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Investigation Consultant Jobs (NOW HIRING)

Allstate

Field SIU Investigation Auto/Casualty

Monroe, NC · On-site +1

$62K - $92K/yr

Key Responsibilities Oversees file quality Investigative Consultant Makes claim decisions regarding highly complex investigations, and pursues restitution Manages vendor relationship and oversees ...

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Parkland Health

Primary Purpose The Senior Compliance Investigations Consultant is responsible for effectively ... investigation. * Researches and reviews suspected activities to develop factual evidence.

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Investigation Consultant information

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How much do investigation consultant jobs pay per hour?

As of Aug 6, 2026, the average hourly pay for investigation consultant in the United States is $49.72, according to ZipRecruiter salary data. Most workers in this role earn between $24.28 and $62.50 per hour, depending on experience, location, and employer.

What are some common challenges investigation consultants face when handling complex cases, and how can they overcome them?

Investigation Consultants often encounter challenges such as managing sensitive information, navigating ambiguous or incomplete evidence, and coordinating with multiple stakeholders. Overcoming these challenges requires strong analytical skills, attention to detail, and effective communication with clients and team members. Staying up to date with investigative techniques, maintaining ethical standards, and leveraging technology for research and reporting can also help Investigation Consultants deliver thorough and reliable results.

What is an investigation consultant?

Investigation Consultants are professionals who provide expert advice and support to organizations or individuals conducting investigations. They help gather, analyze, and interpret data related to fraud, misconduct, regulatory compliance, or other concerns. Their role can include conducting interviews, reviewing documents, and preparing detailed reports. Investigation Consultants often work with legal teams, HR departments, or law enforcement to ensure investigations are thorough and compliant with relevant laws and regulations.

What are the key skills and qualifications needed to thrive as an investigation consultant?

To thrive as an Investigation Consultant, you need strong analytical abilities, attention to detail, and typically a background in law, criminal justice, or a related field. Familiarity with case management software, digital forensics tools, and relevant certifications such as Certified Fraud Examiner (CFE) are often required. Excellent communication, discretion, and critical thinking skills help build trust and effectively present findings to clients or stakeholders. These competencies ensure thorough, ethical, and actionable investigations that uphold professional standards and client interests.

What is the difference between Investigation Consultant vs Private Investigator?

AspectInvestigation ConsultantPrivate Investigator
CredentialsMay require certifications like Certified Fraud Examiner (CFE) or investigator licensesOften licensed, with state-specific private investigator licenses
Work EnvironmentCorporate, legal, or consulting firms; often office-based with fieldworkFieldwork-focused, working independently or with agencies
Employer & IndustryLegal firms, corporations, insurance companiesPrivate investigation agencies, individuals
Common Search & ComparisonInvestigation Consultant vs Private Investigator

Investigation Consultants typically work in corporate or legal settings, providing expert advice and analysis, often requiring certifications like CFE. Private Investigators focus on field investigations, surveillance, and evidence collection, usually holding state licenses. While both roles involve investigations, Investigation Consultants tend to have a broader scope in consulting and analysis, whereas Private Investigators are more hands-on in fieldwork.

Do investigation consultants get paid?

Investigation consultants are typically paid for their services, with compensation varying based on experience, complexity of cases, and industry standards. They may work as independent contractors or employees, often earning hourly rates, project fees, or salaries, and may require relevant certifications or security clearances.
More about Investigation Consultant jobs
What cities are hiring for Investigation Consultant jobs? Cities with the most Investigation Consultant job openings:
What states have the most Investigation Consultant jobs? States with the most job openings for Investigation Consultant jobs include:
What job categories do people searching Investigation Consultant jobs look for? The top searched job categories for Investigation Consultant jobs are:
Investigation Consultant jobs near you
Infographic showing various Investigation Consultant job openings in the United States as of August 2026, with employment types broken down into 87% Full Time, 7% Part Time, and 6% Contract. Highlights an 87% Physical, 4% Hybrid, and 9% Remote job distribution, with an average salary of $103,425 per year, or $49.7 per hour.

Investigations Consultant

Highmark Health

Pittsburgh, PA • On-site

Full-time

Re-posted 28 days ago

Highmark Health rating

7.8

Company rating: 7.8 out of 10

Based on 28 frontline employees who took The Breakroom Quiz

Job description

Company :
Highmark Inc.Job Description :
JOB SUMMARY
This job is responsible for development and implementation of strategic audit plans utilizing numerous inputs including contracts, industry trends and revenue maximization schemes. The incumbent will also work with other audit team members and external vendors to develop specific auditing techniques to identify overbilling and potential recoveries/ savings. Will be called upon as a subject matter expert for investigations providing guidance and mentoring to investigative team. Must be able to testify in a court of law, prepare cases for referral to various federal, state and local law enforcement entities and work with those agencies through closure of the case. Conduct audits for proactive and investigative purposes to comply with internal audit and regulatory requirements.
ESSENTIAL RESPONSIBILITIES
  • Analyze and evaluate claim processes specific to professional, hospital, ambulatory surgical center, home health and durable medical equipment to identify key areas of risk exposure and develop plans to mitigate risks and maximize financial recoveries/savings.
  • Work with audit teams and external audit vendors to identify overbilling, determine data analysis routines and audit approaches.
  • Work with operational areas to recover identified overpayments, performing a follow-up review to ensure that the claims were adjusted correctly, resulting in expected recovery/savings.
  • Perform claims system extracts and create reports, graphs, and charts to timely identify trends and patterns of potential healthcare fraud, waste and abuse. Communicate findings to company management of various areas including provider relations, reimbursement etc.
  • Calculate overpayments in established fraud, waste or abuse cases. Identify all fraudulent activity included in the case, determine what lines of business were involved in the fraudulent activity, and measure overpayment by means of sampling or complete review. Negotiate settlements with providers.
  • Maintain current case related information on all applicable case management tracking systems.
  • Provide investigative support and mentoring to investigative team members.
  • Function as a project lead for special investigation projects of varying complexity.
  • Other duties as assigned or requested.

EDUCATION
Required
  • Bachelor's degree in Accounting, Finance, Business Administration, Nursing, IT or Related Field

Substitutions
  • 6 years of related and progressive experience in lieu of Bachelor's degree

Preferred
  • Master's degree in Fraud, Forensics Accounting, Business or related field

EXPERIENCE
Required
  • 7 years of in the Health Insurance industry and/or Healthcare Fraud investigations
  • 3 years in leading projects of varying size and complexity

Preferred
  • 5 years in Financial Analysis in an acute care hospital or health insurance setting
  • 5 years in professional billing, facility Patient Financial Services, HIM, Internal Audit, Professional/Facility Reimbursement or Provider Contracting

LICENSES or CERTIFICATIONS
Required
  • None

Preferred
  • Certified Fraud Examiner (CFE)
  • Certified Professional Coder (CPC)
  • Certified Professional Coder- Hospital(CPC-H)
  • Certified Outpatient Coder (COC)
  • Accredited Healthcare Fraud Investigator (AHFI)

SKILLS
  • Must have knowledge of provider facility payment methodology, claims processing systems and coding and billing proficiency
  • Must have understanding of technical and financial aspects of the health insurance industry
  • Strong personal computer skills, along with the ability to use fraud/abuse data mining tools are required
  • Must possess excellent communication skills and be detailed oriented
  • Strong written and oral communication skills
  • Strong relationship building skills
  • Client focused with strong business acumen
  • Self-starter with the ability to work under pressure independently and as part of a team
  • Ability to think strategically and act proactively to create strong trust and confidence with business units
  • Strong innovative problem-solving capabilities

Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Frequently
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice

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About Highmark Health

Sourced by ZipRecruiter

A national blended health organization, Highmark Health and our leading businesses support millions of customers with products, services and solutions closely aligned to our mission of creating remarkable health experiences, freeing people to be their best. Headquartered in Pittsburgh, we're regionally focused in Pennsylvania, Delaware, West Virginia, and eastern and northwestern New York with customers in 50 states and the District of Columbia. We passionately serve individual consumers and fellow businesses alike. And our companies cover a diversified spectrum of essential health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions. Our financial position reflects strength and stability, with our year-end 2022 consolidated revenues totaling $26 billion. And we're proud to carry forth an important legacy of compassionate care and philanthropy that began more than 170 years ago. This tradition of giving back, reinvesting and ensuring that our communities remain strong and healthy is deeply embedded in our culture, informing our decisions every day.

Industry

Health care and social assistance and insurance services

Company size

10,000+ Employees

Headquarters location

Pittsburgh, PA, US

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