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Remote Fraud Nurse Investigator information
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$22.02 is the 25th percentile. Wages below this are outliers.
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What are the key skills and qualifications needed to thrive as a remote fraud nurse investigator?
What is the difference between Remote Fraud Nurse Investigator vs Remote Insurance Claims Nurse?
| Aspect | Remote Fraud Nurse Investigator | Remote Insurance Claims Nurse |
|---|---|---|
| Certifications | RN license, fraud investigation training | RN license, claims processing certification |
| Work Environment | Investigating fraud cases, analyzing claims | Reviewing insurance claims, assessing validity |
| Employer & Industry | Insurance companies, healthcare fraud units | Insurance providers, healthcare organizations |
| Search & Comparison Intent | Fraud detection, investigation roles | Claims review, insurance nurse roles |
Remote Fraud Nurse Investigators focus on detecting and investigating insurance fraud, requiring specialized training in fraud detection. Remote Insurance Claims Nurses primarily review and process insurance claims, ensuring accuracy and compliance. While both roles require nursing credentials and work within the insurance industry, their core responsibilities differ—investigation versus claims processing.
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Part-time
Posted 28 days ago
Job description
Senior Healthcare Fraud Investigator / OSINT Analyst
Company: Navanti Group, LLC
Location: Remote
Employment Type: Part-Time / Consultant
Security Clearance: Active Top Secret clearance required at time of application
Estimated Level of Effort: Approximately 1015 hours per week on average, with workload varying based on investigative tasking. The position is anticipated to support approximately 550650 hours annually; no minimum number of hours is guaranteed.
Position Overview
Navanti Group is seeking a senior healthcare fraud investigator and Open-Source Intelligence analyst to support a sensitive federal law-enforcement customer. This individual will serve as the primary technical lead for healthcare fraud-related OSINT research, analysis, and reporting.
The selected candidate will support federal criminal, civil, administrative, and parallel healthcare fraud investigations by identifying publicly available information, relationships, assets, digital activity, business affiliations, and potential indicators of fraudulent conduct. The position requires an uncommon combination of direct healthcare fraud investigative experience, advanced OSINT expertise, federal investigative experience, and an active Top Secret clearance.
Primary Responsibilities
- Conduct complex OSINT research concerning individuals, healthcare providers, businesses, affiliated entities, assets, ownership structures, and associated networks.
- Identify and analyze online presence, business relationships, professional affiliations, financial indicators, and other publicly available information relevant to investigative objectives.
- Conduct link, relationship, and network analysis to identify connections among subjects, providers, businesses, beneficiaries, and associated entities.
- Apply healthcare fraud expertise to develop investigative leads involving:
- Medicare and Medicaid fraud
- Home health agency fraud
- Durable medical equipment fraud
- Hospice fraud
- Provider enrollment and ownership-concealment schemes
- Kickbacks and patient brokering
- Billing irregularities and related fraud typologies
- Translate OSINT findings into actionable healthcare fraud investigative value.
- Monitor publicly available sources relevant to active and proactive investigations.
- Prepare clearly sourced investigative summaries, intelligence products, link analyses, and rapid-turn responses.
- Document research sources, methodologies, limitations, and analytical confidence.
- Ensure findings are suitable for investigative, operational, administrative, and potential legal review.
- Support authorized sensitive operational activities, including limited OSINT assistance related to undercover or covert investigative efforts.
- Coordinate with Navantis Program Manager and Quality Manager to ensure deliverables meet customer requirements.
Mandatory Qualifications
- Minimum of five years of specialized experience supporting civil or criminal healthcare fraud investigations.
- Minimum of ten years of experience providing OSINT or investigative support to federal government agencies, the Intelligence Community, or law-enforcement organizations.
- Demonstrated experience conducting advanced OSINT investigations and intelligence analysis.
- Experience supporting sensitive or complex federal investigations.
- Working knowledge of Medicare and Medicaid programs.
- Familiarity with common and emerging healthcare fraud schemes across multiple provider types.
- Experience supporting civil, criminal, administrative, or parallel investigative proceedings.
- Familiarity with federal investigative standards, evidentiary considerations, documentation practices, and reporting requirements.
- Ability to produce defensible, clearly sourced, and analytically sound investigative products.
- Demonstrated discretion, sound professional judgment, and a security-conscious operational posture.
Preferred Qualifications
- Prior experience supporting an Office of Inspector General, Department of Justice, federal healthcare law-enforcement organization, or federal investigative agency.
- Experience with provider ownership research, corporate records, asset identification, public-record databases, social-media analysis, and digital-presence assessment.
- Experience using network-analysis and social-media intelligence platforms.
- Experience with link-analysis tools and preparation of visual network products.
- Experience supporting protective intelligence, undercover operations, or sensitive online investigative activities.
- Formal training in OSINT tradecraft, fraud investigations, financial investigations, intelligence analysis, criminal justice, or a related discipline.
Availability and Performance Requirements
The selected candidate must generally be available during federal business hours, Monday through Friday, between 8:00 a.m. and 6:00 p.m. Eastern Time. The individual must be able to acknowledge and begin assigned tasking within eight business hours and provide limited after-hours support for priority investigative requirements when necessary. The position is fully remote, and no routine travel is anticipated. Planned periods of unavailability must be communicated in advance to support continuity of operations.
Reporting Structure
The Senior Healthcare Fraud Investigator / OSINT Analyst will report administratively to Navantis Program Manager. Investigative priorities, technical direction, reporting standards, and task deadlines will be established by the authorized federal customer representative.
About Navanti Group
Sourced by ZipRecruiter
Industry
International affairs
Company size
11 - 50 Employees
Headquarters location
Arlington, VA, US
Year founded
2009