Investigator
Pittsburgh, PA · On-site
JOB SUMMARY This job is responsible for developing and maintaining an anti-fraud program which includes development and delivery of training and filing of Fraud Plans and Reports. The incumbent is ...
Investigator
Pittsburgh, PA · On-site
JOB SUMMARY This job is responsible for developing and maintaining an anti-fraud program which includes development and delivery of training and filing of Fraud Plans and Reports. The incumbent is ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
$85 - $115/hr
Professional certification, such as Certified Fraud Examiner (CFE), Certified Anti-Fraud Specialist (CAFS), or Certified AML and Fraud Professional (CAFP), is preferred. * A college degree in a ...
$85 - $115/hr
Professional certification, such as Certified Fraud Examiner (CFE), Certified Anti-Fraud Specialist (CAFS), or Certified AML and Fraud Professional (CAFP), is preferred. * A college degree in a ...
Senior Fraud Analyst - Remote
California, MO · On-site
$85 - $115/hr
Professional certification, such as Certified Fraud Examiner (CFE), Certified Anti-Fraud Specialist (CAFS), or Certified AML and Fraud Professional (CAFP), is preferred. * A college degree in a ...
Senior Fraud Analyst - Remote
California, MO · On-site
$85 - $115/hr
Professional certification, such as Certified Fraud Examiner (CFE), Certified Anti-Fraud Specialist (CAFS), or Certified AML and Fraud Professional (CAFP), is preferred. * A college degree in a ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... it #1 in Anti-Money Laundering #1 in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with ...
... it #1 in Anti-Money Laundering #1 in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
... in Anti-Fraud Have won many innovation awards at Finovate #2 in Compliance Software based on reader feedback demonstrating its across-the-board success with customers in the three core areas of ...
Anti Fraud information
See salary details
$15.63 - $20
15% of jobs
$21.57 is the 25th percentile. Wages below this are outliers.
$20 - $24.37
28% of jobs
The median wage is $25.94 / hr.
$24.37 - $28.74
19% of jobs
$32.31 is the 75th percentile. Wages above this are outliers.
$28.74 - $33.11
16% of jobs
$33.11 - $37.48
12% of jobs
$37.48 - $41.85
3% of jobs
$41.85 - $46.22
1% of jobs
$46.22 - $50.59
3% of jobs
$50.59 - $54.96
0% of jobs
$54.96 - $59.33
3% of jobs
$59.33 - $63.70
0% of jobs
$15
$30
$63
How much do anti fraud jobs pay per hour?
As of Sep 3, 2026, the average hourly pay for anti fraud in the United States is $30.68, according to ZipRecruiter salary data. Most workers in this role earn between $21.15 and $33.89 per hour, depending on experience, location, and employer.
What is an anti fraud?
An Anti-Fraud job involves detecting, preventing, and investigating fraudulent activities within an organization. Professionals in this role analyze transactions, monitor suspicious behavior, and implement fraud prevention strategies to minimize financial losses. They may work with law enforcement, regulatory bodies, and internal teams to ensure compliance with legal and security standards. Strong analytical skills, attention to detail, and knowledge of fraud detection tools are essential for success in this field.
What does an anti fraud do?
In an Anti Fraud position, you can expect to conduct investigations into suspicious transactions, analyze data for fraud patterns, and compile reports of your findings. Your daily tasks may also involve collaborating with compliance, legal, and IT teams to close control gaps and implement preventative measures. You'll often interview witnesses, review documentation, and may participate in training employees on fraud awareness. This role requires adaptability since fraud methods evolve rapidly, so you'll be continually updating your strategies and knowledge to stay ahead of emerging risks.
What are the key skills and qualifications needed to thrive in the anti fraud position, and why are they important?
To thrive in an Anti Fraud role, you need a background in risk analysis, investigative techniques, and data analytics, often supported by a degree in finance, criminology, or related certifications like Certified Fraud Examiner (CFE). Familiarity with anti-fraud software, case management systems, and data visualization tools is essential. Strong attention to detail, critical thinking, and effective communication are standout soft skills in this position. These capabilities are crucial for accurately detecting, investigating, and preventing fraudulent activity within organizations while collaborating across departments.
More about Anti Fraud jobs
What cities are hiring for Anti Fraud jobs?
Cities with the most Anti Fraud job openings:
What are the most commonly searched types of Anti Fraud jobs?
The most popular types of Anti Fraud jobs are:
What states have the most Anti Fraud jobs?
States with the most job openings for Anti Fraud jobs include:
What job categories do people searching Anti Fraud jobs look for?
The top searched job categories for Anti Fraud jobs are:
Highmark Health rating
7.8
Based on 28 frontline employees who took The Breakroom Quiz
Job description
Company :
Highmark Inc.Job Description :
JOB SUMMARY
This job is responsible for developing and maintaining an anti-fraud program which includes development and delivery of training and filing of Fraud Plans and Reports. The incumbent is responsible for conducting investigations of organizational or functional activities related to alleged fraud, waste and abuse perpetrated by providers, members, facilities, pharmacies, groups and/or employees of the organizations and Subsidiaries. The incumbent is responsible for interviews which might include providers and members and may be conducted onsite or offsite. The incumbent is also responsible for the field investigative work necessary to complete a review of a special project, potential fraud, waste and abuse case, conducting the initial investigations and coordinating the recovery/savings of money related to fraud, waste and abuse. The incumbent must be able to testify in a court of law, prepare cases for referral to various federal, state and local law enforcement entities and work with those agencies through closure of the case. Conduct audits for proactive and investigative purposes to comply with internal audit and regulatory requirements.
