Top 99 Claims investigator Jobs in Pennsylvania

Senior Investigator, Special Investigations Unit (Aetna SIU)
CVS Health —Pennsylvania
- $46,988 - $112,200 a year
- Full-time
- Remote
- Research
- Mid-level
- 3 years
- Health insurance
- Dental insurance
Auditor/Investigator II
Qlarant —Pennsylvania
- $57,512 - $85,839 a year
- Full-time
- Remote
- Mid-level
- Analysis skills
- Bachelor's degree
Quick Apply
Certified Professional Coder, Special Investigations Unit (Aetna SIU)
CVS Health —Pennsylvania
- $43,888 - $93,574 a year
- Full-time
- Remote
- Microsoft Excel
- Research
- Mid-level
- Health insurance
- Dental insurance
10d
Manager, Special Investigations Unit – Healthcare Fraud
CVS Health —Pennsylvania
- $54,300 - $159,120 a year
- Full-time
- Remote
- Management
- Finance
- Analysis skills
- Health insurance
- Dental insurance
1d
Healthcare Fraud Investigator
Council Capital —Newtown Square, PA
- Full-time
- Remote
- US work authorization
- Senior level
- Commercial
3d
Claims Representative
County Commissioners Association of Pennsylvania —Harrisburg, PA
- $58,000 - $61,000 a year
- Full-time
- Hybrid work
- Customer service
- Computer literacy
- Office
- Health savings account
- Health insurance
Quick Apply
10d
Casualty Field Investigator
CUSTARD INSURANCE ADJUSTERS —Pittsburgh, PA
- $50,086.78 - $60,319.57 a year
- Full-time
- Mid-level
- Office
- Analysis skills
- Health savings account
- Health insurance
Quick Apply
Field Investigator
CUSTARD INSURANCE ADJUSTERS —Philadelphia, PA
- $50,000 - $65,000 a year
- Full-time
- Customer service
- Mid-level
- Office
- Health savings account
- Health insurance
Quick Apply
Public Adjuster Salesperson
Lacovara Public Adjusters —Philadelphia, PA
- $25,000 - $125,000 a year
- Part-time
- Mid-level
- Leadership
- Communication skills
- Flexible schedule
Quick Apply
2d
Special Investigator 2
Commonwealth of PA —Harrisburg, PA
- $60,538 - $92,010 a year
- Full-time
- Hybrid work
- Mid-level
- Office
- Bachelor's degree
- Paid parental leave
- Health insurance
2d
Investigator PGCB Southeastern Regional Office
Commonwealth of PA —Conshohocken, PA
- $60,538 - $92,010 a year
- Full-time
- Pass drug screening
- Mid-level
- Office
- Paid parental leave
- Health insurance
3d
Claim Rep Outside Liability
The Travelers Companies, Inc. —Pittsburgh, PA
- $67,000 - $110,600 a year
- Clean driving record
- Mid-level
- Driver's License
- Wellness program
- Paid holidays
Special Investigator Trainee
Commonwealth of PA —Scranton, PA
- $46,827 - $70,592 a year
- Full-time
- Bachelor's degree
- Communication skills
- Entry level
- Paid parental leave
- Health insurance
5d
Pre-Surveillance Coordinator
J T Becker & Co Inc —Bridgeville, PA
- Full-time
- Hybrid work
- Research
- Office
- Communication skills
- Paid time off
- Opportunities for advancement
Quick Apply
Field Auto Adjuster - Philadelphia, PA
Allstate —Philadelphia, PA
- $60,000 - $97,125 a year
- Hybrid work
- Writing skills
- Mid-level
- Driver's License
- Tuition reimbursement
- Work from home
Medicaid Investigator (Northeast) NE UPIC - Remote/Field
Purisolve, Inc. —Spring Hill, PA
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Mid-level
Quick Apply
10d
SIU Claims Investigator
Lemieux & Associates LLC —Philadelphia, PA
- $25 - $32 an hour
- Full-time
- Bilingual
- Computer literacy
- Mid-level
- Flexible schedule
Quick Apply
Category Manager
Allegheny Health Network —Pennsylvania
- $94,200 - $151,000 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- 5 years
Incident Management Specialist (County ID Program Specialist 1, LG) Delaware County MH/ID
Commonwealth of PA —Drexel Hill, PA
- $60,186 - $71,505 a year
- Urgently hiring
- Hybrid work
- Experience working with individuals with disabilities
- Mid-level
- Databases
- Work from home
- Opportunities for advancement
9d
Digital Forensic Examiner 1
Commonwealth of PA —Wilkes-Barre, PA
- $69,086 - $104,959 a year
- Full-time
- Computer Science
- Maintenance
- Research
- Paid parental leave
- Health insurance
3d

