Top 65 Insurance fraud investigator Jobs in Hackensack, Nj

Senior Fraud Investigator-NYC (Hybrid)
1199SEIU Family of Funds —New York, NY
- $89,200 - $111,500 a year
- Full-time
- Microsoft Outlook
- HIPAA
- Office
SIU Investigator
Centene —New York, NY
- $56,200 - $101,000 a year
- Full-time
- Remote
- 5 years
- Fair chance
- Senior level
- Paid holidays
- Health insurance
Corporate Ethics & Compliance Investigator
Centene —New York, NY
- $107,700 - $199,300 a year
- Full-time
- Remote
- 7 years
- Management
- HIPAA
- Paid holidays
- Health insurance
Senior Compliance Investigator
Centene —New York, NY
- $70,100 - $126,200 a year
- Full-time
- Remote
- Writing skills
- High school diploma or GED
- Fair chance
- Paid holidays
- Health insurance
Surveillance Investigator
VRC Investigations —Newark, NJ
- Clean driving record
- Military
- Computer literacy
- Profit sharing
- Paid training
Quick Apply
SIU Investigator (Part-Time)
VRC Investigations —Newark, NJ
- $30 - $35 an hour
- Part-time
- Customer service
- 5 years
- Military
- Profit sharing
- Paid training
Quick Apply
CPC Investigator
Horizon Blue Cross Blue Shield of New Jersey —Newark, NJ
- $70,500 - $94,395 a year
- Full-time
- Microsoft Word
- Anatomy knowledge
- Microsoft Excel
- Health insurance
- Dental insurance
Analyst, Customer Performance (BRAM Investigator)
Mastercard —Harrison, NY
- $78,000 - $129,000 a year
- Online Application
- Microsoft Word
- Mid-level
- Communication skills
- Paid jury duty
- Health savings account
16h
Investigator (Investigator 1, NS)
State of New York - Financial Services, Department of —New York, NY
- $86,681 - $109,650 a year
- Extended hours
- Background check
- Research
- Residential
Surveillance Investigator
Frasco Inc —Newark, NJ
- $20 - $26 an hour
- Weekends as needed
- Clean driving record
- Military
- Writing skills
- Paid training
- Mileage reimbursement
SIU Investigator - Newark, NJ
Delta Group —Newark, NJ
- $30 - $40 an hour
- Per diem
- Microsoft Outlook
- Organizational skills
- Senior level
Quick Apply
14d
SIU, Investigator
Marshall Investigative Group —New York, NY
- $50,000 - $65,000 a year
- Weekends as needed
- Remote
- Microsoft Word
- Mid-level
- High school diploma or GED
- Travel reimbursement
- Mileage reimbursement
Quick Apply
19h
Commercial Collections Investigator
Advanced Recovery Group —Fairfield, NJ
- $45,000 - $50,000 a year
- Full-time
- Research
- Mid-level
- Analysis skills
- Health insurance
- Dental insurance
Quick Apply
4h
As Needed Field Investigator- Pompton Lakes, NJ
J T Becker & Co Inc —Pompton Lakes, NJ
- Writing skills
- Mid-level
- Driver's License
- Flexible schedule
Quick Apply
New Jersey, Elizabeth Surveillance Investigator PT
Insight Service Group (ISG) —Elizabeth, NJ
- $20 - $27 an hour
- Part-time
- Writing skills
- Mid-level
- Driver's License
Quick Apply
Investigator
Ethos Risk Services —Bronx, NY
- $30 - $40 an hour
- Part-time
- Mid-level
- Residential
- Driver's License
- Paid time off
- Referral program
Quick Apply
Liability Major Case Specialist
Travelers —Morristown, NJ
- $104,000 - $171,700 a year
- Customer service
- 5 years
- Analysis skills
- Wellness program
- Paid holidays
3d
Senior Liability Litigation Specialist
Travelers —Morristown, NJ
- $94,400 - $155,800 a year
- Customer service
- 3 years
- High school diploma or GED
- Wellness program
- Paid holidays
8d
Construction Liability Major Case Specialist
Travelers —New York, NY
- $104,000 - $171,700 a year
- Customer service
- 5 years
- Analysis skills
- Wellness program
- Paid holidays
8d
Registered Nurse
Greenlife Healthcare Staffing —New York, NY
- $60 an hour
- Temporary
- Background check
- Nursing
- Skilled nursing facility
- Mileage reimbursement
- Health insurance
Quick Apply
4d

