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Fraud Investigations Manager Jobs (NOW HIRING)

Clover Health

Director, Fraud Investigations

By 6 months , you are independently managing a steady caseload of fraud investigations with consistently high-quality work product. Your referral packages are well-received by enforcement partners.

Banner Bank

Fraud Investigator

Lake Oswego, OR · On-site

... fraud investigations using a mix of automated and manual methods. * Identify potential fraud risks and escalate concerns following established procedures. * You'll support fraud risk management ...

Banner Bank

Fraud Investigator

Lake Oswego, OR

... fraud investigations using a mix of automated and manual methods. * Identify potential fraud risks and escalate concerns following established procedures. * You'll support fraud risk management ...

Banner Bank

Fraud Investigator

Lake Oswego, OR · On-site

... fraud investigations using a mix of automated and manual methods. * Identify potential fraud risks and escalate concerns following established procedures. * You'll support fraud risk management ...

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How much do fraud investigations manager jobs pay per hour?

As of Jul 13, 2026, the average hourly pay for fraud investigations manager 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.

What are common challenges faced by a Fraud Investigations Manager and how can they be addressed?

Fraud Investigations Managers often face challenges such as rapidly evolving fraud tactics, managing complex caseloads, and coordinating investigations across departments. Staying updated on the latest fraud schemes and leveraging advanced analytics tools can help address these obstacles. Effective communication and collaboration with compliance, legal, and IT teams are also essential to ensure thorough investigations and minimize organizational risk. Regular training and process reviews further support successful outcomes.

What is the difference between Fraud Investigations Manager vs Fraud Analyst?

AspectFraud Investigations ManagerFraud Analyst
CredentialsTypically requires a bachelor’s degree in criminal justice, finance, or related field; certifications like CFE are commonUsually holds a bachelor’s degree; certifications like CFE or ACFE are advantageous
Work EnvironmentLeads investigation teams, manages cases, and develops strategies within financial institutions or corporationsPerforms data analysis, monitors transactions, and investigates suspicious activity
Employer & IndustryFinancial services, banking, insurance, and corporate sectorsFinancial institutions, retail, and insurance companies

The Fraud Investigations Manager oversees and directs fraud investigation teams, focusing on strategy and case management. In contrast, the Fraud Analyst primarily conducts data analysis and monitors transactions to identify suspicious activity. Both roles require relevant certifications and work within similar industries, but the manager has a broader leadership and strategic focus.

What does a Fraud Investigations Manager do?

A Fraud Investigations Manager oversees and coordinates efforts to detect, investigate, and prevent fraudulent activities within an organization. They lead a team of investigators, develop strategies to identify potential fraud, and ensure compliance with relevant laws and regulations. Their responsibilities include analyzing suspicious activities, preparing detailed reports, and working with law enforcement or regulatory agencies when necessary. They also implement fraud prevention policies and provide training to staff to minimize risk.

What are the key skills and qualifications needed to thrive as a Fraud Investigations Manager, and why are they important?

To thrive as a Fraud Investigations Manager, you need expertise in investigative techniques, data analysis, and a background in finance, law enforcement, or risk management, often supported by a relevant bachelor’s degree or certifications like CFE (Certified Fraud Examiner). Familiarity with case management systems, forensic accounting tools, and anti-fraud software is typically required. Strong analytical thinking, attention to detail, and effective communication skills help you lead investigations and collaborate with stakeholders. These skills are essential for detecting, preventing, and resolving fraudulent activities while ensuring regulatory compliance and minimizing organizational risk.
What cities are hiring for Fraud Investigations Manager jobs? Cities with the most Fraud Investigations Manager job openings:
What states have the most Fraud Investigations Manager jobs? States with the most job openings for Fraud Investigations Manager jobs include:
Fraud Investigations Manager jobs near you
Infographic showing various Fraud Investigations Manager job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 80% Full Time, 18% Part Time, and 1% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $64,132 per year, or $30.8 per hour.
Director, Fraud Investigations

