Top 15 Senior fraud investigator Jobs in Pennsylvania

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
Corporate Ethics & Compliance Investigator
Centene —Pennsylvania
- $107,700 - $199,300 a year
- Full-time
- Remote
- 7 years
- Management
- HIPAA
- Paid holidays
- Health insurance
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
Investigations Manager
Allegheny County Pennsylvania —Allegheny County, PA
- $93,000 - $117,000 a year
- Online Application
- Background check
- Management
- Office
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
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
Senior Specialist, SAR Investigations
The Bank of New York Mellon Corporation —Pittsburgh, PA
- Full-time
- Research
- Mid-level
- 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
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
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
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 Manager, Medical Affairs Operations
Braeburn —Philadelphia, PA
- Remote
- Addiction Medicine
- Writing skills
- Bachelor's degree
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
15h
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

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Investigator, Special Investigations Unit (Meritain Health)
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Senior Compliance Investigator

Centene -
Pennsylvania

Apply Now

Job Details

Full-time
$70,100 - $126,200 a year
11 days ago

Benefits

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

Qualifications

Investigations regulatory compliance
Medical law
State healthcare regulations
Investigating compliance violations
Risk & issue management

Full Job Description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Under the general direction of the VP of Compliance Investigations this position assists with the development, implementation, and continuous monitoring of an enterprise-wide Compliance Investigations Program and leads the Company's Compliance Investigations for all Business Units, Health Plans, and Corporate functions. Leads and oversees compliance and ethics investigations, facilitates and leads meetings with business management and cross-functional stakeholders, and prepares, reviews, and analyzes internal and external reporting. Supports the Director, Ethics & Investigations in the day-to-day operations of the Compliance Investigations Unit (CIU).

Leads and conducts compliance and ethics investigations across all business units and health plans, including but not limited to assessment of allegations, review of relevant documents, witness interviews, analysis of facts, root cause analysis, and preparation of investigation reports with recommended remedial or disciplinary actions.
Independently evaluates and assesses allegations to determine applicable criteria, including federal and state regulations, the Centene Code of Conduct, and internal policies, procedures, and standards that are alleged to have been violated.
Adheres to Compliance Investigation workplans and protocols and conducts investigations in compliance with established protocols and timelines.
Provides weekly case summaries and adheres to established minimum case review quotas to ensure timely progression and resolution of the investigative caseload.
Ensures all investigative findings are clearly tied to applicable company policies (e.g., Code of Conduct), federal and state regulations, and to maintain regulatory defensibility and support appropriate remediation.
Provides timely reports, both orally and in writing, to the Director of Ethics & Investigations and/or senior management regarding the status and outcomes of investigations.
Thoroughly documents, organizes, and reviews case files within centralized case management systems (e.g., Archer) in accordance with Company policy and CIU protocols.
Collaborates cross-functionally with other departments, including Legal, People Relations, SIU, Privacy, Finance, and Business Operations on investigations and the investigative process.
Prepares and analyzes departmental metrics, including investigation KPIs, case aging, and trending data, and makes recommendations accordingly.
Prepares presentations and presents findings to departmental and business management, executive leadership, and other stakeholders as needed.
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, including tracking remediation activities through case management systems.
Assists with various projects as assigned by the Director of Ethics & Investigations or the VP of Compliance Investigations.
Performs other duties as assigned.
Complies with all policies and standards.

Education/Experience:

A Bachelor's Degree in Related Field or Associates with 5 years of applicable experience, or a High School/GED with 6 years of applicable experience may substitute for the Bachelor's Degree, required.
4+ years of experience in investigations, auditing and risk analysis required.
1+ year of experience in reading, analyzing and interpreting State and Federal laws, rules and regulations required.

Preferred Qualifications:

Managed care or health insurance company experience preferred.
Experience with compliance case management systems (e.g., Archer, Navex) preferred.
Demonstrated experience conducting ethics and compliance investigations in a regulated healthcare environment preferred.
Experience collaborating with cross-functional teams including Legal, People Relations, SIU, and Privacy preferred.

Licenses and Certifications:

Certified Fraud Examiner (CFE) preferred.
Certified Compliance & Ethics Professional (CCEP) or Certified Healthcare Compliance (CHC) preferred.

Pay Range: $70,100.00 - $126,200.00 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

Senior Compliance Investigator

Corporate Ethics & Compliance Investigator

Investigator, Special Investigations Unit (Meritain Health)

Investigations Manager

Senior Civil Health Care Fraud Investigator

Senior Financial Investigator

Senior Financial Analyst/Investigator

Senior Specialist, SAR Investigations

Senior Local Trial Manager (Sponsor Dedicated, Multiple Therapeutics)

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

Senior Auditor

Director, Investigations - Crypto Fraud and Market Abuse

Senior Manager, Medical Affairs Operations

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

Director, Investigations - Crypto Exam and Regulatory Conduct

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