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Insurance Fraud Investigator Jobs in Missouri (NOW HIRING)

WRBC Support Services

SIU Manager

Wildwood, MO · On-site

Fraud Claims Law Specialist (FCLS), Certified Insurance Fraud Investigator (CIFI), Certified Fraud Examiner (CFE), Chartered Property Casualty Underwriter (CPCU), Associate in Claims (AIC). • ...

VRC Investigations

Surveillance Investigator

Kansas City, MO · On-site

$21 - $25.75/hr

... insurance fraud. The surveillance investigator position is a field based, hourly, and non-exempt position. This position requires daily travel within the designated city/territory in the advertised ...

VRC Investigations

Surveillance Investigator

Ballwin, MO

$25 - $30/hr

... insurance fraud. The surveillance investigator position is a field based, hourly, and non-exempt position. This position requires daily travel within the designated city/territory in the advertised ...

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Insurance Fraud Investigator information

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$14

$28

$49

How much do insurance fraud investigator jobs pay per hour?

As of Aug 30, 2026, the average hourly pay for insurance fraud investigator in Missouri is $28.92, according to ZipRecruiter salary data. Most workers in this role earn between $20.72 and $33.12 per hour, depending on experience, location, and employer.

What does an insurance fraud investigator do?

As an insurance fraud investigator, your job is to investigate an insurance claim on behalf of your firm to determine whether or not fraud has occurred in any given case. In this role, you may examine the damaged property, coordinate with law enforcement, interview the claimant, and gather information about any casualty that's occurred. Insurance fraud is a crime, but most fraud investigators are not police officers, and you are not expected to arrest fraudsters. Instead, you may be asked to write up a report summarizing your findings and send it to a law enforcement agency. Insurance fraud investigators frequently travel to examine claim sites in person, and you may be asked to do so on short notice.

What are the key skills and qualifications needed to thrive as an insurance fraud investigator?

To thrive as an Insurance Fraud Investigator, you need strong analytical skills, attention to detail, and a background in criminal justice or a related field, often supported by a bachelor's degree. Familiarity with case management software, data analysis tools, and knowledge of legal regulations and investigative procedures is typically required, and certifications like CIFI (Certified Insurance Fraud Investigator) can be advantageous. Excellent communication, critical thinking, and interpersonal skills help build trust, conduct thorough interviews, and present findings effectively. These skills are crucial for detecting fraudulent activity, ensuring accurate claims processing, and protecting company resources.

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

Insurance Fraud Investigators often encounter challenges such as distinguishing between legitimate and fraudulent claims, managing heavy caseloads, and keeping up with evolving fraud tactics. They must remain objective and detail-oriented while conducting interviews and gathering evidence, sometimes under tight deadlines. Working collaboratively with law enforcement, attorneys, and claims adjusters is also essential, requiring strong communication and interpersonal skills.

What is the difference between Insurance Fraud Investigator vs Claims Adjuster?

AspectInsurance Fraud InvestigatorClaims Adjuster
Required CredentialsTypically requires a background in criminal justice, law enforcement, or related certificationsRequires insurance licenses and sometimes adjuster certifications
Work EnvironmentInvestigates suspected fraud cases, often in an office or field settingEvaluates insurance claims, interacts with claimants, and assesses damages
Employer & Industry UsageEmployed by insurance companies, law enforcement, or specialized fraud unitsEmployed by insurance companies, public agencies, or independent adjusting firms

Insurance Fraud Investigators focus on detecting and preventing fraudulent claims, often working in investigative or law enforcement settings. Claims Adjusters handle the assessment and processing of insurance claims, ensuring proper payout. While both roles are vital in the insurance industry, their primary functions, credentials, and work environments differ significantly.

How much do insurance fraud investigators earn?

Insurance fraud investigators typically earn a median annual salary of around $50,000 to $70,000, depending on experience, location, and employer. Advanced skills, certifications, and investigative tools can lead to higher earnings in this field.
More about Insurance Fraud Investigator jobs

What are the most commonly searched types of Insurance Fraud Investigator jobs in Missouri?

The most popular types of Insurance Fraud Investigator jobs in Missouri are:

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For Insurance Fraud Investigator jobs in Missouri, the most frequently searched job titles are:

What job categories do people searching Insurance Fraud Investigator jobs in Missouri look for?

The top searched job categories for Insurance Fraud Investigator jobs in Missouri are:

What cities in Missouri are hiring for Insurance Fraud Investigator jobs?

Cities in Missouri with the most Insurance Fraud Investigator job openings:

Insurance Fraud Investigator jobs near you
Infographic showing various Insurance Fraud Investigator job openings in Missouri as of August 2026, with employment types broken down into 70% Full Time, and 30% Part Time. Highlights an 60% In-person, 10% Hybrid, and 30% Remote job distribution, with an average salary of $60,156 per year, or $28.9 per hour.

Fraud Investigator-Kansas City, MO area

Kansas City, MO • On-site

Blue Cross and Blue Shield of Kansas City
Insurance Services • 501 - 1,000 employees
Learn more about Blue Cross and Blue Shield of Kansas Cityexternal

Full-time

Medical, Dental, Vision, Retirement, PTO

This job post has expired 4 days ago. 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, behavioral health, 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
  • Licensed Clinal Social Worker (LCSW)
  • Licensed Professional Counselor (LPC)

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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