Top 27 Fraud investigator Jobs in Mesa, Az

Program Integrity Investigator (Healthcare Fraud Waste & Abuse)
TriWest Healthcare Alliance —Phoenix, AZ
- $64,000 - $68,000 a year
- Full-time
- Customer service
- Research
- Mid-level
- AD&D insurance
- Disability insurance
Senior Investigative Specialist
Edward Jones —Tempe, AZ
- $74,600 - $122,800 a year
- Full-time
- Hybrid work
- CPA
- Mid-level
- Office
- Profit sharing
- Health savings account
Investigator, Special Investigations Unit (Aetna SIU)
CVS Health —Phoenix, AZ
- $43,888 - $93,574 a year
- Full-time
- Microsoft Word
- Spanish
- Microsoft Excel
- Health insurance
- Dental insurance
Asset Protection Investigator
Neiman Marcus —Scottsdale, AZ
- $21.53 - $26.91 an hour
- Full-time
- Computer literacy
- Writing skills
- Conflict management
- Disability insurance
- Health insurance
FINANCIAL INVESTIGATOR
State of Arizona —Phoenix, AZ
- $60,000 - $89,000 a year
- Full-time
- CPA
- Writing skills
- Research
- Paid holidays
- Disability insurance
Surveillance Agent
MARSHALL INVESTIGATIVE GROUP LLC —Phoenix, AZ
- $22 - $32 an hour
- Part-time
- Microsoft Word
- 11+ years
- Research
Quick Apply
7d
Fraud Analyst
OneAZ Credit Union —Glendale, AZ
- $56,823.44 - $71,029.30 a year
- Mid-level
- Office
- 3 years
- Paid holidays
- Loan repayment program
Quick Apply
5d
SIU Investigator (Part-Time)
VRC Investigations —Phoenix, AZ
- $30 - $35 an hour
- Part-time
- Customer service
- 5 years
- Military
- Profit sharing
- Paid training
Quick Apply
Surveillance Investigator
Allied Universal® Compliance and Investigations —Phoenix, AZ
- Weekends as needed
- Microsoft Word
- Military
- Mid-level
- AD&D insurance
- Paid holidays
Quick Apply
13d
Surveillance Investigator
Lemieux & Associates LLC —Phoenix, AZ
- $25 - $32 an hour
- Part-time
- Bilingual
- Microsoft Word
- Computer literacy
- Flexible schedule
Quick Apply
Surveillance Investigator (Part-Time)
VRC Investigations —Phoenix, AZ
- Part-time
- Clean driving record
- Military
- Computer literacy
- Profit sharing
- Paid training
Quick Apply
GFC Investigator (Brokerage - AML)
Bank of America —Phoenix, AZ
- $68,500 - $102,000 a year
- Full-time
- 5 years
- Writing skills
- Office
As Needed Field Investigator- Scottsdale, AZ
J T Becker & Co Inc —Scottsdale, AZ
- Writing skills
- Mid-level
- Driver's License
- Flexible schedule
Quick Apply
Field Claims Investigator
Phoenix Loss Control —Phoenix, AZ
- $25 an hour
- Part-time
- Hybrid work
- Military
- Mid-level
- Analysis skills
Quick Apply
Experienced AML Investigator - Financial Crimes (Hybrid)
AML RightSource, LLC —Phoenix, AZ
- $43,888 - $69,000 a year
- Full-time
- Hybrid work
- Mid-level
- Analysis skills
- Bachelor's degree
- Paid holidays
- Dental insurance
Quick Apply
14h
Investigator - Network Services - Full Time
CoventBridge Group —Phoenix, AZ
- $25 - $28 an hour
- Weekends as needed
- Background check
- Military
- Computer literacy
- Paid training
- Fuel card
14d
Investigation Specialist II-JP, Flex I&O
Amazon.com LLC - A03 —Tempe, AZ
- $18 - $31 an hour
- Overtime
- Mid-level
- Analysis skills
- Mentoring
- AD&D insurance
- Health insurance
Arizona Professional Investigator
Covert Special Investigations, Inc —Chandler, AZ
- $0.22 - $0.26 an hour
- Part-time
- Spanish
- Writing skills
- English
- Paid time off
- Opportunities for advancement
Quick Apply
Special Investigator
State of Arizona —Phoenix, AZ
- $49,500 - $53,840 a year
- Full-time
- Microsoft Word
- Background check
- Clean driving record
- Paid parental leave
- Paid holidays
13d
Claims Investigator - Part Time
Command Investigations, LLC —Phoenix, AZ
- $23 - $30 an hour
- Overtime
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
Quick Apply
14d

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Program Integrity Investigator (Healthcare Fraud Waste & Abuse)

TriWest Healthcare Alliance -
Phoenix, AZ

Apply Now

Job Details

Full-time
$64,000 - $68,000 a year

Benefits

AD&D insurance
Disability insurance
Health insurance
Dental insurance
401(k)
Tuition reimbursement
Paid time off
Vision insurance
401(k) matching
Life insurance

Qualifications

Healthcare financial misconduct investigations
Health data analysis
Health insurance policy knowledge
Regulatory compliance in claims processing
High school diploma or GED
Investigative data analysis
Case review audits
Insurance claims auditing
Healthcare claims compliance audits

Full Job Description

Profile

We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only).

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

Job Summary

This position is under the general guidance of the Director, Program Integrity and reports directly to the Supervisor, Program Integrity. The PI Investigator t is responsible for the identification, analysis, case development, and reporting of suspected fraud, waste and abuse (FWA) cases as defined by the Department of Veterans Affairs (VA), the Healthcare Finance Administration (HCFA) and the Department of Defense, Defense Health Agency for the TRICARE program; requests and reviews issue-related medical claims and records for FWA and/or administrative and clerical error(s).

Complies with the Veterans Affairs Community Care Network (CCN) and TRICARE T-5 contracts; DHA and TRICARE program guidelines and pertinent Federal regulatory requirements; assists supervisors with FWA trending and reporting requirements; coordinates and assists with investigations and prosecutions by federal agencies interfaces directly with Veterans, Military members and family (as warranted), providers, subcontractors, and other TriWest departments on FWA issues; assist supervisor with the education and training of TriWest, subcontractor, and provider personnel on current FWA matters; prepares appropriate responses to provider compliance issues and complaints referred to Program Integrity by other TriWest departments or external referrals.

Education & Experience

Required:

2 years of experience in fraud, waste and abuse investigations, or equivalent claim auditing experience
U.S. Citizenship
Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
Experience with data analysis techniques, to include Excel and/or SQL expressions
High School Diploma or GED required
Experience with quality review standards and healthcare claims analysis techniques
Knowledge of medical billing regulations and practices, as well as standard healthcare benefits and exclusions

Preferred:

Knowledge of current trends in healthcare fraud, waste and abuse
Knowledge of CMS benefits and policies
Knowledge of Facets
Certified Coder (CPC, CPC-P, CCA, CCS-P), AHFI, or other related certification
Experience with IBM’s Fraud and Abuse Management System (FAMS) and Case Manager Solutions
Experience with PeopleSoft and MS Office Suite

Key Responsibilities

Independently researches FWA issues and effectively employs investigative resources/techniques in achieving projected PI performance goals and outcomes, requiring minimal direction.
Maintains the confidentially and non-discoverability of all fraud and abuse, quality assurance, quality management, and risk management issues.
Reconciles special, unresolved issues associated with beneficiary and provider inquires.
Facilitates and supports Program Integrity goals, objectives, and contract compliance.
Readily accesses and interprets VA, DHA, TRICARE and TriWest guidelines, policies and procedures.
Effectively utilizes appropriate data systems as provided and required by TriWest to identify, research, document and track fraud and abuse issues and activities.
Participates in and/or completes VA, DHA/TRICARE directed leads, audits, investigations, data collection, and medical.
Record reviews for fraud and abuse case development.
Proactively identifies and researches potential fraud and abuse issues.
Performs as a witness in court as requested.
Researches and investigates health care fraud issues, claims data, medical records as they relate to potential fraud and abuse cases (i.e.; problem provider issues).

