Data summary reports
Criminal Justice
Audit Reporting
Investigative data analysis
Insurance investigation report preparation
Outlier detection
Healthcare billing investigations
Case referral
1 year
Insurance claims auditing
Business
Healthcare claims compliance audits
Bachelor's degree in criminal justice

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.

Please note: candidates who reside in Florida are highly preferred.

Position Purpose: Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse.

Conduct investigations of potential waste, abuse, and fraud
Document activity on each case and refer issues to the appropriate party
Perform data mining and analysis to detect aberrancies and outliers in claims
Develop new queries and reports to detect potential waste, abuse, and fraud
Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions
Assist with complex allegations of healthcare fraud
Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies
Complete various special projects and audits
Performs other duties as assigned
Complies with all policies and standards

Education/Experience:

Bachelor's Degree Business, Criminal Justice, Healthcare, or related field, or equivalent experience required
1+ years Medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation required

Pay Range: $56,200.00 - $101,000.00 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

claims investigator jobs in florida

SIU Investigator

Senior Investigator, Special Investigations Unit (Aetna SIU)

Auditor/Investigator II

Enrollment Representative - Benefit Investigator

SIU Field Investigator - Brevard County, FL

Senior Field Security Investigator

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

MEDICAID FRAUD ANALYST II - 41001293 1

Entry-Level Investigator

Investigator, Special Investigative Unit-must reside in Florida

Fraud Investigator I

MEDICAL DISABILITY EXAMINER - 64004787

Regulatory Analyst - Remote

SIU Investigator - Miami, FL

Investigator, Special Investigative Unit Coding-Miami Florida

Seeking Sharp Minds: Investigator | Miami, FL & Surrounding Areas | Must Have Class C – Private Investigator License

MEDICAL DISABILITY EXAMINER - 64005290

SIU Desk Investigator - Miami

Certified Professional Coder, Special Investigations Unit (Aetna SIU)

SIU Investigator

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