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Senior Fraud Investigator-NYC (Hybrid)

1199SEIU Family of Funds -
New York, NY

Apply Now

Job Details

Full-time
$89,200 - $111,500 a year

Qualifications

Healthcare financial misconduct investigations
Customer communication
Documentation review
Medical record review for billing accuracy
Documentation reviews

Full Job Description

Requisition #:

7462

# of openings:

Employment Type:

Full time

Position Status:

Agency Temp

Category:

Non-Bargaining

Workplace Arrangement:

Hybrid

Fund:

1199SEIU National Benefit Fund

Job Classification:

Exempt

Responsibilities

Conducts investigations into allegations of fraud, waste, or abuse, including preliminary assessments and full end-to-end case work.
Reviews and analyzes medical records, claims data, enrollment data, and other documentation to evaluate potential FWA.
Performs coding, billing, reimbursement, and medical necessity assessments based on CPT, HCPCS, ICD-9/10, DRG, and related coding guidelines.
Uses advanced data mining techniques to identify aberrant billing patterns, outliers, and other indicators of fraudulent activity.
Produces reliable, accurate and timely written investigative reports for internal and/external review detailing investigation findings, based on industry standard(s) and/or internal policy and procedure.
Recommends possible interventions for loss control and risk avoidance based on the outcome of the investigation.
Coordinates with various internal customers to gather documentation pertinent to investigations.
Incorporates communication skills to work with physicians, other health professionals, attorneys as well as external regulatory agencies and law enforcement personnel.
Communicate effectively and collaboratively with internal staff, leadership and external customers in a professional manner.
Conducts settlement negotiations with providers and/or attorneys.
Maintain the confidentiality required of the organization and the department.
Follow all Health Insurance Portability and Accountability Act (HIPAA) and Personal Health Information (PHI) requirements and regulations

Qualifications

Bachelor’s degree in business, criminal justice or related field.
Certified Professional Coder (CPC), Accredited Healthcare Fraud Investigator (AFHI), Certified Insurance Fraud Investigator (CIFI), and/or Certified Economic Crime Forensic Examiner (CECFE) preferred (but not required).
Minimum three (3) years’ experience with medical coding and medical record review performed required.
Minimum three (3) years’ experience in healthcare industry within a Special Investigation Unit (SIU) or equivalent governmental agency responsible for investigating healthcare fraud required.
Knowledge of medical coding and medical terminology.
Experience using STARSSolutions or other healthcare FWA case management and detection software preferred (but not required).
Proven track record in conducting investigations and/or the identification and pursuit of the recovery of overpayments.
Excellent report writing skills.
Knowledge of claims processing, reimbursement procedures, and a solid understanding of fraud detection and prevention practices.
Knowledge of data analysis of claims and documenting findings on spreadsheets.
Proficiency in Microsoft Office/Suite applications (Excel, Word, PowerPoint, Outlook, etc.).
Excellent interpersonal and communication skills – oral, written and listening.

This is a hybrid posiiton that will require you to report to our offices in Midtown Manhattan.

Apply Now

Refine Your Search

insurance fraud investigator jobs in hackensack, nj

Senior Fraud Investigator-NYC (Hybrid)

SIU Investigator

Corporate Ethics & Compliance Investigator

Senior Compliance Investigator

Surveillance Investigator

SIU Investigator (Part-Time)

CPC Investigator

Analyst, Customer Performance (BRAM Investigator)

Investigator (Investigator 1, NS)

Surveillance Investigator

SIU Investigator - Newark, NJ

SIU, Investigator

Commercial Collections Investigator

As Needed Field Investigator- Pompton Lakes, NJ

New Jersey, Elizabeth Surveillance Investigator PT

Investigator

Liability Major Case Specialist

Senior Liability Litigation Specialist

Construction Liability Major Case Specialist

Registered Nurse

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