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Healthcare Investigator Jobs (NOW HIRING)

NYC Health Hospitals

Hospital Care Investigator

New York, NY · On-site

$55K/yr

  • Medical

  • Retirement

  • PTO

NYC Health + Hospitals/Carter is a state-of-the-art facility with a 4-Star CMS Quality Rating ... Directly responsible for conducting financial investigations and related activities in health care ...

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$32K

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$131K

How much do healthcare investigator jobs pay per year?

As of Aug 12, 2026, the average yearly pay for healthcare investigator in the United States is $75,325.00, according to ZipRecruiter salary data. Most workers in this role earn between $52,500.00 and $98,500.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a healthcare investigator?

To thrive as a Healthcare Investigator, you need a strong background in healthcare regulations, analytical research, and investigative techniques, often supported by a relevant degree or certification in health administration, compliance, or criminal justice. Familiarity with case management software, electronic health records (EHRs), and data analysis tools is typically required. Attention to detail, critical thinking, and strong communication skills help investigators effectively identify and resolve healthcare fraud or compliance issues. These skills are crucial for ensuring regulatory compliance, protecting patient interests, and maintaining the integrity of healthcare organizations.

What is a healthcare investigator?

A Healthcare Investigator is a professional who examines potential cases of fraud, abuse, or regulatory violations within the healthcare industry. They may work for insurance companies, government agencies, or private organizations to analyze medical claims, audit healthcare providers, and ensure compliance with laws and policies. Their work helps protect patients, reduce costs, and maintain the integrity of healthcare systems. Healthcare Investigators often collaborate with law enforcement and legal teams to resolve cases and may testify in court when necessary.

What are some common challenges healthcare investigators face when conducting investigations, and how can they overcome them?

Healthcare Investigators often encounter challenges such as interpreting complex medical documentation, navigating privacy regulations, and dealing with uncooperative witnesses or entities. To overcome these obstacles, it's important to have a strong understanding of medical terminology, stay up-to-date with regulatory compliance (like HIPAA), and develop effective communication and negotiation skills. Additionally, collaborating closely with medical professionals, legal teams, and regulatory agencies helps ensure thorough and accurate investigations.

What is the difference between Healthcare Investigator vs Healthcare Fraud Analyst?

AspectHealthcare InvestigatorHealthcare Fraud Analyst
Required CredentialsTypically requires healthcare-related certifications, investigative training, or licensureOften requires certifications like CFE, healthcare compliance, or auditing credentials
Work EnvironmentInvestigations often occur in healthcare facilities, government agencies, or insurance companiesPrimarily office-based, analyzing data and reports within healthcare organizations or insurers
Employer & Industry UsageUsed by healthcare providers, insurance companies, and government agencies to conduct investigationsCommonly employed by insurance companies, government agencies, and compliance departments to detect fraud

Both roles involve analyzing healthcare data and require knowledge of healthcare regulations. Healthcare Investigators focus on conducting investigations into suspected misconduct, while Healthcare Fraud Analysts analyze data to identify fraudulent activities. The roles often overlap but differ mainly in their approach—investigative versus analytical.

More about Healthcare Investigator jobs
What cities are hiring for Healthcare Investigator jobs? Cities with the most Healthcare Investigator job openings:
What states have the most Healthcare Investigator jobs? States with the most job openings for Healthcare Investigator jobs include:
What job categories do people searching Healthcare Investigator jobs look for? The top searched job categories for Healthcare Investigator jobs are:
Healthcare Investigator jobs near you
Infographic showing various Healthcare Investigator job openings in the United States as of August 2026, with employment types broken down into 3% As Needed, 67% Full Time, 15% Part Time, and 15% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $75,325 per year, or $36.2 per hour.

Hospital Care Investigator

NYC Health Hospitals

New York, NY • On-site

$55K/yr

Full-time

Medical, Retirement, PTO

Re-posted 14 days ago

NYC Health + Hospitals rating

7.5

Company rating: 7.5 out of 10

Based on 74 frontline employees who took The Breakroom Quiz

235th of 887 rated healthcare providers

Job description

NYC Health + Hospitals/Carter is a state-of-the-art facility with a 4-Star CMS Quality Rating, equipped with 164-bed Skilled Nursing Facility and 201-bed Long-Term Acute Care Hospital (LTACH) based in Harlem. Carter excels at providing quality medical, sub-acute, rehabilitative, and long-term specialty services for individuals in need of medically-complex care like ventilator weaning and onsite-dialysis. Every employee takes a person-centered approach that exemplifies our ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnership.
From more than 600 Nursing Homes in New York, Carter ranks #4 in Newsweek's Best Nursing Homes in New York2026; and also received a high-performance rating for Long-Term Care and Short-term Rehabilitation from U.S. News & World Report's Best Nursing Homes in America 2026. In 2025, Carter was awarded the American Nurses Credentialing Center's Pathway to Excellence with Distinction Award, the nation's first long-term facility to receive it.
At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.
Work Shifts
9:00 A.M - 5:00 P.M
PROVISIONAL APPT
Duties & Responsibilities
Position Overview:
Directly responsible for conducting financial investigations and related activities in health care facility to determine patients/client's ability to pay for medical services or to determine alternative sources of payment, including eligibility for medical insurance coverage, reviewing case records, provide guidance and or direct investigations for complex cases to reach a resolution and facilitate payment; and perform related work assigned by manager.
Responsibilities:
  • Review all new and re-admit admission record received from centralized admission and screen for Long term, short term cases in addition to verification and confirmation of insurance coverage and send out email blast to all appropriate parties on updates needed.
  • Responsible for screening uninsured or underinsured inpatient to identify insurance coverage or enrollment eligibility. Screening most often occur on the inpatient floors.
  • Assist inpatient that do not qualify for enrollment with NYC Care or H+H options.
  • Telephoning resident/families/responsible parties within 48 hours for initial interview, quoting facility daily rate, confirming demographic, verifying insurance coverage and request for financial documentation for Nursing Home Medicaid determination to be send via secure email.
  • Scan patient ID, insurance card(s), and consent forms obtain from the patient into shared drive.
  • Verify insurance coverage coded in Point Click Care (PCC) for discrepancies also verifies insurance coverage from various insurance portals
  • Sending email to financial clearance team to verify secondary and commercial insurance found that is not coded in PCC
  • Document all transactions in PCC notes
  • Act as liaison with social worker to assist in obtaining signature on significant documents from the attending physicians, and family members
  • Follow up on cases to ensure Medicaid submission are within 45 days and complete submission to HRA or follow up on documentation needed for submission and follow up on status of applications until a coverage determination is made.
  • Certified Assistor Counselor (CAC) credentials enrolling consumer in health coverage through Affordable Care Act's Health Insurance Marketplace.
  • Maintains competency of MAPS (Electronic Portal for Medicaid application submission) on all Post-Acute Care outstanding cases needing to submit to HRA for determination of eligibility insurance
  • Review transmission report in MAPS on approved, denied, deferred cases in MAPS for and update; maintains statistical records and prepares status reports.
  • Refer accounts requiring escalation to Supervisor in a timely manner.
  • Import/scan budget letter approvals into the computerized system (Point Click Care).
  • Notify resident or responsible party of approved Medicaid with their monthly NAMI (Net Available Monthly Income) responsibility and encourage to sign up for RFMS electronic NAMI withdrawal and pension re-routing.
  • Assist resident with annual Medicaid recertification for continuing eligibility insurance coverage
  • Update UR tracker and attending weekly UR meeting to discuss residents needing Medicaid insurance coverage
  • Courteously and properly handle or refer all calls received
  • Serves as liaison between department administrative, technical and professional divisions and work harmoniously with a culturally diversified staff.
  • Perform other duties as assigned by Manager relating to Eligibility field

Minimum Qualifications
1. A baccalaureate degree from an accredited college or university; or
2.An Associate's degree from an accredited college or university; and completion of an accredited certificate program in medical billing; or
3.A four-year high school diploma or its educational equivalent; and completion of an accredited certificate program in medical billing; and two (2) years of full-time experience in interviewing, investigation, or a related field, such as credit and collection follow-up or bookkeeping, or as a customer service representative providing comprehensive customer service entailing the dispensing of information or listening to and resolving customer's concerns, problems and complaints or troubleshooting; or
4.A four-year high school diploma or its educational equivalent; and four (4) years of full-time experience, as described in #3 above, at least two years of which must have been in interviewing, investigations, or a related field such as credit and collection follow-up or bookkeeping; or
5.Education and/or experience which is equivalent to (1), (2), (3) or (4) above. College education may be substituted for experience on the basis that thirty (30) semester credits are equivalent to one (1) year of experience and candidates must have completed an accredited certificate program in medical billing or have at least two years of full-time experience in interviewing, investigations, or a related field such as credit and collection follow-up or bookkeeping. In addition, all candidates must have at least a four-year high school diploma or its educational equivalent.
Department Preferences
Certified Assistor Counselor (CAC) credentials enrolling consumer in health coverage through Affordable Care Act's Health Insurance Marketplace.
Ability to analyze a problem or situation and make appropriate judgments, such a logical conclusion, feasible solution or most appropriate action.
Be cognizant of all HIPPA privacy rules to PHI. Proficiency in Microsoft Excel and Word.
Benefits
NYC Health and Hospitals offers a competitive benefits package that includes:
  • Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
  • Retirement Savings and Pension Plans
  • Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
  • Loan Forgiveness Programs for eligible employees
  • College tuition discounts and professional development opportunities
  • College Savings Program
  • Union Benefits for eligible titles
  • Multiple employee discounts programs
  • Commuter Benefits Programs

If you wish to apply for this position, please apply online by clicking the "Apply for Job" button.

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