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Insurance Fraud Investigator Jobs in Decatur, GA

Truist

Fraud Specialist I

Atlanta, GA · On-site

$16.25 - $21.75/hr

Experience in investigation, law enforcement, or lending role 12. Knowledge of Fraud regulations ... Truist offers medical, dental, vision, life insurance, disability, accidental death and ...

Truist

Fraud Specialist II

Atlanta, GA · On-site

$16.25 - $21.75/hr

Experience in investigation, law enforcement, or lending role 12. Knowledge of Fraud regulations ... Truist offers medical, dental, vision, life insurance, disability, accidental death and ...

Truist

Fraud Specialist I

Atlanta, GA · On-site

$16.25 - $21.75/hr

Experience in investigation, law enforcement, or lending role 12. Knowledge of Fraud regulations ... Truist offers medical, dental, vision, life insurance, disability, accidental death and ...

Truist

Fraud Specialist II

Atlanta, GA · On-site

$16.25 - $21.75/hr

Experience in investigation, law enforcement, or lending role 12. Knowledge of Fraud regulations ... Truist offers medical, dental, vision, life insurance, disability, accidental death and ...

Truist

Fraud Senior Specialist I

Atlanta, GA · On-site

Experience in investigation, law enforcement, or lending role 12. Knowledge of Fraud regulations ... Truist offers medical, dental, vision, life insurance, disability, accidental death and ...

New

RPM Living

Director of Audit

Atlanta, GA

Legal, Risk, and Insurance supports the advancement of RPM's business objectives by strategically ... Fraud Prevention, Detection & Investigations • Conduct fraud investigations, including ...

New

RPM Living

Director of Audit

Atlanta, GA · On-site

Legal, Risk, and Insurance supports the advancement of RPM's business objectives by strategically ... Fraud Prevention, Detection & Investigations Conduct fraud investigations, including ...

RPM Living

Director of Audit

Atlanta, GA · On-site

Legal, Risk, and Insurance supports the advancement of RPM's business objectives by strategically ... Fraud Prevention, Detection & Investigations Conduct fraud investigations, including ...

RPM Living

Director of Audit

Atlanta, GA · On-site

Legal, Risk, and Insurance supports the advancement of RPM's business objectives by strategically ... Fraud Prevention, Detection & Investigations Conduct fraud investigations, including ...

RPM Living

Director of Audit

Atlanta, GA · On-site

Legal, Risk, and Insurance supports the advancement of RPM's business objectives by strategically ... Fraud Prevention, Detection & Investigations • Conduct fraud investigations, including ...

New

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All JobsInsurance Fraud Investigator JobsInsurance Fraud Investigator Jobs in Decatur, GA

Insurance Fraud Investigator information

See Decatur, GA salary details

$15

$30

$51

How much do insurance fraud investigator jobs pay per hour?

As of Jul 3, 2026, the average hourly pay for insurance fraud investigator in Decatur, GA is $30.10, according to ZipRecruiter salary data. Most workers in this role earn between $21.59 and $34.52 per hour, depending on experience, location, and employer.

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.

How to become a certified insurance fraud investigator?

To become a certified insurance fraud investigator, candidates typically need a background in law enforcement, insurance, or criminal justice, along with relevant experience. Certification programs such as the Certified Fraud Examiner (CFE) or specialized insurance fraud investigator certifications are often pursued, which require passing exams and demonstrating professional experience in fraud detection and investigation. Continuing education and familiarity with investigative tools and legal procedures are also important for certification and career advancement.

How can I become a fraud investigator?

To become an insurance fraud investigator, typically a high school diploma or equivalent is required, with many employers preferring candidates with a bachelor's degree in criminal justice, law enforcement, or a related field. Relevant experience in law enforcement, insurance, or investigations, along with strong analytical skills and attention to detail, are important. Certifications such as the Certified Fraud Examiner (CFE) can enhance job prospects and credibility in the field.

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.

What are the key skills and qualifications needed to thrive as an Insurance Fraud Investigator, and why are they important?

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.

How much do fraud investigators earn?

Insurance fraud investigators typically earn between $45,000 and $75,000 annually, depending on experience, location, and employer. Advanced skills, certifications, and investigative tools can influence salary levels within this range.

What does an insurance fraud investigator do?

An insurance fraud investigator examines insurance claims to detect and prevent fraudulent activities. They review documentation, interview claimants and witnesses, analyze evidence, and collaborate with law enforcement when necessary, often using specialized software and investigative techniques. Their work helps ensure the integrity of insurance processes and may require knowledge of legal procedures and industry regulations.

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.

More about Insurance Fraud Investigator jobs
What job categories do people searching Insurance Fraud Investigator jobs in Decatur, GA look for? The top searched job categories for Insurance Fraud Investigator jobs in Decatur, GA are:
What cities near Decatur, GA are hiring for Insurance Fraud Investigator jobs? Cities near Decatur, GA with the most Insurance Fraud Investigator job openings:
Insurance Fraud Investigator jobs near you
Coding Specialist

Coding Specialist

Ortho Sport and Spine Physicians

Atlanta, GA • On-site

Full-time

Posted 16 days ago

Job description

Description
SUMMARY:
We are seeking a qualified and dedicated Billing and Coding Specialist to join our Central Billing Office. In this position, you will be responsible for a variety of tasks requiring data analysis, in-depth evaluation, and sound judgment. As our Biller and Coder, your daily duties will include entering and coding patient services and charges into our EMR system and generating invoices to mail out to patients. The ideal candidate must also be able to demonstrate excellent written and verbal communication skills, as communicating with clients and various insurance agents or patients will form a large part of the job.
DUTIES:
  • Remain HIPAA and OSHA compliant.
  • Translate patient information and alphanumeric medical code entries.
  • Electronic "clean" claims submissions to Insurance Carriers.
  • Collect, post, and manage patient account payments.
  • Sort and file paperwork.
  • Analyzing and correcting coding errors.
  • Ensure healthcare facilities are reimbursed for all procedures.
  • Follow Up on accepted or denied claims.
  • Review denied claims for denial reasons and provide resolution.
  • Investigate insurance fraud and report if found.
  • Collect information regarding patient treatments, diagnosis, and related procedures to ensure proper coding.

Qualifications:
  • A minimum of 2 years' experience as a Medical Biller or similar role.
  • Knowledge of unfair debt collection practices and insurance guidelines.
  • Understanding of primary code classifications: ICD-10 CM, ICD-10-PCS, CPT and HCPCS
  • Computer proficiency and medical billing software
  • Must have the ability to multitask and manage time effectively.
  • Excellent written and verbal communication skills.
  • Outstanding problem-solving and organizational abilities.
  • Productivity Driven.

EDUCATION AND EXPERIENCE:
  • High School, Associate Degree or 1-3 years of Billing and Coding experience
  • Professional Certification preferred

Ortho Sport and Spine Physicians is an Equal Opportunity Employer and does not discriminate in its employment practices on the basis of race, religion, sex, color, national origin, age, disability, citizenship, genetic information, veteran status, military service, or any other characteristic protected by federal law or Georgia law.
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