Top 120 Fraud investigator Jobs in Newark Nj

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
Investigator - Network Services - Full Time
CoventBridge Group —Staten Island, NY
- $26 - $30 an hour
- Weekends as needed
- Background check
- Military
- Computer literacy
- Paid training
- Fuel card
Investigator - Network Services - Full Time
CoventBridge Group —Brooklyn, NY
- $26 - $30 an hour
- Weekends as needed
- Background check
- Military
- Computer literacy
- Paid training
- Fuel card
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
7d
Private Investigator
Confidential —New York, NY
- $30 - $35 an hour
- Part-time
- Research
- Analysis skills
- Travel
- Paid time off
- Flexible schedule
Quick Apply
Field Investigator (OTR)
Probe Services —Queens, NY
- $25 - $30 an hour
- Part-time
- Computer literacy
- High school diploma or GED
- Driver's License
- Travel reimbursement
- Paid training
Quick Apply
8d
Private Investigator
Photofax, Inc —Queens, NY
- $22 - $27 an hour
- 8 hour shift
- Clean driving record
- No experience needed
- High school diploma or GED
- Travel reimbursement
- Health insurance
Quick Apply
Private Investigator (Entry Level)
DigiStream Investigations, Inc. —Matawan, NJ
- $19 an hour
- 12 hour shift
- Background check
- Writing skills
- Residential
- Travel reimbursement
- Paid training
4d
Surveillance and SIU Investigator
NWI Investigative Group, Inc. —New York, NY
- From $25 an hour
- Part-time
- Microsoft Word
- Clean driving record
- Research
- Profit sharing
- 401(k)
Quick Apply
Surveillance Investigator I - Entry Level
Command Investigations, LLC —Bronx, NY
- $20 - $25 an hour
- 8 hour shift
- Microsoft Word
- Clean driving record
- Customer service
- Health insurance
- Dental insurance
Quick Apply
Private Investigator (Entry Level)
DigiStream Investigations, Inc. —New Brunswick, NJ
- $19 an hour
- 12 hour shift
- Background check
- Writing skills
- Residential
- Travel reimbursement
- Paid training
4d
Private Investigator (Entry Level)
DigiStream Investigations, Inc. —Summit, NJ
- $19 an hour
- 12 hour shift
- Background check
- Writing skills
- Residential
- Travel reimbursement
- Paid training
4d
SIU Investigator - NY Labor Law
Allied Universal® Compliance and Investigations —Manhattan, NY
- $32 - $40 an hour
- Weekends as needed
- Spanish
- OSHA
- Military
- AD&D insurance
- Paid holidays
Quick Apply
8d
Fraud Investigation and Operations Lead, Audible Fraud Defense, Business Risk Content
Amazon.com —Newark, NJ
- $133,300 - $185,000 a year
- Full-time
- Writing skills
- SQL
- Analysis skills
- AD&D insurance
- Health insurance
Claims Investigator
Gallagher Bassett —Fairfield, NJ
- $40,000 - $78,000 a year
- Full-time
- Remote
- Mid-level
- Bachelor's degree
- Computer skills
- Benefits from day one
4d
SIU Investigator - Newark, NJ
Delta Group —Newark, NJ
- $30 - $40 an hour
- Per diem
- Microsoft Outlook
- Organizational skills
- Senior level
Quick Apply
AML Operations Analyst
Ramp —New York, NY
- $100,000 - $150,000 a year
- Full-time
- Hybrid work
- Mid-level
- Analysis skills
- Continuous improvement
- Travel reimbursement
- AD&D insurance
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
Senior Security Investigator
Northwell Health —New Hyde Park, NY
- $85,090 - $147,220 a year
- Full-time
- Maintenance
- Mid-level
- 3 years
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

I want to receive the latest job alert for fraud investigator in newark nj

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

fraud investigator jobs near newark nj

CPC Investigator

Horizon Blue Cross Blue Shield of New Jersey -
Newark, NJ

Apply Now

Job Details

Full-time
$70,500 - $94,395 a year

Benefits

Health insurance
Dental insurance
Tuition reimbursement
Paid time off
Vision insurance
Volunteer time off
Retirement plan

Qualifications

Microsoft Word
Anatomy knowledge
Microsoft Excel
Underwriting
High school diploma or GED
Certified Professional Coder
Conflict management
Medical terminology