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claims investigator jobs near pennsylvania

Senior Investigator, Special Investigations Unit (Aetna SIU)

CVS Health -
Pennsylvania

Apply Now

Job Details

Full-time
$46,988 - $112,200 a year

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance

Qualifications

Healthcare financial misconduct investigations
Customer communication
Spreadsheets
Research
Suspicious activity investigations
HCPCS
Insurance investigations
Productivity software

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.

Position Summary

As a Senior Investigator you will conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high profile, those that are complex cases involving or cases involving multiple perpetrators or intricate healthcare fraud schemes.

Investigates to prevent payment of fraudulent claims submitted to the Medicaid lines of business
Researches and prepares cases for clinical and legal review
Documents all appropriate case activity in case tracking system
Facilitates feedback with providers related to clinical findings
Initiates proactive data mining to identify aberrant billing patterns
Makes referrals, both internal and external, in the required timeframe
Facilitates the recovery of company and customer money lost as a result of fraud matters
Provides on the job training to new Investigators and provides guidance for less experienced or skilled Investigators.
Assists Investigators in identifying resources and best course of action on investigations
Serves as back up to the Team Leader as necessary
Cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud and abuse matters.
Demonstrates high level of knowledge and expertise during interactions and acts confidently when providing testimony during civil and criminal proceedings
Gives presentations to internal and external customers regarding healthcare fraud matters and Aetna's approach to fighting fraud
Provides input regarding controls for monitoring fraud related issues within the business units

Required Qualifications

3+ years investigative experience in the area of healthcare fraud and abuse matters.

Working knowledge of medical coding; CPT, HCPCS, ICD10
Experience with Microsoft Office with advanced skills in Excel (must know how to do pivot tables).
Ability to travel up to 10% (approx. 2-3x per year, depending on business needs)

Preferred Qualifications

Previous Medicaid/Medicare investigatory experience
Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations for fraud and abuse.
Credentials such as certification from the Association of Certified Fraud Examiners (CFE), or an accreditation from the National Health Care Anti-Fraud Association (AHFI)
Knowledge of Aetna's policies and procedures.
Knowledge and understanding of complex clinical issues.
Competent with legal theories.
Strong communication and customer service skills.
Ability to effectively interact with different groups of people at different levels in any situation.
Strong analytical and research skills.
Proficient in researching information and identifying information resources.
Strong verbal and written communication skills.

Education:

Bachelor's degree or equivalent experience (3+ years of working health care fraud, waste and abuse investigations).

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$46,988.00 - $112,200.00

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: 08/01/2026

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 pennsylvania

Senior Investigator, Special Investigations Unit (Aetna SIU)

Auditor/Investigator II

Certified Professional Coder, Special Investigations Unit (Aetna SIU)

Manager, Special Investigations Unit – Healthcare Fraud

Healthcare Fraud Investigator

Claims Representative

Casualty Field Investigator

Field Investigator

Public Adjuster Salesperson

Special Investigator 2

Investigator PGCB Southeastern Regional Office

Claim Rep Outside Liability

Special Investigator Trainee

Pre-Surveillance Coordinator

Field Auto Adjuster - Philadelphia, PA

Medicaid Investigator (Northeast) NE UPIC - Remote/Field

SIU Claims Investigator

Category Manager

Incident Management Specialist (County ID Program Specialist 1, LG) Delaware County MH/ID

Digital Forensic Examiner 1

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