Director, Fraud Investigations

Clover Health

Remote

Full-time

Medical, Dental, Vision, Retirement

Posted 18 days ago

Job description

Clover Health's legal team is a group of proactive business partners whose mission is to empower the organization to innovate and achieve its goals within a dynamic and fluid regulatory environment. We are committed to supporting continued excellence for our customers while building a sustainable future for the organization. We believe integrity, collaboration, and sustainability ensures Clover Health exceeds its objectives, while upholding the highest standards of legal and ethical responsibility.
Clover Health is investing in our fraud detection and investigation capabilities, and we are looking for a Director, Fraud Investigations to join our Legal department as a senior individual contributor. This role is an extension of our Special Investigations Unit (SIU) that sits within Legal-you will spend your days investigating suspected fraud against Clover's Medicare Advantage business and ensuring that those investigations are coordinated, well-documented, and supported by the right legal advice from the Legal department.
Reporting to Clover's Legal department, you will own a portfolio of fraud investigations end-to-end. Those investigations will originate from SIU's standard intake processes as well as other channels. In every case, you will dig in, gather and analyze the facts, partner with stakeholders across the company, and reach a defensible conclusion.
This is a non-attorney role. You will not be providing legal advice yourself; instead, you will work hand-in-hand with Clover's lawyers to make sure your investigations have the legal guidance they need, and that referrals, recoveries, and provider actions are appropriately reviewed by counsel. You are sharp, creative, and technology-forward, and you see AI and data analytics not as threats to the craft of investigation but as the most exciting tools to enter the field in a generation.
As a Director, Fraud Investigations, you will:
  • Investigate Suspected Fraud End-to-End: Own a portfolio of fraud investigations from intake through resolution. Develop investigative plans, gather and analyze evidence (including claims data, medical records, and provider documentation), interview witnesses where appropriate, and reach well-supported conclusions.
  • Handle Ad Hoc Internal Referrals: Take on investigations triggered by referrals from senior leaders and other internal stakeholders-e.g., a suspected provider outlier or a tip about potentially anomalous behavior-and provide a clear, factual assessment of whether something is amiss.
  • Coordinate Legal Support for Your Investigations: Work closely with Clover's attorneys to ensure each investigation has the legal guidance it needs. Identify legal questions early, route them to the right lawyer, and incorporate counsel's input into investigative strategy, documentation, referrals, and provider actions.
  • Build Defensible Documentation: Develop case files, memos, and referral packages that are factually complete, well-organized, and prepared with the evidentiary and procedural standards necessary for downstream enforcement, recoveries, or provider actions-working with Legal to confirm those standards are met.
  • Support Regulatory and Law Enforcement Referrals: Prepare referral packages for CMS, the MEDIC contractor, HHS-OIG, state fraud units, and law enforcement agencies, and coordinate with Legal on the form and substance of each referral. Track referral outcomes and help maintain relationships with enforcement partners.
  • Leverage Technology and AI: Partner with SIU and Clover's data science and engineering teams to evaluate, deploy, and refine AI-driven detection tools, predictive analytics, and data visualization platforms. Be a hands-on user and champion of technology in your own investigative work.
  • Collaborate Across Functions: Work with Clover's clinical, compliance, claims, payment integrity, provider relations, revenue operations, and SIU teams to gather information, validate findings, and translate investigative outcomes into operational improvements, provider education, and member impact.
  • Communicate Findings Clearly: Prepare concise written reports and oral briefings that translate complex investigative facts into clear narratives for senior leadership and other stakeholders.

