Top 15 Senior fraud investigator Jobs in Pennsylvania

Corporate Ethics & Compliance Investigator
Centene —Pennsylvania
- $107,700 - $199,300 a year
- Full-time
- Remote
- 7 years
- Management
- HIPAA
- Paid holidays
- Health insurance
Senior Compliance Investigator
Centene —Pennsylvania
- $70,100 - $126,200 a year
- Full-time
- Remote
- Writing skills
- High school diploma or GED
- Fair chance
- Paid holidays
- Health insurance
11d
Senior Civil Health Care Fraud Investigator
Contact Government Services, LLC —Harrisburg, PA
- $100,000 - $200,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- CPA
- Health insurance
- Dental insurance
Quick Apply
Investigations Manager
Allegheny County Pennsylvania —Allegheny County, PA
- $93,000 - $117,000 a year
- Online Application
- Background check
- Management
- Office
Senior Specialist, SAR Investigations
The Bank of New York Mellon Corporation —Pittsburgh, PA
- Full-time
- Research
- Mid-level
- Bachelor's degree
Senior Financial Investigator
Contact Government Services, LLC —Philadelphia, PA
- $74,156.16 - $107,114.45 a year
- Full-time
- Hybrid work
- Mid-level
- Driver's License
- Presentation skills
- Health insurance
- Dental insurance
Quick Apply
Senior Financial Analyst/Investigator
Contact Government Services, LLC —Harrisburg, PA
- $80,000 - $140,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- CPA
- Health insurance
- Dental insurance
Quick Apply
Investigator, Special Investigations Unit (Meritain Health)
CVS Health —Harrisburg, PA
- $46,988 - $122,400 a year
- Full-time
- Customer service
- Research
- Mid-level
- Health insurance
- Dental insurance
Senior Manager, Medical Affairs Operations
Braeburn —Philadelphia, PA
- Remote
- Addiction Medicine
- Writing skills
- Bachelor's degree
Senior Local Trial Manager (Sponsor Dedicated, Multiple Therapeutics)
IQVIA —Bethlehem, PA
- $93,100 - $232,800 a year
- Full-time
- Remote
- Bachelor of Science
- Writing skills
- 3 years
- Work from home
Director, Investigations - Crypto Fraud and Market Abuse
Financial Industry Regulatory Authority, Inc. —Philadelphia, PA
- $134,400 - $312,600 a year
- Extended hours
- Hybrid work
- CPA
- Research
- Office
- Paid jury duty
- Commuter assistance
Quick Apply
2d
Senior Auditor
Contact Government Services, LLC —Philadelphia, PA
- $80,000 - $150,000 a year
- Full-time
- Hybrid work
- CPA
- 5 years
- Analysis skills
- Health insurance
- Dental insurance
Quick Apply
Medical Science Liaison/Senior Medical Science Liaison - Immunology and Targeted Therapy - East
EVERSANA —Philadelphia, PA
- $190,000 - $220,000 a year
- Full-time
- Remote
- Medicine
- Doctor of Philosophy
- Travel
Quick Apply
Director, Investigations - Crypto Exam and Regulatory Conduct
Financial Industry Regulatory Authority, Inc. —Philadelphia, PA
- $134,400 - $312,600 a year
- Extended hours
- Hybrid work
- CPA
- Research
- Office
- Paid jury duty
- Commuter assistance
Quick Apply
2d
Medical Science Liaison/Senior Medical Science Liaison - Ophthalmology - Northeast
EVERSANA —Philadelphia, PA
- $185,000 - $210,000 a year
- Full-time
- Remote
- Public speaking
- Analysis skills
- Doctor of Philosophy
Quick Apply
16h

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Investigator, Special Investigations Unit (Meritain Health)
CVS Health —Columbus, OH
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Corporate Ethics & Compliance Investigator

Centene -
Pennsylvania

Apply Now

Job Details

Full-time
$107,700 - $199,300 a year

Benefits

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

Qualifications

Investigations regulatory compliance
State healthcare regulations

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.

Position Purpose: Responsible for leading and managing the most complex, sensitive, and high-impact internal investigations across the organization. Serves as a strategic advisor and subject matter expert on investigative best practices, regulatory compliance, and risk mitigation. Requires exceptional judgment, discretion, and the ability to influence senior leadership decisions while ensuring adherence to federal and state regulations, internal policies, and ethical standards.

Consults with management, in-house counsel, and/or the Director of Corporate Compliance as needed to resolve difficult, highly sensitive or complex compliance issues.
Independently evaluates and assesses allegations to determine whether domestic laws, regulatory policies, or internal policies, procedures, and standards have been violated.
Plans, scopes, and conducts complex, confidential internal investigations from inception to conclusion. This includes defining investigation strategy, preserving evidence, conducting interviews, analyzing records, conducting root cause analysis, and recommended corrective and disciplinary actions.
Conducts, manages, and documents interviews with witnesses, as required for investigatory purposes.
Reviews investigation reports prepared by junior investigators.
Identifies risks, interprets investigation results, and recommends and communicates remedial actions to mitigate future potential risks.
Performs follow up to ensure remedial / disciplinary measures are implemented appropriately and timely.
Plans, develops, leads, and manages multiple projects, including prioritizing and managing through execution.
Maintains meticulous case files and chronologies in accordance with best practices.
Thoroughly documents, organizes, and reviews case files, electronic and hardcopy, relative to each investigation in accordance with Company policy and ensures remediation activities are tracked and implemented.
Prepares clear and concise draft investigation plans and reports.
Provides support and guidance to junior investigation staff as applicable.
Attends, actively participates in, and/or leads meetings with various business area managers.
Communicates directly with Federal or State regulators.
Supports the development and maintenance of Corporate Compliance policies and procedures and workflows.
Participates in and leads special projects (e.g., auditing, training, and HIPAA compliance).
Provides support of and guidance to other associates.
Performs other duties as assigned.
Complies with all policies and standards.

Education/Experience: Bachelor's Degree Criminal Justice/Criminology, Law, Healthcare Administration/Health Policy, or related field, equivalent experience required. Juris Doctorate highly preferred. 7+ years progressive experience in conducting and managing complex investigations or auditing and risk analysis required. 7+ years experience reading, analyzing and interpreting State and Federal laws, rules and regulations required. Prosecutorial experience preferred. Previous experience as an investigator within a large corporation or Federal Agency preferred.

Licenses/Certifications:
Certified Fraud Investigator preferred

Pay Range: $107,700.00 - $199,300.00 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

senior fraud investigator jobs in pennsylvania

Corporate Ethics & Compliance Investigator

Senior Compliance Investigator

Senior Civil Health Care Fraud Investigator

Investigations Manager

Senior Specialist, SAR Investigations

Senior Financial Investigator

Senior Financial Analyst/Investigator

Investigator, Special Investigations Unit (Meritain Health)

Senior Manager, Medical Affairs Operations

Senior Local Trial Manager (Sponsor Dedicated, Multiple Therapeutics)

Director, Investigations - Crypto Fraud and Market Abuse

Senior Auditor

Medical Science Liaison/Senior Medical Science Liaison - Immunology and Targeted Therapy - East

Director, Investigations - Crypto Exam and Regulatory Conduct

Medical Science Liaison/Senior Medical Science Liaison - Ophthalmology - Northeast

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