Top 20 Fraud investigator Jobs in New Mexico

Senior Investigator
UnitedHealthcare —Albuquerque, NM
- $60,200 - $107,400 a year
- Full-time
- Remote
- Microsoft Word
- Up to 50% travel
- Pass drug screening
- AD&D insurance
- Employee stock purchase plan
Senior Compliance Investigator
Centene —New Mexico
- $70,100 - $126,200 a year
- Full-time
- Remote
- Writing skills
- High school diploma or GED
- Fair chance
- Paid holidays
- Health insurance
14d
Surveillance Investigator I - Entry Level
Command Investigations, LLC —New Mexico
- $20 - $25 an hour
- 8 hour shift
- Microsoft Word
- Clean driving record
- Customer service
- Health insurance
- Dental insurance
Quick Apply
Investigator, Special Investigations Unit (Meritain Health)
CVS Health —Santa Fe, NM
- $46,988 - $122,400 a year
- Full-time
- Customer service
- Research
- Mid-level
- Health insurance
- Dental insurance
Certified Professional Coder, Special Investigations Unit (Aetna SIU)
CVS Health —New Mexico
- $43,888 - $93,574 a year
- Full-time
- Remote
- Microsoft Excel
- Research
- Mid-level
- Health insurance
- Dental insurance
Licensure Senior Investigator (PED #73441)
State of New Mexico —Santa Fe, NM
- $27.37 - $41.06 an hour
- Full-time
- Office
- Driver's License
- Bachelor's degree
4d
Surveillance Investigator II - Experienced
Command Investigations, LLC —New Mexico
- $25 - $30 an hour
- 8 hour shift
- Microsoft Word
- Clean driving record
- Customer service
- Health insurance
- Dental insurance
Quick Apply
Surveillance Investigator
Allied Universal® Compliance and Investigations —Las Cruces, NM
- Weekends as needed
- Microsoft Word
- Military
- Mid-level
- AD&D insurance
- Paid holidays
Quick Apply
SIU - Experienced Field Investigator - Part-Time
Command Investigations, LLC —Roswell, NM
- $30 an hour
- Overtime
- Bilingual
- Microsoft Outlook
- Customer service
- Health insurance
- Dental insurance
Quick Apply
Surveillance Agent
Marshall Investigative Group —Las Cruces, NM
- $22 - $32 an hour
- Part-time
- Microsoft Word
- 11+ years
- Research
Quick Apply
As Needed Field Investigator- Las Cruces, NM
J T Becker & Co Inc —Las Cruces, NM
- Writing skills
- Mid-level
- Driver's License
- Flexible schedule
Quick Apply
As Needed Field Investigator- Santa Fe, NM
J T Becker & Co Inc —Santa Fe, NM
- Writing skills
- Mid-level
- Driver's License
- Flexible schedule
Quick Apply
As Needed Field Investigator- Albuquerque, NM
J T Becker & Co Inc —Albuquerque, NM
- Writing skills
- Mid-level
- Driver's License
- Flexible schedule
Quick Apply
As Needed Field Investigator- Carlsbad, NM
J T Becker & Co Inc —Carlsbad, NM
- Writing skills
- Mid-level
- Driver's License
- Flexible schedule
Quick Apply
Senior Forensic Structural Engineer, P.E
EFI Global, Inc. —Albuquerque, NM
- Full-time
- Remote
- Customer service
- Ability to walk for extended periods
- Bachelor of Science
- Health insurance
- Dental insurance
12d

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Senior Investigator
UnitedHealthcare —Albuquerque, NM
Ability to travel up to 50%, access to reliable transportation, and & valid US driver's license. The Senior Investigator is responsible for conducting…
$60,200 - $107,400 a year
Senior Compliance Investigator
Centene —New Mexico
Leads and conducts compliance and ethics investigations across all business units and health plans, including but not limited to assessment of allegations,…
$70,100 - $126,200 a year
14d

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Surveillance Investigator II
Command Investigations, LLC —Columbus, OH
Valid driver’s license with clean DMV record. In this role, you will conduct field surveillance investigations by observing, tracking, and documenting subjects’…
$25 - $30 an hour
Quick Apply
Fraud and Abuse Investigator / CPC - Remote
Sentara Workforce Solutions, LLC —Columbus, OH
Keywords: Healthcare, Health Plan, Remote, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada,…
$25.60 - $42.67 an hour
Quick Apply
4d