Success in this role looks like:
  • In your first 90 days, you have embedded yourself as a trusted partner to both the Legal department and the SIU. You have built working relationships with key stakeholders across Clover's clinical, compliance, claims, payment integrity, revenue operations, and legal teams, and you have begun working through your initial portfolio of fraud investigations and ad hoc referrals.
  • By 6 months, you are independently managing a steady caseload of fraud investigations with consistently high-quality work product. Your referral packages are well-received by enforcement partners. You have a clear working rhythm with Legal that makes it easy to surface legal questions and incorporate counsel's input, and you have helped deploy or actively use at least one new technology or analytics tool to make your investigations more effective.
  • By 12 months, you have a track record of strong investigations, successful recoveries within your portfolio, and effective cross-functional collaboration. Senior leaders across Clover view you as the trusted person to call when they have a hunch that something doesn't look right and want it examined.

You should get in touch if:
  • You have 7+ years of experience in healthcare fraud investigations, program integrity, or SIU operations, with meaningful time spent at a Medicare Advantage or managed care plan.
  • You have management experience overseeing at least a segment of SIU work-whether a particular region or market, or a specific category of fraud (e.g., billing/coding fraud, pharmacy fraud, provider credentialing fraud).
  • You have a sophisticated understanding of healthcare fraud schemes and how to investigate them, including how to work with claims data, medical records, and provider documentation to build a factual record.
  • You are creative, tech-savvy, and genuinely excited about using AI, data analytics, and automation to transform how investigations are conducted. You want to be at the forefront of modernizing fraud detection work.
  • You have strong knowledge of Medicare Advantage regulatory requirements, CMS program integrity obligations, and the federal fraud and abuse framework, and you know when and how to bring legal questions to counsel.
  • You are a strong writer and communicator who can translate complex investigative facts into clear memos, referral packages, and executive summaries.
  • You thrive in a fast-paced, remote-first environment and are comfortable with ambiguity-you are helping shape an evolving function, not inheriting a static playbook.
    Bonus points if:
    • You hold a J.D. or have legal training, though a law degree is not required for this role.
    • You have worked within or alongside the Legal department at a health plan, supporting SIU or compliance functions.
    • You have prior experience at a Medicare Advantage plan specifically (as opposed to commercial or Medicaid only).
    • You hold industry certifications such as CFE (Certified Fraud Examiner), AHFI (Accredited Health Care Fraud Investigator), or CHC (Certified in Healthcare Compliance).
    • You have experience with New Jersey's regulatory and provider environment.
    • You have hands-on experience implementing or using AI/ML tools in an investigative or compliance setting.
    • You have experience with government enforcement-whether at a U.S. Attorney's Office, HHS-OIG, a state AG's office, or a Medicaid Fraud Control Unit.

Benefits Overview:
  • Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
  • Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.
  • Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location.
  • Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews.

Additional Perks:
  • Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
  • Reimbursement for office setup expenses
  • Monthly cell phone & internet stipend
  • Remote-first culture, enabling collaboration with global teams
  • Paid parental leave for all new parents
  • And much more!

About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.
We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
From Clover's inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences, perspectives, opinions, and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one's identity. All of our employee's points of view are key to our success, and inclusion is everyone's responsibility.
#LI-REMOTE
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.
Final pay is based on several factors including but not limited to internal equity, market data, and the applicant's education, work experience, certifications, etc.
A reasonable estimate of the base salary range for this role is:
$150,000-$240,000 USD
Clover Health Services logo

About Clover Health Services

Sourced by ZipRecruiter

Clover Health Services is a dynamic provider of travel nurse staffing services. Our Corporate staffs are the finest in the industry and are committed to paying attention to details when it comes to client requirements. Our frontline team of experienced recruiters is very friendly and well-informed, always willing and ready to help nurses with every phase of your travel assignment. Our Account Managers have a thorough understanding of hospital requirements and are quick to address all the requests from hospitals and also work seamlessly with the compliance department in placing nurses against open jobs on time. Clover partners with first-class hospitals across the nation which gives our nurses a variety of employment options to choose from. Added to this, our 24x7 helpline with professional support staff promptly address any special requests you may have and ensure all your needs are promptly addressed

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

White Plains, NY, US

Year founded

2016

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