Top 40 Claims investigator Jobs in North Carolina

Certified Professional Coder, Special Investigations Unit (Aetna SIU)
CVS Health —North Carolina
- $43,888 - $93,574 a year
- Full-time
- Remote
- Microsoft Excel
- Research
- Mid-level
- Health insurance
- Dental insurance
Case Development Specialist
Judi Health —Charlotte, NC
- $64,000 - $80,000 a year
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- Research
Quick Apply
Senior Fraud, Waste and Abuse (FWA) Investigator
PacificSource Health Plans —North Carolina
- $65,296.83 - $111,004.62 a year
- Full-time
- Computer literacy
- Writing skills
- HIPAA
Senior Field Security Investigator
GEICO —Charlotte, NC
- $32.05 - $49.86 an hour
- Full-time
- 5 years
- Senior level
- Associate's degree
Collision Data Analyst
Advantage Surveillance LLC —Charlotte, NC
- $28.50 - $38.50 an hour
- Part-time
- ASE Certification
- Mid-level
- Analysis skills
Quick Apply
Field Investigator (Full-Time & Part-Time) – Raleigh, NC
Origin Investigations Inc —Raleigh, NC
- $20 - $30 an hour
- Part-time
- Background check
- Military
- Computer literacy
Quick Apply
9d
Incident Investigation Analyst
Sky Zone —North Carolina
- $75,000 - $85,000 a year
- Full-time
- 3 years
- Travel
- Business Administration
- Health insurance
- Dental insurance
Quick Apply
7d
Income Maintenance Investigator II
Johnston County, NC —Johnston County, NC
- $51,977.34 - $88,361.50 a year
- Urgently hiring
- Bilingual
- Background check
- Pass drug screening
- Paid holidays
- Health insurance
Fraud Investigator I
BM Technologies, Inc. —Rocky Mount, NC
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Research
- Paid holidays
- Health insurance
5d
Part-Time Surveillance Investigator
The Robison Group —Greensboro, NC
- $25 - $30 an hour
- Part-time
- Background check
- Computer literacy
- Pass drug screening
- Mileage reimbursement
Quick Apply
SIU Claims Investigator
Lemieux & Associates LLC —Charlotte, NC
- $25 - $32 an hour
- Part-time
- Bilingual
- Computer literacy
- Mid-level
- Flexible schedule
Quick Apply
7d
Wage & Hour Investigator I
State of North Carolina - Department of Labor —Wake County, NC
- $39,244 - $68,679 a year
- Full-time
- Background check
- Spanish
- Writing skills
6d
Affirmative Civil Enforcement (ACE) Investigator
Contact Government Services, LLC —Charlotte, NC
- $51,435.30 - $66,131.10 a year
- Full-time
- Hybrid work
- Microsoft Access
- Microsoft Outlook
- Office
- Health insurance
- Dental insurance
Quick Apply
Experienced AML Investigator - Financial Crime (Remote)
AML RightSource, LLC —Raleigh, NC
- $43,888 - $69,000 a year
- Full-time
- Remote
- Mid-level
- Analysis skills
- Bachelor's degree
- Paid holidays
- Dental insurance
Quick Apply
6d
FT Private Investigator - Charlotte, NC
Delta Group —Charlotte, NC
- $20 - $30 an hour
- Full-time
- Background check
- 18 years or older
- Clean driving record
- Disability insurance
- Health insurance
Quick Apply
SIU - Experienced Field Investigator - Part-Time
Command Investigations, LLC —Winston-Salem, NC
- $28 - $32 an hour
- Overtime
- Bilingual
- Microsoft Outlook
- Customer service
- Health insurance
- Dental insurance
Quick Apply
Construction Defect Senior Technical Specialist
The Travelers Companies, Inc. —Charlotte, NC
- $94,400 - $155,800 a year
- Hybrid work
- Customer service
- 3 years
- High school diploma or GED
- Wellness program
- Paid holidays
Surveillance Investigator
Allied Universal® Compliance and Investigations —Asheville, NC
- Weekends as needed
- Microsoft Word
- Military
- Mid-level
- AD&D insurance
- Paid holidays
Quick Apply
Surveillance Investigator
Allied Universal® Compliance and Investigations —Charlotte, NC
- Weekends as needed
- Microsoft Word
- Military
- Mid-level
- AD&D insurance
- Paid holidays
Quick Apply
Surveillance Agent - Full-time or Part-time
MARSHALL INVESTIGATIVE GROUP LLC —Raleigh, NC
- $22 - $32 an hour
- Weekends as needed
- Microsoft Word
- 11+ years
- Research
Quick Apply

