Top 149 Fraud investigator Jobs in Remote¨

Investigator, Special Investigations Unit (Aetna SIU) - Must reside in Oklahoma
CVS Health —Oklahoma
- $43,888 - $76,500 a year
- Full-time
- Remote
- Writing skills
- Mid-level
- Residential
- Health insurance
- Dental insurance
11d
Fraud Triage Specialist (Mobile)
Assurant —Remote
- $20.96 - $34.59 an hour
- Full-time
- Remote
- Microsoft Excel
- Research
- Mid-level
13h
Healthcare Fraud Investigator
Contact Government Services, LLC —Remote
- $85,000 - $105,000 a year
- Full-time
- Hybrid work
- Microsoft Outlook
- Mid-level
- 3 years
Quick Apply
Fraud and Waste Investigator
Humana —Remote
- $65,000 - $88,600 a year
- 8 hour shift
- Remote
- Microsoft Word
- Mid-level
- Bachelor's degree
- Paid parental leave
- Paid holidays
4d
FRAML Investigator
First Bank & Trust —Remote
- $50,835.75 - $802,295.27 a year
- Full-time
- Research
- Mid-level
- Bachelor's degree
- Paid parental leave
- Health savings account
4d
Auditor/Investigator I
Qlarant —Remote
- $60,000 - $72,000 a year
- Full-time
- Remote
- Analysis skills
- Bachelor's degree
- Entry level
Quick Apply
1d
Fraud and Abuse Investigator / CPC - Remote
Sentara Workforce Solutions, LLC —Denham Springs, LA
- $25.60 - $42.67 an hour
- Overtime
- Remote
- Mid-level
- Bachelor's degree
- 2 years
- 403(b) matching
- Paid parental leave
Quick Apply
1d
AML Investigator
Zap Solutions Europe —Remote
- $78,000 - $91,000 a year
- Remote
- High school
- Mid-level
- Analysis skills
- Disability insurance
- Dental insurance
Fraud Audit & Investigations Analyst
Public Partnerships LLC —Remote
- Up to $99,000 a year
- Full-time
- Remote
- 5 years
- Mid-level
- Bachelor's degree
Quick Apply
14d
Financial Crimes Investigator - Cryptocurrency/Blockchain
Treliant LLC —Remote
- $50 - $60 an hour
- Mid-level
- 3 years
- Bachelor's degree
- Health insurance
- 401(k)
Experienced AML Investigator - Financial Crime (Remote)
AML RightSource, LLC —Remote
- $43,888 - $69,000 a year
- Full-time
- Remote
- Background check
- Microsoft Excel
- Research
- Paid holidays
- Health insurance
Quick Apply
9d
Ethics and Compliance Specialist (Investigations and Audit)
Chromalloy —Remote
- $79,200 - $103,950 a year
- Overtime
- Remote
- Up to 50% travel
- 5 years
- Pass drug screening
- Wellness program
- Paid holidays
Quick Apply
Licensed Private Investigator Kansas City, MO
Direct Insight Services, Inc. —Kansas City, MO
- $20 - $40 an hour
- Part-time
- Remote
- Microsoft Word
- Military
- Computer literacy
Quick Apply
Senior Financial Investigator
Contact Government Services, LLC —Remote
- $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
Principal, Advanced Analytics – Internal Claims Fraud
Liberty Mutual —Remote
- $94,000 - $176,000 a year
- Full-time
- Remote
- 7 years
- Master's degree
- SQL
9d
Healthcare Fraud Investigator
Council Capital —Newtown Square, PA
- Full-time
- Remote
- US work authorization
- Senior level
- Commercial
Corporate Ethics & Compliance Investigator
Centene —New York, NY
- $107,700 - $199,300 a year
- Full-time
- Remote
- 7 years
- Management
- HIPAA
- Paid holidays
- Health insurance
Commercial Bank Fraud Investigator
Avidbank —San Jose, CA
- $65,000 - $100,000 a year
- Full-time
- Remote
- Microsoft Excel
- Research
- Mid-level
- Paid holidays
- Disability insurance
Quick Apply
Investigator- Remote in Nebraska
UnitedHealthcare —Omaha, NE
- $49,700 - $88,800 a year
- Full-time
- Remote
- Microsoft Word
- Pass drug screening
- Analysis skills
- AD&D insurance
- Employee stock purchase plan
SIU INVESTIGATOR - Newark, NJ
Origin Investigations Inc —Newark, NJ
- $25 - $40 an hour
- Remote
- Mid-level
- Analysis skills
- Travel
- Mileage reimbursement
- Health insurance
Quick Apply
10d

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fraud investigator jobs near remote¨

Investigator, Special Investigations Unit (Aetna SIU) - Must reside in Oklahoma

CVS Health -
Oklahoma

Apply Now

Job Details

Full-time
$43,888 - $76,500 a year
11 days ago

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance

Qualifications

Healthcare financial misconduct investigations
Data mining
Fraud Detection Systems
Data analysis 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
The Special Investigations Unit (SIU) Investigator is responsible for thoroughly investigating any allegations of Medicaid healthcare fraud, waste, or abuse in accordance with federal and state regulation. This position will be responsible for collaborating with Compliance, State Medicaid Plans, Health Plans, and Coding teams.

Oklahoma residence required.

Review concern/allegation, develop an investigation plan, identify additional information needed, and individuals to interview.
Manage an active caseload ensuring timely and thorough task completions while adhering to legal and organizational standards.
Interview healthcare providers, patients/members, and others to gather information pertinent to the investigation.
Use data analytics and software tools to analyze billing patterns, identify anomalies, and detect suspicious activities.
Use medical records, billing data, and coding systems to ensure compliance with regulations and code requirements.
Partner with the Senior Investigator, as needed, to support FWA case activities and ensure alignment on investigative strategy and next steps.
Partner with the Clinical team to support pre-payment and post-payment coding reviews.
Collaborate with SIU Compliance and PI Managers for specific state requirements and deliverables.
Refer cases to law enforcement and regulatory agencies as required by state plans.
Coordinate with internal legal teams to review findings, case outcomes, prepare evidence for potential court cases or administrative hearings.
Prepare comprehensive investigation reports that document fact findings and provide recommendations for appropriate corrective action outcomes.
Maintain and document accurate records of all investigations, including evidence collected, interviews, and outcomes.
Monitor and promote healthcare provider adherence to applicable federal and state requirements, as well as payer billing and claims guidelines.
Communicate case outcomes to healthcare providers and complete follow-up outreach as needed.

Required Qualifications

Must reside in Oklahoma.
Experience in working healthcare investigations.
2 years of experience in healthcare fraud investigation.
Experience with using fraud, waste, and abuse (FWA) detection tools and enterprise databases to support data mining, analysis, and information gathering.
Ability to travel and participate in legal proceedings, arbitrations, depositions, etc.

Preferred Qualifications

Credential(s) such as Certified Fraud Examiners (CFE) and National Health Care Anti-Fraud Association (AHFI).
3+ years Medicaid Fraud, Waste and Abuse investigatory experience.
Coding certification such as CPC (AAPC) and/or CCS (AHIMA).
Knowledge of Behavioral Health care delivery, policies and procedures, and contractual implications.
Knowledge of healthcare laws, regulations, and CPT/HCPCS coding.
Strong analytical and investigative skills.
Strong communication skills needed for interviewing and presentations to Health Plans and State Regulators.
Strong documentation/writing skills needed for presentations and case documentation.

Education

Bachelor’s degree in criminal justice, healthcare administration, accounting, or a related field preferred or equivalent experience.

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$43,888.00 - $76,500.00

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: 07/25/2026

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

fraud investigator jobs in remote¨

Investigator, Special Investigations Unit (Aetna SIU) - Must reside in Oklahoma

Fraud Triage Specialist (Mobile)

Healthcare Fraud Investigator

Fraud and Waste Investigator

FRAML Investigator

Auditor/Investigator I

Fraud and Abuse Investigator / CPC - Remote

AML Investigator

Fraud Audit & Investigations Analyst

Financial Crimes Investigator - Cryptocurrency/Blockchain

Experienced AML Investigator - Financial Crime (Remote)

Ethics and Compliance Specialist (Investigations and Audit)

Licensed Private Investigator Kansas City, MO

Senior Financial Investigator

Principal, Advanced Analytics – Internal Claims Fraud

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Corporate Ethics & Compliance Investigator

Commercial Bank Fraud Investigator

Investigator- Remote in Nebraska

SIU INVESTIGATOR - Newark, NJ

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