ZipRecruiter

Log In

1

Problem Investigator Jobs (NOW HIRING)

Health Plan

$80 - $100/hr

Critical problem-solving skills and attention to detail. * Healthcare investigations, program integrity, or similar experience; * 3 years Medical Claims or multi-discipline clinical experience;

TEN Credit Union

Fraud Investigator

Nashville, TN · On-site

$19 - $24/hr

If you enjoy problem-solving, conducting investigations, working with technology, and making a real impact every day, we want to hear from you! What You'll Do Investigate and resolve fraud claims ...

Chainalysis

$100 - $125/hr

As an Investigator at Chainalysis Government Solutions, you'll be a world-class problem solver adept at covert analysis and conducting complex investigations. You'll combine technical knowledge with ...

Chainalysis

Investigator

Morgantown, WV · On-site

$100 - $125/hr

As an Investigator at Chainalysis Government Solutions, you'll be a world-class problem solver adept at covert analysis and conducting complex investigations. You'll combine technical knowledge with ...

Johnson County Clintrials

Sub-Investigator

Kansas City, MO · On-site

$110K - $130K/yr

Sub-Investigator (CRC) Purpose: The purpose of the Sub-Investigator role is to ensure the safe ... Uses advanced communication skills to problem solve complex situations and improve processes and ...

Health Plan

Nurse Investigator

Charleston, WV · On-site

$80 - $100/hr

Critical problem-solving skills and attention to detail. * Healthcare investigations, program integrity, or similar experience; * 3 years Medical Claims or multi-discipline clinical experience;

Chainalysis Government Solutions

Investigator

Virginia, IL · On-site

$125 - $150/hr

As an Investigator at Chainalysis Government Solutions, you'll be a world-class problem solver adept at covert analysis and conducting complex investigations. You'll combine technical knowledge with ...

Xerox

Corporate Investigator

Webster, SD · On-site

Investigating sensitive and/or complex employee relations matters from start to finish, including ... Ability to take initiatives and be proactive Critical thinking, problem solving and decision making ...

TEN Credit Union

Fraud Investigator

Nashville, TN · On-site

$19 - $24/hr

If you enjoy problem-solving, conducting investigations, working with technology, and making a real impact every day, we want to hear from you!What You'll DoInvestigate and resolve fraud claims ...

Belcan

Senior Investigator

Atlanta, GA · On-site

$39.20 - $51.84/hr

... problem-solving and decision-making abilities in complex scenarios. • Highly ethical and able to handle sensitive and confidential information with the utmost discretion. • Experience conducting ...

previous pagenext page

Showing results 21-40

All JobsProblem Investigator Jobs

Problem Investigator information

See salary details

$32K

$75.3K

$131K

How much do problem investigator jobs pay per year?

As of Sep 9, 2026, the average yearly pay for problem 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 cities are hiring for Problem Investigator jobs?

Cities with the most Problem Investigator job openings:

What states have the most Problem Investigator jobs?

States with the most job openings for Problem Investigator jobs include:

What are popular job titles related to Problem Investigator jobs?

For Problem Investigator jobs, the most frequently searched job titles are:

Nurse Investigator

Charleston, WV • On-site

The Health Plan of West Virginia Inc
Insurance Services • 51 - 200 employees
Learn more about The Health Plan of West Virginia Incexternal

Full-time

Posted 19 days ago

Key responsibilities

  • Conduct investigations into suspected healthcare fraud, waste, and abuse, including data analysis, medical record reviews, interviews, and coordination with law enforcement or regulatory agencies.

  • Analyze and synthesize information from claims data, medical records, and regulatory materials to assess claims payments and determine medical necessity and billing appropriateness.

  • Review and analyze healthcare claims, medical records, and documentation to identify overpayments, inappropriate billing, and prepare case reports for regulatory or investigative agencies.

Job description

The Nurse Investigator works as part of the Special Investigations Unit (SIU) team, detecting and investigating suspected fraud, waste, and abuse (FWA). This position is responsible for conducting both pre-payment and post-payment reviews to ensure program integrity, and to support fraud, waste, and abuse detection and investigation efforts. This position serves as the SIU’s subject matter expert in terms of clinical reviews, coding and documentation, conducting medical chart reviews and billing audits. The successful candidate will utilize their unique blend of coding, claims payment, clinical, and payment integrity/investigations expertise to assist the SIU in achieving its mission to prevent, detect, investigate, and resolve healthcare fraud, waste, and abuse.

Required:

  1. Registered Nurse;
  2. Certified Coder (or eligible within 12 months)or similar certification;
  3. Basic knowledge of ICD-9/10, CPT, HCPCS, DRG and/or Rev codes;
  4. Proficiency with Office products, including Word and Excel;
  5. Critical problem-solving skills and attention to detail.

Desired:

  1. Healthcare investigations, program integrity, or similar experience;
  2. 3 years Medical Claims or multi-discipline clinical experience;
  3. Regulatory experience relevant to healthcare;
  4. Experience with WV Medicaid, Medicare Advantage, and/or Fully-Funded Commercial Health Insurance;
  5. Familiarity with CMS regulations.

Responsibilities:

  • Conducting full investigations which may include data analysis, research, contract review, medical records review, interviews of patients/witnesses/providers, site visits, consulting with other subject matter experts, coordination with law enforcement or regulatory agencies, and other necessary investigative activities;
  • Analyzing and synthesizing information from multiple sources including claims data, contracts, enrollment data, provider manuals, educational materials, bulletins, medical records, employee records, and state and federal regulations, to determine impact on claims payments as it relates to SIU cases or leads;
  • Creating plans of investigation, determining scope, timing, and direction of investigation;
  • Ensuring investigations are completed in a lawful, ethical, and appropriate manner;
  • Properly documenting all investigative actions and decisions in the case management/tracking system;
  • Ensuring all investigative actions and decisions are executed expeditiously, with integrity and discretion;
  • Serve as a subject matter expert for medical reviews, coding, and documentation;
  • Review and analyze healthcare claims, medical records, physician statements, care management reports, and other documentation which requires interpretation and understanding of state and federal regulations, standards of care, applicable benefit language, and reimbursement language to determine medical necessity, billing appropriateness, and sufficiency of documentation in the evaluation of cases for potential fraud, waste, or abuse;
  • Investigate, analyze, and render opinions on the delivery and billing of health care services
  • Conduct audits of medical charts and claims records;
  • Utilize knowledge of healthcare coding, medical policies, and other relevant guidelines to assess claims submissions and make appropriate recommendations to the SIU, claims examiners, and other relevant stakeholders;
  • Prepare findings identifying overpayments and/or inappropriate billing, documenting findings in a Word document, and overpayment calculations in a spreadsheet;
  • Prepare case reports for submission to regulatory and/or investigative agencies;
  • Speak and act confidently when conveying information, including explaining overpayment determinations which may include court testimony;
  • Coordinate with internal partners including Operations, Compliance, QI, Credentialing, and Provider Delivery Services to gather information relevant to the investigation;
  • Maintain licensure and certification, completing required continuing education.




8:00am to 5:00pm
40