ESSENTIAL RESPONSIBILITIES
EDUCATION
Required
Substitutions
Preferred
EXPERIENCE
Required
Preferred
LICENSES or CERTIFICATIONS
Required
Preferred (any of the following)
SKILLS
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Highmark Inc.Job Description :
JOB SUMMARY
This job is responsible for developing and maintaining an anti-fraud program which includes development and delivery of training and filing of Fraud Plans and Reports. The incumbent is responsible for conducting investigations of organizational or functional activities related to alleged fraud, waste and abuse perpetrated by providers, members, facilities, pharmacies, groups and/or employees of the organizations and Subsidiaries. The incumbent is responsible for interviews which might include providers and members and may be conducted onsite or offsite. The incumbent is also responsible for the field investigative work necessary to complete a review of a special project, potential fraud, waste and abuse case, conducting the initial investigations and coordinating the recovery/savings of money related to fraud, waste and abuse. The incumbent must be able to testify in a court of law, prepare cases for referral to various federal, state and local law enforcement entities and work with those agencies through closure of the case. Conduct audits for proactive and investigative purposes to comply with internal audit and regulatory requirements.
ESSENTIAL RESPONSIBILITIES
- Performs investigations into potential and existing provider and member fraud, waste and abuse activities. Identifies parties involved by reviewing inquiries and complaints against providers, members, facilities, pharmacies, groups, and/or employees of Highmark and Subsidiaries. Conduct Interviews with providers, members or any other individual(s) necessary to complete an assigned investigation or special project. Determines the scope of the allegation or special project by assembling the necessary information, statistics, policies and procedures, licensure information, doctors' agreements, contract, etc.
- Develop and maintain annual anti-fraud program which includes facilitating fraud training and fraud awareness day, as well as filing annual fraud plans and reports according to state regulations. Responsible for updating annually the changes in insurance laws with regard to lines of business
- Coordinates data extracts by assessing multiple databases both internally and externally. Takes action to prevent further improper payments. Forwards case to the Credentialing and/or Medical Review Committee, law enforcement and regulatory agencies.
- Responsible for completing all necessary field (externally) investigative work for resolution or alleged fraud/waste and abuse cases or special projects.
- Provides advisory support as needed to internal and external law enforcement and regulatory agencies, Credentialing or Medical Review Committee.
- Engages in delivery of audit results and overpayment negotiations. Responsible for recovery/ savings of misappropriated funds paid by Highmark and affiliated companies and work with Finance to ensure proper recording the financial statements.
- Conduct audits for proactive and investigative purposes to comply with internal audit and regulatory requirements. Audits consist of contract, commissions, surveillance, workers' compensation and IME. In addition, this position will complete Office of Foreign Asset Control (OFAC) to ensure payments are not issued to unauthorized parties.
- Other duties as assigned or requested.
EDUCATION
Required
- Bachelor's Degree in Accounting, Finance, Business Administration, Nursing, IT or Related Field
Substitutions
- 6 years of related and progressive experience in lieu of Bachelor's degree
Preferred
- Master's Degree in Fraud, Forensics Accounting, Business or related field
EXPERIENCE
Required
- 3 years of relevant, progressive experience in the health insurance industry and/or healthcare fraud investigations
Preferred
- 1 year in Financial Analysis in an acute care hospital or health insurance setting
- 1 year in professional billing, facility Patient Financial Services, HIM, Internal Audit, Professional/Facility Reimbursement or Provider Contracting
LICENSES or CERTIFICATIONS
Required
- None
Preferred (any of the following)
- Certified Fraud Examiner (CFE)
- Certified Professional Coder (CPC)
- Certified Outpatient Coder (COC)
- Accredited Healthcare Fraud Investigator (AHFI)
- CPMA, CCA, or CCS
SKILLS
- Must have knowledge of provider facility payment methodology, claims processing systems and coding and billing proficiency
- Must have understanding of technical and financial aspects of the health insurance industry
- Strong personal computer skills, along with the ability to use fraud/abuse data mining tools are required
- Must possess excellent communication skills and be detailed oriented
- Strong written and oral communication skills
- Strong relationship building skills
- Client focused with strong business acumen
- Self-starter with the ability to work under pressure independently and as part of a team
- Ability to think strategically and act proactively to create strong trust and confidence with business units
- Strong innovative problem-solving capabilities
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
What Highmark Health employees say
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Get the full story on Breakroom
About Highmark Health
Sourced by ZipRecruiter
A national blended health organization, Highmark Health and our leading businesses support millions of customers with products, services and solutions closely aligned to our mission of creating remarkable health experiences, freeing people to be their best. Headquartered in Pittsburgh, we're regionally focused in Pennsylvania, Delaware, West Virginia, and eastern and northwestern New York with customers in 50 states and the District of Columbia. We passionately serve individual consumers and fellow businesses alike. And our companies cover a diversified spectrum of essential health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions. Our financial position reflects strength and stability, with our year-end 2022 consolidated revenues totaling $26 billion. And we're proud to carry forth an important legacy of compassionate care and philanthropy that began more than 170 years ago. This tradition of giving back, reinvesting and ensuring that our communities remain strong and healthy is deeply embedded in our culture, informing our decisions every day.
Industry
Health care and social assistance and insurance services
Company size
10,000+ Employees
Headquarters location
Pittsburgh, PA, US