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

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 north carolina

Business Development Specialist jobs in Charlotte, NC

Field Investigator jobs in Charlotte, NC

Data Analyst jobs in Charlotte, NC

Siu Investigator jobs in Charlotte, NC

Private Investigator jobs in Charlotte, NC

Siu Investigator jobs in North Carolina

Field Investigator jobs in Raleigh, NC

Surveillance Investigator jobs in Charlotte, NC

Financial Investigator jobs in Raleigh, NC

Civil Enforcement Officer jobs in Charlotte, NC

Pipeline Operator jobs in Oklahoma

Surveillance Operator jobs in Eatontown, NJ

Surveillance Operator jobs in Miami, FL

Cargo Van Owner Operator jobs in Michigan

Surveillance Operator jobs in Nashville, TN

Heavy Equipment Operator jobs in Monmouth County, NJ

Forklift Operator jobs in Plant City, FL

Surveillance Operator jobs in Louisville, KY

Business Development Specialist jobs in Santa Ana, CA

Remote Charge Capture Specialist jobs in Remote

Certified Professional Coder, Special Investigations Unit (Aetna SIU)

CVS Health -
North Carolina

Apply Now

Job Details

Full-time
$43,888 - $93,574 a year

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance

Qualifications

Microsoft Excel
Word embeddings
Research
High school diploma or GED
Certified Professional Coder
Productivity software
Clinical documentation standards
Documentation review

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 Certified Professional Coder (CPC) will perform medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. The CPC must have the ability to determine correct coding and appropriate documentation during the review of medical records. The CPC must also ensure that the state, federal and company requirements are met and recognize any concerning billing patterns or trends.

Conduct a comprehensive medical record audit to ensure the CPT/HCPCS or modifiers billed are consistent with medical record documentation.
Provide detailed written summary of medical record review findings.
Must be able to articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc.
Research and accurately apply state or CMS guidelines related to the audit with minimal support.
Review and discuss cases with Medical Directors to validate decisions.
Assist with investigative research related to coding questions, state and federal policies.
Identify potential billing errors, abuse, and fraud.
Identify opportunities for savings related to potential cases which may warrant a prepayment review.
Maintain appropriate records, files, documentation, etc.
Uses department resources regularly and follows workflows with minimal assistance or intervention to perform daily work to meet metrics.
Maintains up-to-date coding knowledge, including new changes to coding compliance and reimbursement.

Required Qualifications

AAPC Certified Professional Coder Certification (CPC)
3+ years of experience in medical coding or documentation auditing.
Knowledge of standard industry coding guides and guidelines including CPT, HCPCS, ICD-10, CMS 1500 and UB04 data elements
Experience with researching coding and policies.
Experience with Microsoft products, specifically Excel and Word

Preferred Qualifications

CPMA
Strong attention to detail and ability to review and interpret data.
Demonstrates strong communication skills.
Prior payor auditing experience
Excellent communication skills
Excellent analytical skills
Two years or more previous experience with Behavioral Health coding/auditing of records

Education

GED or equivalent
AAPC Certified Professional Coder Certification (CPC)

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$43,888.00 - $93,574.00

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: 08/22/2026

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 north carolina

Certified Professional Coder, Special Investigations Unit (Aetna SIU)

Case Development Specialist

Senior Fraud, Waste and Abuse (FWA) Investigator

Senior Field Security Investigator

Collision Data Analyst

Field Investigator (Full-Time & Part-Time) – Raleigh, NC

Incident Investigation Analyst

Income Maintenance Investigator II

Fraud Investigator I

Part-Time Surveillance Investigator

SIU Claims Investigator

Wage & Hour Investigator I

Affirmative Civil Enforcement (ACE) Investigator

Experienced AML Investigator - Financial Crime (Remote)

FT Private Investigator - Charlotte, NC

SIU - Experienced Field Investigator - Part-Time

Construction Defect Senior Technical Specialist

Surveillance Investigator

Surveillance Investigator

Surveillance Agent - Full-time or Part-time

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

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected