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Remote Fraud Nurse Investigator Jobs (NOW HIRING)

Humana, Inc.

Fraud and Waste Investigator

Remote anywhere in US, work at home. While this is a remote position, occasional travel to Humana ... Experience in Medicare fraud investigations * Bilingual in Spanish * Additional degrees and/or ...

Humana, Inc.

Fraud and Waste Investigator

The Fraud and Waste Investigator collaborates in investigations with law enforcement authorities ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...

Humana

Fraud and Waste Investigator

The Fraud and Waste Investigator collaborates in investigations with law enforcement authorities ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...

Humana

Fraud and Waste Investigator

Use your skills to make an impact WORK STYLE: Work at Home. While this is a remote position ... healthcare fraud investigations and auditing experience Knowledge of healthcare payment ...

Humana

Fraud and Waste Investigator

Use your skills to make an impact WORK STYLE: Work at Home. While this is a remote position ... healthcare fraud investigations and auditing experience Knowledge of healthcare payment ...

Humana

Fraud and Waste Investigator

The Fraud and Waste Investigator collaborates in investigations with law enforcement authorities ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...

Humana

Fraud and Waste Investigator

Use your skills to make an impact WORK STYLE: Work at Home. While this is a remote position ... healthcare fraud investigations and auditing experience Knowledge of healthcare payment ...

Humana, Inc.

Fraud and Waste Investigator

Use your skills to make an impact WORK STYLE: Work at Home. While this is a remote position ... fraud investigations and auditing experience • Knowledge of healthcare payment methodologies ...

Humana

Fraud and Waste Investigator

The Fraud and Waste Investigator collaborates in investigations with law enforcement authorities ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...

Highmark Health

Investigator

JOB SUMMARY This job is responsible for developing and maintaining an anti-fraud program which ... Bachelor's Degree in Accounting, Finance, Business Administration, Nursing, IT or Related Field ...

S3 Shared Services

Fraud Analyst

Englewood, CO · Remote

$52K - $60K/yr

Fraud Analyst - Remote / Colorado Applicants only Salary range: $52,000 to $60,000 annually The ... Monitor alerts and communications from various sources to identify and investigate suspicious ...

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How much do remote fraud nurse investigator jobs pay per hour?

As of Aug 22, 2026, the average hourly pay for remote fraud nurse investigator in the United States is $30.83, according to ZipRecruiter salary data. Most workers in this role earn between $22.12 and $35.34 per hour, depending on experience, location, and employer.

What is a remote fraud nurse investigator?

A Remote Fraud Nurse Investigator is a registered nurse who works remotely to identify, investigate, and help prevent healthcare fraud, waste, and abuse. They review medical claims, patient records, and provider billing practices to detect discrepancies or suspicious activities that may indicate fraudulent behavior. Their work often involves collaborating with insurance companies, law enforcement, and healthcare providers to ensure compliance with regulations and protect patients and payers from fraud. Remote roles allow these professionals to conduct investigations, interviews, and audits using secure digital platforms. This position requires strong analytical, clinical, and investigative skills.

What are the key skills and qualifications needed to thrive as a remote fraud nurse investigator?

To thrive as a Remote Fraud Nurse Investigator, you need a strong clinical background, experience in medical claims review, and an active RN license. Familiarity with medical coding systems, healthcare claims software, and investigative tools such as SIU platforms is typically required. Critical thinking, attention to detail, and strong written communication skills are essential soft skills in this role. These competencies enable accurate detection and reporting of fraudulent activity, ensuring compliance and protecting healthcare resources.

What are some common challenges faced by remote fraud nurse investigators, and how can they be addressed?

Remote Fraud Nurse Investigators often encounter challenges such as limited access to in-person medical records, difficulty verifying the authenticity of claims, and navigating complex healthcare regulations across different states. To overcome these obstacles, strong analytical skills, attention to detail, and proficiency with digital investigation tools are essential. Regular communication with colleagues and claims professionals, as well as ongoing training in emerging fraud schemes, can help ensure accurate assessments and effective teamwork even in a remote setting.

What is the difference between Remote Fraud Nurse Investigator vs Remote Insurance Claims Nurse?

AspectRemote Fraud Nurse InvestigatorRemote Insurance Claims Nurse
CertificationsRN license, fraud investigation trainingRN license, claims processing certification
Work EnvironmentInvestigating fraud cases, analyzing claimsReviewing insurance claims, assessing validity
Employer & IndustryInsurance companies, healthcare fraud unitsInsurance providers, healthcare organizations
Search & Comparison IntentFraud detection, investigation rolesClaims 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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Remote Fraud Nurse Investigator jobs near you
Infographic showing various Remote Fraud Nurse Investigator job openings in the United States as of August 2026, with employment types broken down into 82% Full Time, 6% Part Time, and 12% Contract. Highlights an 100% Remote job distribution, with an average salary of $64,132 per year, or $30.8 per hour.

Specialist Fraud Investigator

24 Seven Talent

Manhattan, NY • Remote

Full-time

Posted 16 days ago

Job description

Location: REMOTE – MUST be based in the United States Type: Contract/Freelance based opportunity We are actively seeking bilingual and multilingual professionals fluent in one or more of the following languages: Thai, Japanese, Korean, Mandarin, German, French, Vietnamese, or Hindi If you are fluent in any of these languages and have strong analytical and problem-solving skills, this is a high-impact opportunity to join a fast-paced eCommerce risk and fraud operations team. This position supports eCommerce operations by resolving seller-related issues and identifying potential fraud through Risk Operations workstreams and fraud detection activities. You will play a critical role in protecting marketplace, supporting global sellers, and improving operational processes. Your language skills will be heavily utilized to investigate cases, communicate with international sellers, and identify region-specific risk trends. Key Responsibilities Resolve seller issues across multiple systems and communication channels, ensuring timely and accurate support for global marketplace sellers. Manage escalated cases by acting as a subject matter expert, advising sellers on required actions, researching seller history, and determining appropriate resolution paths. Monitor and manage case volume to ensure investigations are completed efficiently and resolutions are clearly communicated. Identify fraud trends, risk indicators, and recurring issue types, escalating concerns to leadership, training, or quality teams as needed. Collect, validate, and analyze screening data to identify trends and insights; compare findings against current processes and industry best practices. Develop, document, and implement process improvements in collaboration with cross-functional partners. Track progress and outcomes while proactively identifying opportunities for operational and personal performance improvement. Remain open to coaching and feedback to continuously improve performance and business practices. Demonstrate and promote compliance with company policies, procedures, and ethical standards. Support team initiatives by sharing knowledge, coordinating work assignments, and helping ensure quality standards and timelines are met. Required Skills & Qualifications Fluency (written and verbal) in English AND at least one of the following languages is required: Thai, Japanese, Korean, Mandarin, German, French, Vietnamese, or Hindi Strong computer proficiency with the ability to quickly learn and navigate multiple systems. Excellent analytical and problem-solving skills with strong attention to detail. Ability to recognize patterns, trends, and risk signals related to fraud or seller behavior. Strong written and verbal communication skills, especially when explaining complex issues. Ability to manage multiple priorities in a fast-paced, high-volume environment. Collaborative mindset with a commitment to continuous improvement and ethical business practices. #J-18808-Ljbffr

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