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Remote Insurance Fraud Investigator Jobs in California

Wealthfront

Fraud Operations Specialist

San Francisco, CA · Remote

$81K - $90K/yr

... remote Fraud Operations Specialist to be responsible for daily fraud monitoring and investigation ... Investment management and advisory services-which are not FDIC insured-are provided by Wealthfront ...

Wealthfront

Fraud Operations Specialist

Palo Alto, CA · Remote

$81K - $90K/yr

... remote Fraud Operations Specialist to be responsible for daily fraud monitoring and investigation ... Investment management and advisory services-which are not FDIC insured-are provided by Wealthfront ...

Wealthfront

Fraud Operations Specialist

San Francisco, CA · Remote

$81K - $90K/yr

... remote Fraud Operations Specialist to be responsible for daily fraud monitoring and investigation ... Investment management and advisory services-which are not FDIC insured-are provided by Wealthfront ...

Wealthfront

Fraud Operations Specialist

Palo Alto, CA · Remote

$81K - $90K/yr

... remote Fraud Operations Specialist to be responsible for daily fraud monitoring and investigation ... Investment management and advisory services-which are not FDIC insured-are provided by Wealthfront ...

SpaceXAI

Fraud Analyst (Sat-Weds)

Palo Alto, CA · On-site +1

$100K - $135K/yr

In this role, you will support the detection, investigation, and mitigation of financial crime ... Remote work is permitted on Saturdays and Sundays; in-office attendance is required Monday through ...

New

SpaceXAI

Fraud Analyst (Sat-Weds)

Palo Alto, CA · On-site +1

$100K - $135K/yr

Monitor, investigate, and escalate potential fraud, money laundering, and suspicious activity ... insurance, and various other discounts and perks. ITAR REQUIREMENTS: * To conform to U.S.

New

Collectorsuniverse

Head of Fraud Operations

Santa Ana, CA · On-site +1

$139K - $200K/yr

For remote roles, and at our discretion, candidates may be asked to participate in an on-site ... Investigations & Response * Multi-typology investigations. Lead investigations into payment fraud ...

Efi global

Certified Industrial Hygienist

Rocklin, CA · On-site +1

$39.50 - $52/hr

... fire investigation, environmental, health and safety, and specialty consulting services firm ... in handling insurance fraud and arson cases and providing expert witness testimony, into a ...

Efi global

Certified Industrial Hygienist

San Diego, CA · On-site +1

$40.25 - $53/hr

... fire investigation, environmental, health and safety, and specialty consulting services firm ... in handling insurance fraud and arson cases and providing expert witness testimony, into a ...

Efi global

Certified Industrial Hygienist

Sacramento, CA · On-site +1

$40.50 - $53.25/hr

... fire investigation, environmental, health and safety, and specialty consulting services firm ... in handling insurance fraud and arson cases and providing expert witness testimony, into a ...

Efi global

Certified Industrial Hygienist

Pasadena, CA · On-site +1

$41.50 - $54.50/hr

... fire investigation, environmental, health and safety, and specialty consulting services firm ... in handling insurance fraud and arson cases and providing expert witness testimony, into a ...

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Remote Insurance Fraud Investigator information

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

AspectRemote Insurance Fraud InvestigatorRemote Insurance Claims Adjuster
Required CredentialsCertifications in fraud detection, insurance investigationsAdjuster licenses, insurance claims certifications
Work EnvironmentInvestigations, data analysis, interviewsClaims assessment, policy review, settlement processing
Employer & Industry UsageInsurance companies, fraud prevention firmsInsurance carriers, third-party claims services
Common Search & ComparisonYesYes

While both roles work within the insurance industry, Remote Insurance Fraud Investigators focus on detecting and preventing fraudulent claims through investigations and data analysis. In contrast, Remote Insurance Claims Adjusters handle the assessment and settlement of legitimate claims. Both positions require relevant certifications and are often employed remotely by insurance companies or third-party firms.

Are remote insurance fraud investigators in demand?

