Top 53 Claims investigator Jobs in Ohio

SIU Investigator
Centene —Ohio
- $56,200 - $101,000 a year
- Full-time
- Remote
- Mid-level
- Fair chance
- Associate's degree
- Paid holidays
- Health insurance
Senior Pharmacy SIU Investigator
Centene —Ohio
- $70,100 - $126,200 a year
- Full-time
- Remote
- Master's degree
- Continuous improvement
- Fair chance
- Paid holidays
- Health insurance
3d
Surveillance Investigator
Allied Universal® Compliance and Investigations —Dayton, OH
- $20 - $22 an hour
- Weekends as needed
- Microsoft Word
- Military
- Mid-level
- AD&D insurance
- Paid holidays
Quick Apply
7d
Experienced AML Investigator - Financial Crime (Remote)
AML RightSource, LLC —Highland Hills, OH
- $43,888 - $69,000 a year
- Full-time
- Remote
- Mid-level
- Analysis skills
- Bachelor's degree
- Paid holidays
- Dental insurance
Quick Apply
3d
Field Investigator (Full-Time & Part-Time) – Cleveland, OH
Origin Investigations Inc —Cleveland, OH
- $20 - $30 an hour
- Part-time
- Background check
- Military
- Computer literacy
Quick Apply
7d
Experienced AML Investigator - Financial Crimes (Hybrid)
AML RightSource, LLC —Highland Hills, OH
- $43,888 - $69,000 a year
- Full-time
- Hybrid work
- Mid-level
- Analysis skills
- Bachelor's degree
- Paid holidays
- Dental insurance
Quick Apply
Field Investigator (Full-Time & Part-Time) – Columbus, OH
Origin Investigations Inc —Columbus, OH
- $20 - $30 an hour
- Part-time
- Background check
- Military
- Computer literacy
Quick Apply
7d
Surveillance Agent
MARSHALL INVESTIGATIVE GROUP LLC —Cleveland, OH
- $22 - $32 an hour
- Weekends as needed
- Remote
- Microsoft Word
- 11+ years
- Research
Quick Apply
5d
SIU, Investigator
Marshall Investigative Group —Cincinnati, OH
- $50,000 - $65,000 a year
- Weekends as needed
- Microsoft Word
- Mid-level
- High school diploma or GED
- Travel reimbursement
- Mileage reimbursement
Quick Apply
Certified Professional Coder, Special Investigations Unit (Aetna SIU)
CVS Health —Ohio
- $43,888 - $93,574 a year
- Full-time
- Remote
- Microsoft Excel
- Research
- Mid-level
- Health insurance
- Dental insurance
Field Auto Adjuster - Cincinnati, OH
Allstate —Columbus, OH
- $60,000 - $117,700 a year
- Writing skills
- Mid-level
- Driver's License
- Wellness program
- Paid parental leave
Litigation Analyst
Core Specialty —Cincinnati, OH
- Full-time
- Hybrid work
- Mid-level
- Bachelor's degree
- US work authorization
- Wellness program
- Health savings account
Claims Investigator - Part Time
Command Investigations, LLC —Cincinnati, OH
- $23 - $30 an hour
- Overtime
- Microsoft Excel
- Microsoft Outlook
- Customer service
Quick Apply
Surveillance Agent
Marshall Investigative Group —Columbus, OH
- $22 - $32 an hour
- Part-time
- Microsoft Word
- 11+ years
- Research
Quick Apply
Collision Data Analyst
Advantage Surveillance LLC —Columbus, OH
- $28.50 - $38.50 an hour
- Part-time
- ASE Certification
- Mid-level
- Analysis skills
Quick Apply
Incident Investigation Analyst
Sky Zone —Ohio
- $75,000 - $85,000 a year
- Full-time
- 3 years
- Travel
- Business Administration
- Health insurance
- Dental insurance
Quick Apply
5d
Part-Time Surveillance Investigator
The Robison Group —Columbus, OH
- $25 - $30 an hour
- Part-time
- Background check
- Computer literacy
- Pass drug screening
- Mileage reimbursement
Quick Apply
As Needed Field Investigator- Dayton, OH
J T Becker & Co Inc —Dayton, OH
- Writing skills
- Mid-level
- Driver's License
- Flexible schedule
Quick Apply
As Needed Field Investigator- Columbus, OH
J T Becker & Co Inc —Columbus, OH
- Writing skills
- Mid-level
- Driver's License
- Flexible schedule
Quick Apply
As Needed Field Investigator- Cincinnatti, OH
J T Becker & Co Inc —Ohio
- Writing skills
- Mid-level
- Driver's License
- Flexible schedule
Quick Apply

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SIU Investigator

Centene -
Ohio

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Job Details

Full-time
$56,200 - $101,000 a year

Benefits

Paid holidays
Health insurance
401(k)
Tuition reimbursement
Paid time off

Qualifications

Healthcare financial misconduct investigations
Health data analysis
Suspicious activity investigations
Investigative data analysis
Healthcare billing investigations
Insurance claims auditing
Healthcare claims compliance audits
Healthcare coding investigations

Full Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Please note: this is a remote role with preference on candidates residing within Ohio.

Position Purpose: Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse.

Conduct investigations of potential waste, abuse, and fraud
Document activity on each case and refer issues to the appropriate party
Perform data mining and analysis to detect aberrancies and outliers in claims
Develop new queries and reports to detect potential waste, abuse, and fraud
Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions
Assist with complex allegations of healthcare fraud
Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies
Complete various special projects and audits
Performs other duties as assigned
Complies with all policies and standards

Education/Experience:

Bachelor's degree, or an Associate's degree with an additional 2 years working on health care fraud, waste, and abuse investigations and audits in lieu of a Bachelors is required.
A minimum of 2 years in a health care field working on fraud, waste, and abuse investigations and audits required.
The ability to understand and analyze health care claims and coding required.

Pay Range: $56,200.00 - $101,000.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Apply Now

Refine Your Search

claims investigator jobs in ohio

SIU Investigator

Senior Pharmacy SIU Investigator

Surveillance Investigator

Experienced AML Investigator - Financial Crime (Remote)

Field Investigator (Full-Time & Part-Time) – Cleveland, OH

Experienced AML Investigator - Financial Crimes (Hybrid)

Field Investigator (Full-Time & Part-Time) – Columbus, OH

Surveillance Agent

SIU, Investigator

Certified Professional Coder, Special Investigations Unit (Aetna SIU)

Field Auto Adjuster - Cincinnati, OH

Litigation Analyst

Claims Investigator - Part Time

Surveillance Agent

Collision Data Analyst

Incident Investigation Analyst

Part-Time Surveillance Investigator

As Needed Field Investigator- Dayton, OH

As Needed Field Investigator- Columbus, OH

As Needed Field Investigator- Cincinnatti, OH

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