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Fraud Examiner Jobs (NOW HIRING)

THREAD BANK

Fraud Risk Unit Analyst

Nashville, TN · On-site

Demonstrated interest in pursuing professional certifications (e.g., Certified Fraud Examiner (CFE)). Strong collaboration skills with the ability to work across Compliance, Operations, Technology ...

Global Credit Union

Fraud Investigator I

Anchorage, AK · On-site

$63K - $99K/yr

Certified Fraud Examiner (CFE) or equivalent credentials are preferred. Tenure: Assignment to the Fraud Investigator I (Category 10), or Fraud Investigator II (Category 09) position will be ...

Thread Bank

Fraud Risk Unit Analyst

Nashville, TN · On-site

... Fraud Examiner (CFE)). • Strong collaboration skills with the ability to work across Compliance, Operations, Technology, and external partners. Employee must be able to perform essential functions ...

Global Credit Union

Fraud Investigator I

Anchorage, AK

$69K - $112K/yr

Certified Fraud Examiner (CFE) or equivalent credentials are preferred. Tenure: Assignment to the Fraud Investigator I (Category 10), or Fraud Investigator II (Category 09) position will be ...

Winston Staffing

Fraud Manager

Hauppauge, NY · On-site

Certified Fraud Examiner (CFE), Accredited ACH Professional (AAP), or Accredited Payments Risk Professional (APRP) is a significant plus. * Core Competencies: Strong analytical and decision-making ...

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How much do fraud examiner jobs pay per year?

As of Sep 4, 2026, the average yearly pay for fraud examiner in the United States is $147,203.00, according to ZipRecruiter salary data. Most workers in this role earn between $144,500.00 and $150,000.00 per year, depending on experience, location, and employer.

What is a fraud examiner?

A fraud examiner assesses cases to determine if there is fraudulent activity in a variety of industries. As a fraud examiner, your responsibilities may include conducting research about an individual or company, acquiring and reviewing financial records or insurance claims, or examining tax statements. You may work in the insurance industry, as an accountant, or another more specialized field. These jobs can be found in-house for companies or with third-party fraud investigation firms who hire expert consultants.

What does a fraud examiner do?

A Fraud Examiner is a professional who investigates allegations of fraud within organizations or industries. Their responsibilities include collecting and analyzing evidence, interviewing witnesses and suspects, preparing reports, and testifying in court if necessary. They work to identify fraudulent activities, prevent future incidents, and recommend improvements to internal controls. Fraud Examiners often collaborate with law enforcement, auditors, and legal teams to resolve cases efficiently. Their work is crucial in protecting organizations from financial and reputational harm caused by fraud.

What are the key skills and qualifications needed to thrive as a fraud examiner, and why are they important?

To thrive as a Fraud Examiner, you need a strong background in accounting, investigative techniques, and analytical skills, often supported by a degree in finance or criminal justice and professional certifications like CFE (Certified Fraud Examiner). Familiarity with forensic accounting software, data analysis tools, and case management systems is typically required. Attention to detail, integrity, and effective communication are vital soft skills for uncovering fraud and presenting findings. These abilities ensure accurate detection, thorough investigation, and clear reporting of fraudulent activities to protect organizations from financial loss.

What are some common challenges faced by fraud examiners in their daily work?

Fraud Examiners often deal with complex cases that require thorough analysis and attention to detail, which can be time-consuming and mentally demanding. They may encounter resistance or lack of cooperation from individuals under investigation, making evidence gathering more difficult. Balancing multiple cases at once and staying up-to-date with evolving fraud schemes and regulatory requirements are also frequent challenges. However, collaboration with legal teams, law enforcement, and internal departments helps navigate these obstacles and ensures effective fraud detection and prevention.

What is the difference between Fraud Examiner vs Forensic Accountant?

AspectFraud ExaminerForensic Accountant
Required CredentialsCertifications like CFE (Certified Fraud Examiner)Certifications like CPA, CFF (Certified in Financial Forensics)
Work EnvironmentInvestigations, audits, law enforcement settingsLegal proceedings, litigation support, detailed financial analysis
Employer & Industry UsageFinancial institutions, corporations, law enforcementLaw firms, courts, consulting firms

Fraud Examiners focus on detecting and investigating fraud cases, often working with law enforcement, while Forensic Accountants analyze financial data for legal cases, providing expert testimony. Both roles require similar certifications and work in related environments, but their primary focus and application differ.