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fraud investigator jobs near new mexico

Senior Investigator

UnitedHealthcare -
Albuquerque, NM

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Job Details

Full-time
$60,200 - $107,400 a year

Benefits

AD&D insurance
Employee stock purchase plan
Paid holidays
Disability insurance
Health insurance
Dental insurance
401(k)
Tuition reimbursement
Paid time off
Employee assistance program
Vision insurance
Employee discount
Referral program
Pet insurance

Qualifications

Microsoft Word
Healthcare financial misconduct investigations
Investigations regulatory compliance
Medical law
Spreadsheets
State healthcare regulations
Investigative data analysis
Driver's License

Full Job Description

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The Senior Investigator is responsible for identification, investigation and prevention of healthcare fraud, waste, and abuse. The Senior Investigator will utilize claims data, applicable guidelines, and other sources of information to identify aberrant billing practices and patterns. The Senior Investigator is responsible for conducting investigations which may include field work to perform interviews and obtain records and/or other relevant documentation.

If you reside in the state of New Mexico, you will have the flexibility to telecommute* as you take on some tough challenges.

Schedule: Monday-Friday 8-4:30 CST

Primary Responsibilities:

Assess complaints of alleged misconduct received within the Company
Investigate medium to high complex cases of fraud, waste, and abuse
Detect fraudulent activity by members, providers, employees, and other parties against the Company
Develop and deploy the most effective and efficient investigative strategy for each investigation
Maintain accurate, current, and thorough case information in the Special Investigations Unit's (SIU's) case tracking system
Collect and secure documentation or evidence and prepare summaries of the findings
Participate in settlement negotiations and/or produce investigative materials in support of the latter
Collect, collate, analyze, and interpret data relating to fraud, waste, and abuse referrals
Ensure compliance of applicable federal/state regulations or contractual obligations
Report suspected fraud, waste, and abuse to appropriate federal or state government regulators
Comply with goals, policies, procedures, and strategic plans as delegated by SIU leadership
Collaborate with state/federal partners, at the discretion of SIU leadership, to include attendance at workgroups or regulatory meetings
Communicate effectively, including written and verbal forms of communication
Develop goals and objectives, track progress and adapt to changing priorities
Must participate in legal proceedings, arbitration, and depositions at the direction of management

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
Medical Plan options along with participation in a Health Spending Account or a Health Saving account
Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
401(k) Savings Plan, Employee Stock Purchase Plan
Education Reimbursement
Employee Discounts
Employee Assistance Program
Employee Referral Bonus Program
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

Associate's degree or above
2+ years of experience in fraud, waste and abuse (FWA) investigations/audit
2+ years of experience with state/federal laws and regulations pertaining to healthcare FWA
2+ years of experience in analyzing data to identify fraud, waste and abuse trends
Intermediate level of proficiency in Microsoft Excel and Word
Ability to travel up to 50%, access to reliable transportation, and & valid US driver's license
Reside in the state of New Mexico

Preferred Qualifications:

Specialized knowledge/training in healthcare FWA investigations
Active affiliations with the National Health Care Anti-Fraud Association (NHCAA)
Accredited Health Care Fraud Investigator (AHFI)
Certified Fraud Examiner (CFE)
Certified Professional Coder (CPC)
Medical Laboratory Technician (MLT)
Statistical Analysis
All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO #GREEN

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fraud investigator jobs in new mexico

Senior Investigator

Senior Compliance Investigator

Surveillance Investigator I - Entry Level

Investigator, Special Investigations Unit (Meritain Health)

Certified Professional Coder, Special Investigations Unit (Aetna SIU)

Licensure Senior Investigator (PED #73441)

Surveillance Investigator II - Experienced

Surveillance Investigator

SIU - Experienced Field Investigator - Part-Time

Surveillance Agent

As Needed Field Investigator- Las Cruces, NM

As Needed Field Investigator- Santa Fe, NM

As Needed Field Investigator- Albuquerque, NM

As Needed Field Investigator- Carlsbad, NM

Senior Forensic Structural Engineer, P.E

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