Full Job Description

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

About the Role

The Certified Professional Coder (CPC) is responsible for performing reviews, audits and coding oversight of medical records to ensure the appropriate CPT codes, diagnosis codes and modifiers according to Generally Accepted Medical Coding Guidelines, CPT-4; HCPCS; ICD-10 Guidelines; and, CMS Correct Coding. Also, the incumbent will complete and take appropriate action in gathering, analyzing and interpreting requisite documentation to conduct low level investigations. The incumbent will also support the investigators related to research and resolution of fraudulent activity. Manage the Special Investigations Unit pended claims to insure we are meeting SLAs and service standards associated with ASO accounts and Blue Card requirements. The incumbent will also be responsible for handling low level investigative activities (external) related to claims, enrollment, accounting, receive and review suspected fraud and to complete cases with all information and analysis for resolution, as the manager and prior approved guidelines may direct.

What You'll Do

Accurately reviews, interprets, audits, codes and analyzes medical record documentation for claims that are suspended for Special Investigations pre-payment process. Review may include inpatient, outpatient treatment and/or professional medical services, according to ICD-9/ICD-10 CM coding guidelines.
Follow established procedures, guidelines and research utilizing multiple systems and tools.
Assure timely, accurate and efficient processing and resolution of pended claims and service requests.
Analyze and review confidential and highly sensitive investigative material/documents concerning employees, subscribers, providers and groups.
Obtain documentation, claims forms, checks, medical records, utilization records, specialized printouts and other data needed to determine if fraud or misrepresentation of fact is present in claims submissions.
Primary contact for other Blues Plans on any claim inquiries related to fraud investigations.
Collecting, collating, analyzing and interpreting data in a timely, accurate fashion, both internally and externally, to gather the requisite documentation to conduct an investigation.
Personally handles subpoena requests, coordinates efforts with law enforcement state agencies and claims stakeholders.
Investigates calls received to the Fraud Hotline with legitimate allegations of fraud. Gathers information related to the hotline call which includes provider and member outreach, request medical records, and claims review. Routes all other calls (i.e. customer service related) to the appropriate business unit for proper handling.
Knowledge of CPT coding, HCPCS coding, and ICD 10.

What You Bring

Education/Experience:

High School Diploma/GED required.
2 years’ experience in Health Insurance/quality chart audits and/or Utilization Review.
2-3 years’ medical coding experience.
ITS/BlueCard Knowledge preferred.

Additional licensing, certifications, registrations:

AAPC - Certified Professional Coding (CPC) Designation Required.

Knowledge:

Requires knowledge of health insurance operations (i.e. claims, enrollment, underwriting, etc.)
Prefers knowledge of claims processing and customer service systems (NASCO adjustment and pend processing, UPS, UCSW, Research Station, Cognos, and ImagePlus)
Prefers knowledge of ITS/Blue card process
Prefers knowledge in Microsoft products (Word, Excel, and Access)
Requires Medical Coding experience
Requires proficiency in the CPT-4, HCPC, ICD-9/ICD-10 coding
Requires knowledge of medical terminology and anatomy & physiology related to of medical procedures, abbreviations and terms
Requires knowledge of the health care delivery system

Skills and Abilities:

Requires excellent verbal and written communication skills
Requires the ability to effectively handle confrontational situations
Requires demonstrated ability in MS Office applications, in particular Excel and Access
Requires strong organizational skills
Requires strong interpersonal skills
Prefers strong analytical skills and the ability to interpret data and conduct root cause analysis

Travel:

Travel as needed to support investigative activity within Company's service area.

Why Horizon?

At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we’d love to hear from you!

Salary Range:

$70,500 - $94,395

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement

Disclaimer:

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.

Apply Now

Refine Your Search

fraud investigator jobs in newark nj

CPC Investigator

Investigator - Network Services - Full Time

Investigator - Network Services - Full Time

Commercial Collections Investigator

Private Investigator

Field Investigator (OTR)

Private Investigator

Private Investigator (Entry Level)

Surveillance and SIU Investigator

Surveillance Investigator I - Entry Level

Private Investigator (Entry Level)

Private Investigator (Entry Level)

SIU Investigator - NY Labor Law

Fraud Investigation and Operations Lead, Audible Fraud Defense, Business Risk Content

Claims Investigator

SIU Investigator - Newark, NJ

AML Operations Analyst

Investigator (Investigator 1, NS)

Senior Security Investigator

SIU Investigator

I want to receive the latest job alert for fraud investigator in newark nj

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected