Top 82 Claims investigator Jobs in Illinois

Senior Investigator, Special Investigations Unit (Aetna SIU)
CVS Health —Illinois
- $46,988 - $112,200 a year
- Full-time
- Remote
- Research
- Mid-level
- 3 years
- Health insurance
- Dental insurance
8d
Senior Fraud and Waste Investigator, Medicaid
Humana —Illinois
- $71,100 - $97,800 a year
- 8 hour shift
- Remote
- Microsoft Word
- Microsoft Outlook
- Computer literacy
- Paid parental leave
- Paid holidays
2d
Fraud, Waste and Abuse Investigation, Senior Analyst
CVS Health —Illinois
- $46,988 - $112,200 a year
- Full-time
- Remote
- Mid-level
- 3 years
- High school diploma or GED
- Health insurance
- Dental insurance
Auditor/Investigator II
Qlarant —Illinois
- $57,512 - $85,839 a year
- Full-time
- Remote
- Mid-level
- Analysis skills
- Bachelor's degree
Quick Apply
Field Investigator - SIU
Auto-Owners Insurance Company —Mount Vernon, IL
- $73,000 - $93,000 a year
- Full-time
- Writing skills
- Mid-level
- Driver's License
- Paid holidays
- Disability insurance
Quick Apply
Investigator, Special Investigations Unit (Meritain Health)
CVS Health —Springfield, IL
- $46,988 - $122,400 a year
- Full-time
- Customer service
- Research
- Mid-level
- Health insurance
- Dental insurance
19h
General Liability Claim Representative
The Travelers Companies, Inc. —Downers Grove, IL
- $67,000 - $110,600 a year
- Hybrid work
- Mid-level
- Bachelor's degree
- Children
- Wellness program
- Continuing education credits
Claim Investigation Specialist I
RLI Corp —Peoria, IL
- $23.05 - $32.33 an hour
- Full-time
- Research
- Analysis skills
- Bachelor's degree
- Profit sharing
- Health savings account
Private Investigator
Digistream Investigations —Illinois
- $18 an hour
- Overtime
- Remote
- Background check
- 21 years or older
- Travel
- Travel reimbursement
- Health insurance
Quick Apply
Associate Attorney - Plaintiff Personal Injury
Everforth —Willowbrook, IL
- $65,000 - $120,000 a year
- Full-time
- Mid-level
- Business development experience
- Analysis skills
- 401(k)
Quick Apply
3d
Associate Attorney
Everforth —Chicago, IL
- Full-time
- Writing skills
- Mid-level
- Driver's License
Quick Apply
11d
Property Adjuster Inside Trainee Hybrid Northbrook, IL
Allstate —Northbrook, IL
- $47,500 - $83,755 a year
- Weekends as needed
- Hybrid work
- Background check
- Office
- US work authorization
- Tuition reimbursement
- Work from home
3d
Special Investigation Unit (SIU) Manager
CVS Health —Illinois
- $54,300 - $159,120 a year
- Full-time
- Remote
- Microsoft Excel
- Research
- 3 years
- Health insurance
- Dental insurance
3d
Investigator I
ArcBest —Chicago, IL
- $56,000 - $73,000 a year
- Full-time
- Computer literacy
- Research
- Mid-level
Manager Special Investigations
Health Care Service Corporation —Chicago, IL
- $92,700 - $167,500 a year
- Full-time
- Hybrid work
- HIPAA
- Office
- Finance
2h
Affirmative Civil Enforcement (ACE) Investigator
Contact Government Services, LLC —Chicago, IL
- $51,435.30 - $66,131.10 a year
- Full-time
- Hybrid work
- Microsoft Access
- Microsoft Outlook
- Office
- Health insurance
- Dental insurance
Quick Apply
MRSGM NA Logistics Claims Manager - First Party
Roanoke Insurance Group Inc —Schaumburg, IL
- $75,000 - $120,000 a year
- Full-time
- Hybrid work
- Writing skills
- Office
- Organizational skills
- Paid holidays
- Disability insurance
Claim Investigation Specialist II
RLI Corp —Peoria, IL
- $57,889 - $81,189 a year
- Full-time
- Research
- Mid-level
- Analysis skills
- Profit sharing
- Health savings account
Senior Investigator
Dycom Industries, Inc. —Chicago, IL
- 18 years or older
- Google Workspace
- 7 years
- Employee stock purchase plan
- Paid holidays
Quick Apply
Property Adjuster - Field Estimating - Gadsen/Anniston, AL
Allstate —Illinois
- $56,000 - $117,700 a year
- Remote
- Background check
- Mid-level
- Driver's License
- Tuition reimbursement
- Benefits from day one

I want to receive the latest job alert for claims investigator in illinois

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

claims investigator jobs near illinois

Investigations Manager jobs in Chicago, IL

Private Investigator jobs in Illinois

Siu Investigator jobs in Illinois

Senior Fraud Investigator jobs in Chicago, IL

Fraud Investigator jobs in Illinois

Senior Auditor jobs in Illinois

Logistics Manager jobs in Schaumburg, IL

Associate Attorney jobs in Chicago, IL

Civil Enforcement Officer jobs in Chicago, IL

Government Attorney jobs in Chicago, IL

Associate Attorney jobs in Marietta, GA

Associate Product Manager jobs in Minneapolis, MN

Non Profit Attorney jobs in California

Associate Attorney jobs in Columbia, MO

Associate Attorney jobs in Pensacola, FL

Associate Attorney jobs in Bradenton, FL

Jefferson Patient Service Associate jobs in Philadelphia, PA

Manager jobs in Dallas, TX

Investigations Manager jobs in Atlanta, GA

Automotive Service Manager jobs in Tennessee

Senior Investigator, Special Investigations Unit (Aetna SIU)

CVS Health -
Illinois

Apply Now

Job Details

Full-time
$46,988 - $112,200 a year
8 days 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

claims investigator jobs in illinois

Senior Investigator, Special Investigations Unit (Aetna SIU)

Senior Fraud and Waste Investigator, Medicaid

Fraud, Waste and Abuse Investigation, Senior Analyst

Auditor/Investigator II

Field Investigator - SIU

Investigator, Special Investigations Unit (Meritain Health)

General Liability Claim Representative

Claim Investigation Specialist I

Private Investigator

Associate Attorney - Plaintiff Personal Injury

Associate Attorney

Property Adjuster Inside Trainee Hybrid Northbrook, IL

Special Investigation Unit (SIU) Manager

Investigator I

Manager Special Investigations

Affirmative Civil Enforcement (ACE) Investigator

MRSGM NA Logistics Claims Manager - First Party

Claim Investigation Specialist II

Senior Investigator

Property Adjuster - Field Estimating - Gadsen/Anniston, AL

I want to receive the latest job alert for claims investigator in illinois

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected