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Insurance Fraud Jobs in Wisconsin (NOW HIRING)

Government Employees Insurance Company

WI · On-site

$34.60 - $44.01/hr

As a SIU Field Investigator, you will conduct investigations of suspected cases of fraud or other ... insurers in the United States. Learn more about GEICO Benefits #J-18808-Ljbffr

Acuity Insurance

Claims Intern

Sheboygan, WI · On-site

$19 - $24/hr

... under the insurance policy, evaluating liability, assessing damages, and forecasting reserves ... Thoroughly investigate assigned claims to determine coverage, subrogation, and fraud by conducting ...

mgx

Part Time Teller

Onalaska, WI · On-site

$14.75 - $18.50/hr

... insurance, 401(k) retirement plan; bonus plan; paid time off; and a variety of voluntary ... Tellers also play an important role in fraud prevention. Tellers play a vital role in providing ...

Merchants Bank

Part Time Teller

Onalaska, WI · On-site

$17.74 - $20.38/hr

... insurance, 401(k) retirement plan; bonus plan; paid time off; and a variety of voluntary ... Tellers also play an important role in fraud prevention. Tellers play a vital role in providing ...

Socket.dev

WI · On-site

... risk, fraud or compliance organizations * - Master's degree or equivalent Amazon is an equal ... Amazon also offers comprehensive benefits including health insurance (medical, dental, vision ...

Ho-Chunk Nation

FITNESS SPECIALIST

Baraboo, WI · On-site

$17.15/hr

ESSENTIAL: 1. Must not have been convicted of any criminal offense relating to theft, fraud, or ... license, dependable transportation, and proper insurance may be required. 6. Maintain ...

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Showing results 21-40

All JobsInsurance Fraud JobsInsurance Fraud Jobs in Wisconsin

Insurance Fraud information

See Wisconsin salary details

$26.2K

$48.9K

$73.7K

How much do insurance fraud jobs pay per year?

As of Sep 15, 2026, the average yearly pay for insurance fraud in Wisconsin is $48,862.00, according to ZipRecruiter salary data. Most workers in this role earn between $40,400.00 and $55,500.00 per year, depending on experience, location, and employer.

What is insurance fraud?

Insurance fraud is the act of intentionally deceiving an insurance company or agent to obtain benefits, payouts, or advantages to which one is not entitled. This can include exaggerating claims, falsifying information on applications, staging accidents, or submitting false documents. Insurance fraud is a serious crime that can result in legal penalties, increased premiums for all policyholders, and reduced trust in the insurance system. Both individuals and organized groups can commit insurance fraud, and it occurs in various types of insurance, including health, auto, and property insurance.

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 thinking, attention to detail, and a background in criminal justice or a related field. Familiarity with investigative software, claims management systems, and sometimes certifications like the Certified Insurance Fraud Investigator (CIFI) credential are typically required. Excellent communication, critical thinking, and interpersonal skills allow you to conduct interviews, write clear reports, and collaborate with law enforcement. These capabilities are crucial for effectively identifying fraudulent claims, ensuring accurate investigations, and protecting organizational assets.

What are some common challenges faced by professionals working in insurance fraud investigation?

Professionals in insurance fraud investigation often face challenges such as distinguishing genuine claims from fraudulent ones, handling sensitive or confrontational interactions with claimants, and keeping up with evolving fraud tactics. The work requires strong attention to detail, persistence in gathering and analyzing evidence, and effective collaboration with law enforcement, legal teams, and other departments. Investigators also need to manage a significant workload while ensuring all cases are handled ethically and in compliance with regulations.

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

AspectInsurance FraudInsurance Claims Adjuster
Primary RoleDetecting and preventing fraudulent insurance claimsEvaluating insurance claims to determine coverage and settlement
Required CredentialsKnowledge of insurance policies, investigation skillsLicensing, insurance knowledge, sometimes certifications like CPCU
Work EnvironmentInvestigations, office, field inspectionsOffice-based, field visits, interviews
Industry UsageInsurance companies, law enforcementInsurance companies, adjusting firms

Insurance Fraud specialists focus on identifying and preventing fraudulent claims, often working closely with law enforcement. Insurance Claims Adjusters evaluate legitimate claims to determine appropriate payouts. While both roles require insurance knowledge, fraud specialists emphasize investigation skills, whereas adjusters focus on claim assessment and settlement.

Insurance Fraud jobs near you
Infographic showing various Insurance Fraud job openings in Wisconsin as of August 2026, with employment types broken down into 1% As Needed, 74% Full Time, 20% Part Time, and 5% Contract. Highlights an 84% Physical, 1% Hybrid, and 15% Remote job distribution, with an average salary of $48,862 per year, or $23.5 per hour.

Claims Examiner III, Fraud and Abuse - LPN (Must live in vicinity of Madison, WI WPS campus)

Madison, WI • On-site, Remote

WPS
See more jobs at WPSexternal

$19.35/hr

Part-time

Medical, Dental, Retirement, PTO

Posted 12 days ago

Job description

U.S. citizenship is required for this position due to Department of Defense restrictions.
Our Claims Examiner III, Fraud and Abuse focuses on identifying, developing, and reporting fraudulent or abusive practices. They provide support to Military Veterans Health (MVH) Management Activity, referral to law enforcement for lead action, and ensure only medically appropriate MVH benefits are paid.
Must live within vicinity of Madison, WI campus location, within 45 miles of WPS Headquarters (1717 W. Broadway in Madison, WI, 53713)
Additional Information
  • Start Date: 10/6/2026
  • Starting Base Salary: $19.35/hour
  • Training Location/Schedule:
    • Monday-Friday 8am~4
    • If any, all onsite training will take place at the WPS Corporate Center Building (1717 W. Broadway) in Madison, WI 53713
  • Scheduled Shift: Flexible schedule once trained, 8-hours shifts 7am-5pm)
    Work from Home: Currently able to work from home, including training (not considered a permanent remote position).
  • Work Location: This is a remote position, must live within vicinity of Madison, WI campus location, within 45 miles of WPS Headquarters (1717 W. Broadway in Madison, WI, 53713), employees may be required to work at this location at times.

How do I know this opportunity is right for me? If you:
  • Can generate reports and review data obtained from anti-fraud software to uncover potential fraud and/or abuse situations.
  • Have developed cases, reviewed statistical data and medical records to identify aberrant patterns, and determined reason for exceeding norms.
  • Enjoy compiling data in appropriate format for use by Physician/PEER Review.
  • Would like to receive and research allegations of fraud and abuse in MVH program.
  • Can initiate correspondence to beneficiaries, providers, contractors, TMA, and other outside contacts to disseminate and obtain information.
  • Can compose letters in a professional, concise manner to educate providers/beneficiaries, obtain information, and refer cases to TMA/law enforcement.
  • Enjoy evaluating statistics and information from federal and in-house sources for their significance in program controls.
  • Like to perform individual audits and create spreadsheets to summarize findings.
  • Can perform pre-payment and post-payment review of claims and medical records to determine medical necessity and appropriateness of care, and for compliance with MVH policy.
  • Have utilized medical knowledge to review claims history and medical records to identify beneficiary overutilization patterns.
  • Can provide RN oversight on LPN decisions as required by MVH Program regulations.
  • Would like to participate in Quality Management System to maintain MVH International Standard Organization (ISO) certification.

Minimum Qualifications
  • Must live within vicinity of Madison, WI campus location, within 45 miles of WPS Headquarters (1717 W. Broadway in Madison, WI, 53713)
  • U.S. citizenship is required for this position due to Department of Defense restrictions.
  • Licensed Registered Nurse (RN): Associate Degree in Nursing or equivalent diploma from accredited Nursing Program OR Licensed Practical Nurse (LPN): Accredited Practical Nursing Program Certification
  • Current RN or LPN licensure.
  • 3 or more years clinical practice experience.
  • Ability to learn and apply governing MVH regulations, policies, and procedures.
  • Ability to analyze and document medical findings.

Preferred Qualifications
  • Bachelor of Science Degree in Nursing (RN).
  • 5 or more years clinical practice experience with 2 or more years in an acute care setting.
  • Fluent in a foreign language.
  • Fraud prevention or medical auditing background.

Remote Work Requirements
  • Wired (ethernet cable) internet connection from your router to your computer.
  • High speed cable or fiber
  • Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net).
  • Please review Remote Worker FAQs for additional information.

Benefits
  • Bargaining Unit position
  • Remote and hybrid work options available
  • Performance bonus and/or merit increase opportunities
  • 401(k) with dollar-per-dollar match up to 6% of salary (100% vested immediately)
  • Competitive paid time off
  • Health insurance, dental insurance, and telehealth services start DAY 1
  • Employee Resource Groups
  • Professional and Leadership Development Programs
  • Review additional benefits: (https://www.wpshealthsolutions.com/careers/)

Who We Are
WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.
Culture Drives Our Success
WPS' culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce-both current and future-to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.
We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition.
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WPS Health BlogThis position supports services under U.S. Department of Defense (DoD) Defense Health Agency (DHA) contract(s). As such, the role is subject to all applicable federal regulations, DoD contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. DoD contractors and their personnel are subject to screening and background investigation prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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