Top 7 Senior fraud investigator Jobs in Oh

Investigator, Special Investigations Unit (Meritain Health)
CVS Health —Columbus, OH
- $46,988 - $122,400 a year
- Full-time
- Customer service
- Research
- Mid-level
- Health insurance
- Dental insurance
Senior Economics Crimes Counsel
State of Ohio - Auditor Of State —Franklin County, OH
- Full-time
- Writing skills
- Analysis skills
- Senior level
- Paid holidays
- Health insurance
Employee Relations Team Leader
KeyBank National Association —Brooklyn, OH
- $80,000 - $150,000 a year
- Full-time
- Hybrid work
- 5 years
- Office
- Bachelor's degree
13d
Senior Local Trial Manager (Sponsor Dedicated, Multiple Therapeutics)
IQVIA —Columbus, OH
- $93,100 - $232,800 a year
- Full-time
- Remote
- Bachelor of Science
- Writing skills
- 3 years
- Work from home
Security Specialist (Senior to Staff Level)
AEP Service Corporation —Columbus, OH
- $87,633 - $177,503 a year
- Full-time
- Computer science
- Computer Science
- High school diploma or GED
- Tuition reimbursement
5d
Faculty - Center for Innate Immunity and Inflammation, OSU Comprehensive Cancer Center (Open Rank/Track)
The Ohio State University —Columbus, OH
- Email
- Background check
- Medicine
- Pass drug screening
- Health insurance
- Dental insurance
Manager Ethics & Compliance - Ethics & Compliance - Akron FirstEnergy Headquarters
FirstEnergy Corp —Akron, OH
- Full-time
- Office
- Finance
- Travel
- Health insurance
- Dental insurance

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Investigator, Special Investigations Unit (Meritain Health)
CVS Health —Columbus, OH
The SIU Investigator will conduct investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover…
$46,988 - $122,400 a year
Senior Economics Crimes Counsel
State of Ohio - Auditor Of State —Franklin County, OH
Serve as Special Prosecutor when requested by county prosecutor, present cases to Grand Juries, prepare discovery, attend pretrial conferences and motions…

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Investigator, Special Investigations Unit (Meritain Health)

CVS Health -
Columbus, OH

Apply Now

Job Details

Full-time
$46,988 - $122,400 a year

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance

Qualifications

Healthcare financial misconduct investigations
Claim investigation
Process audits
Spreadsheets
Research
Documentation tools
Insurance investigations
Productivity software
Healthcare ethical conduct investigations
Excel data analysis

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.

Job Description

As an independently owned subsidiary of Aetna and CVS Health, Meritain Health is a leading third-party administrator of self-insured commercial health plans. The SIU Investigator will support Meritain Health’s Network Cost Management team, specifically the Special Investigations Unit (SIU).

The SIU Investigator will conduct 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.

The SIU Investigator:

Must be flexible to work EDT hours (8:00 am - 5 pm EDT).
Conducts investigations to effectively pursue the prevention, investigation, and prosecution of healthcare fraud and abuse, in order to recover lost funds, as well as to comply with state regulations mandating fraud plans and practices.
Conducts investigations of known or suspected acts of healthcare fraud and abuse.
Communicates with federal, state, and local law enforcement agencies as appropriate in matters pertaining to the prosecution of specific healthcare fraud cases.
Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, customer members, etc.
Facilitates the recovery of company and customer money lost as a result of fraud matters.
Provides input regarding controls for monitoring fraud related issues within the business units.
Delivers educational programs designed to promote deterrence and detection of fraud and minimize losses to the company
Maintains open communication with constituents internal and external to the company.
Uses available resources and technology in developing evidence, supporting allegations of fraud and abuse.
Researches and prepares cases for clinical and legal review.
Documents all appropriate case activity in tracking system.
Makes referrals and deconflictions, both internal and external, in the required timeframe.
Cost effectively manages use of outside resources and vendors to perform activities necessary for investigations.

Required Qualifications

3+ years of experience working in fraud, waste and abuse investigations and audits.
3+ years of experience in healthcare/medical insurance claims investigation or professional/clinical experience.
Demonstrated proficiency in Microsoft Office Suite (including Excel, specifically with pivot tables), database search tools, and use of the Intranet/Internet to research information.

Preferred Qualifications

Strong analytical and research skills.
Strong verbal and written communication skills.
Strong customer service skills.
Previous experience as a senior investigator.
Previous experience utilizing QuickBase.
Proficient in researching information and identifying information resources.
Ability to utilize company systems to obtain relevant electronic documentation.
Ability to travel and participate in legal proceedings, arbitrations, depositions, etc.
Ability to interact with different groups of people at different levels and aid on a timely basis.
Previous experience working with a Third-Party Administrator (TPA) and/or Self-Funded Plans in an investigative capacity.
AHFI (Accredited Health Care Fraud Investigator), CFE (Certified Fraud Examiner), and/or CPC (Certified Professional Coder).
Knowledge of CVS/Aetna/Meritain Health’s policies and procedures

Education

Bachelor's Degree or equivalent work experience (high school diploma or GED + 4 years of relevant work experience).

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$46,988.00 - $122,400.00

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: 08/28/2026

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 oh

Investigator, Special Investigations Unit (Meritain Health)

Senior Economics Crimes Counsel

Employee Relations Team Leader

Senior Local Trial Manager (Sponsor Dedicated, Multiple Therapeutics)

Security Specialist (Senior to Staff Level)

Faculty - Center for Innate Immunity and Inflammation, OSU Comprehensive Cancer Center (Open Rank/Track)

Manager Ethics & Compliance - Ethics & Compliance - Akron FirstEnergy Headquarters

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