• Prepares and submits medical records for PI clinical review as appropriate. • Ensures accuracy, completeness, and timely submission of all required leads, reports, audits, and case development activities and documents.

Coordinates/liaises with TriWest departments, PGBA POC’s, and government agencies in researching, determining, and reporting FWA issues.
Participates in and contributes to PI education and training for beneficiaries, providers, subcontractor, and TriWest interdepartmental personnel regarding fraud and abuse.
Assists supervisor in the preparation and compilation of monthly, quarterly, semiannual, and special reports as required.
Participates in system enhancements for reporting fraud and abuse activities.
Facilitates the development of Program Integrity materials for staff, provider and beneficiary education and training as well as assist other departments with educational requests.
Facilitates the development of Program Integrity materials for provider seminars, provider newsletter, and quarterly bulletins.
Assists in the development of quality studies as directed by TriWest Medical Directors.
Assists supervisor with the annual review of PI policies and desk procedures.
Demonstrates effective use of documentation systems for communication, tracking, trending, and reporting purposes.
Research and prepare appropriate and timely responses to beneficiaries, provider and congressional compliant issues referred to Program Integrity by other company departments.
Interfaces with all levels of TriWest employees and maintains effective working relationships while adhering to all customer service goals and guidelines.
Demonstrates flexibility and adaptability towards achieving PI departmental performance/production goals and objectives.
Routinely processes recoupment requests, live claims, and performs other duties as assigned. Attends and participates in continuous training opportunities in current schemes and trends related to FWA.
Participates in and contributes to FWA information-sharing resources, task forces, and joint investigative efforts.
Regular and reliable attendance is required.

Competencies

Commitment to Task: Ability to conform to established policies and procedures; exhibit high motivation.

Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.

Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.

Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.

Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.

Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.

Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.

Technical Skills: Knowledge with CPT4, ICD-10-CM, HCPCS, DRG and Revenue Code coding conventions. Knowledge of standard benefit coverage policies and exclusions, including National and Local Coverage Determinations. Knowledge of standard healthcare billing regulations and practices.

Working Conditions

Working Conditions:

Availability to work any shift
Works in a standard office environment, with minimal travel
Extensive computer work with prolonged sitting

Company Overview

Taking Care of Our Nation’s Heroes.

It’s Who We Are. It’s What We Do.

Do you have a passion for serving those who served?

Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!

Our job is to make sure that America’s heroes get connected to health care in the community.

At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.

DoD Statement

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Benefits

We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

Medical, Dental and Vision Coverage
Paid time off
401(k) Retirement Savings Plan (with matching)
Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
Tuition reimbursement
Paid volunteer time

TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $64,000 to $68,000 per year.

Equal Employment Opportunity

TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

Apply Now

Refine Your Search

fraud investigator jobs in mesa, az

Program Integrity Investigator (Healthcare Fraud Waste & Abuse)

Senior Investigative Specialist

Investigator, Special Investigations Unit (Aetna SIU)

Asset Protection Investigator

FINANCIAL INVESTIGATOR

Surveillance Agent

Fraud Analyst

SIU Investigator (Part-Time)

Surveillance Investigator

Surveillance Investigator

Surveillance Investigator (Part-Time)

GFC Investigator (Brokerage - AML)

As Needed Field Investigator- Scottsdale, AZ

Field Claims Investigator

Experienced AML Investigator - Financial Crimes (Hybrid)

Investigator - Network Services - Full Time

Investigation Specialist II-JP, Flex I&O

Arizona Professional Investigator

Special Investigator

Claims Investigator - Part Time

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