More about Fraud Examiner jobs

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Fraud Examiner jobs near you
Infographic showing various Fraud Examiner job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 18% Part Time, and 1% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $147,203 per year, or $70.8 per hour.

Fraud Investigator

Blue Cross and Blue Shield of Kansas City

Kansas City, MO • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Job description

Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include:
  • Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
  • Annual incentive bonus plan based on company achievement of goals
  • Time away from work including paid holidays, paid time off and volunteer time off
  • Professional development courses, mentorship opportunities, and tuition reimbursement program
  • Paid parental leave and adoption leave with adoption financial assistance
  • Employee discount program

Job Description Summary: As part of Blue KC's Special Investigations Unit (SIU), the Fraud Investigator conducts reviews to identify potential fraud, waste, and abuse (FWA) and claim overpayments. Assigned cases and projects are generally of moderate complexity and performed with limited oversight.Job Description
  • Assist in performing ongoing FWA risk assessments, leveraging data analytics to identify trends, patterns, outliers relative to peers and clinical standards, etc. In conjunction with the Manager and/or Senior Investigator, evaluate FWA risks and prioritize for further review, based upon member health/safety and protection of plan assets.
  • Monitor hotlines, internal referrals, external fraud alerts (e.g., CMS, BCBSA), external healthcare anti-fraud workgroups, and other resources for potential FWA schemes.
  • Conduct investigations of fraud, waste and abuse in accordance with SIU policies and procedures. May work with Manager and/or Senior Investigator on larger, more complex, investigations.
  • Create and maintain detailed case files in accordance with SIU policies and procedures, where key investigative activities and outcomes are timely and accurately documented
  • Prepare detailed case reports summarizing investigative findings and recommendations. Present reports to key stakeholders (e.g., Provider Relations, Medical Management, Pharmacy, Claims, Legal)
  • Assist in coordinating responses to subpoenas and preparation of cases for referral to law enforcement and/or regulators.
  • Perform day-to-day activities for vendor-based claim overpayment recovery program (e.g., data file exchanges, proposing / reviewing new audit concepts, coordinating claim adjustments, invoices).
  • Assist in preparing reports for executive updates, Blue KC Audit Committee, BCBSA/FEP surveys, and other reports as needed.
  • Support the FWA training program for Blue KC employees and First Tier, Downstream and Related entities.

Minimum Qualifications

  • Bachelor's degree in criminal justice, finance, accounting, medical or other relevant academic discipline. 1 years investigative experience in the following areas (e.g., medical review, financial, medical analytics, research & adjustment, appeals) that provided the types and levels of knowledge, skills, and abilities required.
  • Strong communication skills with a broad range of individuals and groups (e.g., members, providers, operational areas, medical directors, provider relations, legal counsel, senior management)

Preferred Qualifications

  • Master's degree in criminal justice, finance, accounting, medical or other relevant academic discipline
  • 3 years' experience conducting healthcare FWA investigations at a health insurer; experience analyzing claims data to identify FWA trends and patterns using tools such as Excel and business intelligence platforms (e.g., Power BI, Business Objects).
  • Knowledge of major BCBSKC business systems (e.g., Facets, ITS Host and Home) and operational processes (e.g., Claims Processing, Pharmacy, Provider Contracting/Relations, Member Services, Customer Service)
  • Knowledge of BCBSKC provider contracts, medical policies and member benefits
  • Knowledge of medical terminology and ICD/CPT coding
  • Experience working with the regulators (e.g., CMS, State Department of Insurance) and law enforcement (e.g., FBI, DEA, HHS-OIG, OPM-OIG and/or Department of Justice)
  • Juris Doctorate
  • Coding Certification: AAPC, AHIMA
  • FWA Certification: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI)
  • Medical License: Registered Nurse (RN), Licensed Practical Nurse (LPN), pharmacist, physician

Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.

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