Remote insurance fraud investigators are in growing demand due to increased efforts to detect and prevent insurance fraud, which costs the industry billions annually. Employers seek professionals with skills in data analysis, investigation techniques, and familiarity with fraud detection tools, making this a promising field for job seekers with relevant experience and certifications. The role often offers flexible schedules and the ability to work from home, aligning with current remote work trends.

How much do remote insurance fraud investigators earn?

Remote insurance fraud investigators typically earn between $45,000 and $75,000 annually, depending on experience, location, and employer. Some roles may offer additional compensation such as bonuses or benefits, and proficiency with investigative tools and certifications can influence salary levels.

How to become a remote insurance fraud investigator?

To become a remote insurance fraud investigator, candidates typically need a background in insurance, law enforcement, or criminal justice, along with strong analytical and investigative skills. Relevant certifications such as the Certified Fraud Examiner (CFE) can enhance prospects, and proficiency with data analysis tools and remote communication platforms is often required. A bachelor's degree is commonly preferred, and experience in claims investigation or fraud detection is beneficial.

What are the most commonly searched types of Insurance Fraud Investigator jobs in California?

The most popular types of Insurance Fraud Investigator jobs in California are:

What are popular job titles related to Remote Insurance Fraud Investigator jobs in California?

For Remote Insurance Fraud Investigator jobs in California, the most frequently searched job titles are:

What job categories do people searching Remote Insurance Fraud Investigator jobs in California look for?

The top searched job categories for Remote Insurance Fraud Investigator jobs in California are:

What cities in California are hiring for Remote Insurance Fraud Investigator jobs?

Cities in California with the most Remote Insurance Fraud Investigator job openings:

Remote Insurance Fraud Investigator jobs near you

Investigator, Special Investigative Unit Coding (Remote)

Molina Healthcare

Long Beach, CA • Remote

$21.82 - $51.06/hr

Full-time

Posted 14 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 199 frontline employees who took The Breakroom Quiz

173rd of 315 rated insurance

Job description

JOB DESCRIPTION
Provides support for special investigation unit (SIU) activities specific to medical provider coding fraud, waste and abuse (FWA). Investigates and resolves instances of health care fraud and abuse investigations of medical providers using informational tips from member benefits and medical records following review of post-payment claims.
Essential Job Duties

Independently re-evaluates medical claims and associated records by applying knowledge of advanced coding, applicable federal and state regulatory requirements, and Molina policies.
Reviews post-pay claims against corresponding medical records to determine accuracy of claims payments.
Manages documents and prioritizes caseloads to ensure timely turnaround.
Ensures adherence to applicable state/federal/internal policies, Current Procedural Terminology (CPT) guidelines and provider contract requirements.
Devises clinical summary post-review.
Communicates and participates in meetings related to cases.
Completes medical review to facilitate referral to law enforcement or payment recovery.
Supports investigation work as necessary and required by the regulatory agency.
 

Job Requirements

At least 2 years of CPT coding experience in a surgical, hospital and/or clinic setting, or equivalent combination of relevant education and experience.
Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Professional Medical Auditor (CPMA), or American Academy of Professional Coders (AAPC) certified.
 Critical-thinking, problem-solving and analytical skills.
Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations.
Knowledge of managed care and the Medicaid, Medicare, and Marketplace programs.
Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems.
Ability to research and interpret regulatory requirements.
Ability to prioritize and manage multiple tasks.
Ability to work in a team setting.
Strong verbal/written communication skills, and presentation skills.
Microsoft Office suite (including Excel), and applicable software program(s) proficiency.
In some states, 5 years of experience working in a fraud, waste and abuse (FWA)/special investigations unit (SIU)/fraud investigations role may be required (dependent on state/contractual requirements).
 

Preferred Qualifications

Certified Professional Compliance Officer (CPCO).Certified Fraud Examiner (CFE) and/or Accredited Health Care Fraud Investigator (AHFI).
Experience working in group health insurance, particularly within claims processing or operations.
Working knowledge of local, state and federal laws and regulations pertaining to health insurance, investigations and legal processes (commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, etc.).
Experience with claims processing systems.
Ability to use Microsoft Excel platform and work with large quantities of data.
Ability to answer questions, identify trends and patterns, and present findings.'
 

 
To all current Molina employees. If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $21.82 - $51.06 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

What Molina Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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