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Day Shift Remote Fraud Investigator Jobs (NOW HIRING)

Centene

Special Investigation Unit Investigator

$56K - $101K/yr

Conduct fraud, waste, and abuse (FWA) investigations by reviewing referrals, claims data, medical ... day. You'll take on meaningful challenges that directly support individuals, families, and ...

Centene

SIU Investigator

$56K - $101K/yr

Conduct fraud, waste, and abuse (FWA) investigations by reviewing referrals, claims data, medical ... day. You'll take on meaningful challenges that directly support individuals, families, and ...

Centene

SIU Investigator

OR · On-site +1

$56K - $101K/yr

Conduct fraud, waste, and abuse (FWA) investigations by reviewing referrals, claims data, medical ... day. You'll take on meaningful challenges that directly support individuals, families, and ...

Centene

SIU Investigator

$56K - $101K/yr

Conduct fraud, waste, and abuse (FWA) investigations by reviewing referrals, claims data, medical ... day. You'll take on meaningful challenges that directly support individuals, families, and ...

S3 Shared Services

Fraud Analyst

Englewood, CO · Remote

$52K - $60K/yr

Fraud Analyst - Remote / Colorado Applicants only Salary range: $52,000 to $60,000 annually The ... Monitor alerts and communications from various sources to identify and investigate suspicious ...

S3 Shared Services

Fraud Analyst

Englewood, CO · Remote

$52K - $60K/yr

Fraud Analyst - Remote / Colorado Applicants only Salary range: $52,000 to $60,000 annually The ... Investigate complex fraud cases. * Mentor Associate Fraud Analysts through their investigations ...

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As of Sep 2, 2026, the average hourly pay for day shift remote fraud investigator in the United States is $30.83, according to ZipRecruiter salary data. Most workers in this role earn between $22.12 and $35.34 per hour, depending on experience, location, and employer.

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Infographic showing various Day Shift Remote Fraud Investigator job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 68% Full Time, 26% Part Time, and 5% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $64,132 per year, or $30.8 per hour.

Investigator, Special Investigative Unit Coding (Remote)

Molina Healthcare

Remote

$19.64 - $42.55/hr

Full-time

Re-posted 5 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 199 frontline employees who took The Breakroom Quiz

170th of 315 rated insurance

Job description


JOB DESCRIPTION
Provides investigative support for special investigation unit (SIU) activities specific to medical provider coding fraud, waste and abuse (FWA). Investigates and resolves instances of health care fraud and abuse investigations of medical providers using informational tips from member benefits and medical records following review of post-payment claims.
Essential Job Duties
  • Independently re-evaluates medical claims and associated records by applying knowledge of advanced coding, all relevant and applicable Federal and State regulatory requirements, and Molina policies.
  • Reviews post-pay claims against corresponding medical records to determine accuracy of claims payments.
  • Manages documents and prioritizes caseloads to ensure timely turnaround.
  • Ensures adherence to applicable state/federal/internal policies, Current Procedural Terminology (CPT) guidelines and provider contract requirements.
  • Devises clinical summary post-review.
  • Communicates and participates in meetings related to cases.
  • Completes medical review to facilitate referral to law enforcement or payment recovery.
  • Supports investigation work as necessary and required by the regulatory agency.

Job Requirements
  • Associates in criminal justice or degree. If no Degree:
  • 5-7 Years of Health Care Claims Investigations
  • 5-7 Years of previous SIU Investigations
  • Previous Law Enforcement
  • At least 2 years CPT coding experience in a surgical, hospital and/or clinic setting, or equivalent combination of relevant education and experience.
  • Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Professional Medical Auditor (CPMA), or American Academy of Professional Coders (AAPC) certified
  • Critical-thinking, problem-solving and analytical skills.
  • Ability to prioritize and manage multiple tasks.
  • Ability to work in a team setting.
  • Strong verbal/written communication skills, and presentation skills.
  • Microsoft Office suite (including Excel), and applicable software program(s) proficiency.
  • In some states, 5 years of experience working in a fraud, waste and abuse (FWA)/special investigations unit (SIU)/fraud investigations role may be required (dependent on state/contractual requirements).
  • Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations.
  • Knowledge of Managed Care and the Medicaid, Medicare, and Marketplace programs.
  • Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems.
  • Ability to research and interpret regulatory requirements.

Preferred Qualifications
  • Certified Professional Compliance Officer (CPCO).
  • Certified Fraud Examiner (CFE) and/or Accredited Health Care Fraud Investigator (AHFI).
  • Experience working in group health insurance, particularly within claims processing or operations.
  • Working knowledge of local, state and federal laws and regulations pertaining to health insurance, investigations and legal processes (commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, etc.).
  • Experience with claims processing systems.
  • Ability to use Microsoft Excel/Access platforms working with large quantities of data.
  • Ability to answer questions, identify trends and patterns, and present findings.

#PJCorp
#LI-AC1
To all current Molina employees. If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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