Top 6 Senior fraud investigator Jobs in Miami Fl

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
Fraud Risk & Detection Director
City National Bank of Florida —Miami, FL
- Full-time
- Office
- Finance
- Business Administration
Senior Financial Investigator
Contact Government Services, LLC —Miami, FL
- $74,156.16 - $107,114.45 a year
- Full-time
- Hybrid work
- Mid-level
- Driver's License
- Presentation skills
- Health insurance
- Dental insurance
Quick Apply
Senior Auditor
Contact Government Services, LLC —Miami, FL
- $80,000 - $150,000 a year
- Full-time
- Hybrid work
- CPA
- 5 years
- Analysis skills
- Health insurance
- Dental insurance
Quick Apply
LAW ENFORCEMENT INVESTIGATOR II - 43001191
The State of Florida —Miami, FL
- $60,000 - $63,000 a year
- On call
- Bilingual
- Background check
- Computer Science
- Health savings account
- Paid holidays
Senior Auditor - Comptroller Audit Operations (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

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

CVS Health -
Plantation, FL

Apply Now

Job Details

Full-time
$46,988 - $102,000 a year

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance

Qualifications

Criminal procedure
Healthcare financial misconduct investigations
Customer communication
Claim investigation
Microsoft Excel
Microsoft Outlook
Process audits
Medical coding guidelines
Research
Documentation tools
Case review audits
Healthcare billing investigations
Legal evidence
Insurance investigations
Healthcare coding investigations
Healthcare ethical conduct investigations

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.

The SIU Senior Investigator conducts complex investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with state regulations mandating fraud plans and practices.

What you will do

Routinely handles complex cases involving behavioral health or multi-disciplinary provider groups in a prepayment environment
Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc.
Researches and prepares cases for clinical and legal review.
Documents all appropriate case activity in case tracking system.
Prepares and presents referrals, both internal and external, in the required timeframe.
Facilitates the recovery of company lost as a result of fraud matters.
Assists team in identifying resources and best course of action on investigations.
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.
Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations of fraud and abuse

Required Qualifications

Must reside in Florida.
3 years working on health care fraud, waste, and abuse investigatory and audits required.
Knowledge of CPT/HCPCS/ICD coding
Knowledge and understanding of clinical issues.
Experience and proficiency in Microsoft Word, Excel, and Outlook, Database search tools, and use in the Intranet/Internet to research information.
Ability to travel and participate in legal proceedings, arbitrations, depositions, etc.
Ability to travel to provider offices within the state of Florida on a monthly basis

Preferred Qualifications

Credentials such as a certification from the Association of Certified Fraud Examiners (CFE), an accreditation from the National Health Care Anti-Fraud Association (AHFI), or have a minimum of three years Medicaid Fraud, Waste and Abuse investigatory experience.
Billing and Coding certifications such as CPC (AAPC)and/or CCS (AHIMA)
Knowledge of Behavioral Health policies and procedures.
Experience working Behavioral Health fraud cases.
Strong analytical and research skills using health care data.
Strong communication and customer service skills.
Proficient in researching information and identifying information resources.
Ability to effectively interact with different groups of people at different levels in any situation.
Ability to utilize company systems to obtain relevant electronic documentation.

Education

Bachelor's degree preferred, or an Associate's degree, with an additional three years (3 years total) working on health care fraud, waste, and abuse investigations and audits required.

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$46,988.00 - $102,000.00

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: 08/15/2026

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

senior fraud investigator jobs in miami fl

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

Fraud Risk & Detection Director

Senior Financial Investigator

Senior Auditor

LAW ENFORCEMENT INVESTIGATOR II - 43001191

Senior Auditor - Comptroller Audit Operations (Clerk of the Court and Comptroller)

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