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Remote Insurance Investigator Jobs (NOW HIRING)

Digistream Investigations

Private Investigator

CA · Remote

$20/hr

Health, Dental, Vision, and Life insurance offered, and 401(k) retirement plan with 4% Company ... Willingness to travel and stay overnight on remote assignments (as needed) * Availability to work ...

Digistream Investigations

Surveillance Investigator

WA · Remote

$21/hr

Health, Dental, Vision, and Life insurance offered, and 401(k) retirement plan with 4% Company ... Willingness to travel and stay overnight on remote assignments (as needed) * Availability to work ...

Digistream Investigations

Private Investigator

HI · Remote

$24/hr

Health, dental, vision, life insurance, and 401(k) with up to 4% company match * Performance ... Paid travel to and from local and remote assignments * Cellphone reimbursement * Equipment provided ...

Kentech Consulting, Inc.

LEAD INVESTIGATOR: W2

$45K/yr

Vision insurance About KENTECH Consulting Inc KENTECH Consulting Inc. is an award-winning ... As a remote investigator, you will analyze applications, conduct interviews, research public ...

Acadia Healthcare

Compliance Investigator

Franklin, TN · On-site +1

Franklin, TN corporate office with remote work flexibility Travel: Up to 25% The Compliance ... Comprehensive Medical, Dental, and Vision Insurance * 401(k) Plan with Company Match * Paid Time ...

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How much do remote insurance investigator jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for remote insurance investigator in the United States is $25.77, according to ZipRecruiter salary data. Most workers in this role earn between $21.88 and $31.73 per hour, depending on experience, location, and employer.

What is a remote insurance investigator?

A Remote Insurance Investigator examines insurance claims to detect fraud, verify information, and ensure compliance with policy terms, all while working from a remote location. They conduct interviews, analyze documents, review surveillance footage, and collaborate with insurance companies or law enforcement. Strong analytical skills, attention to detail, and experience in insurance or investigations are often required.

What does a remote insurance investigator do?

A typical day for a Remote Insurance Investigator involves reviewing and analyzing insurance claims for potential fraud, conducting interviews with claimants and witnesses over the phone or video calls, and gathering and verifying documentation. Investigators often prepare detailed reports, collaborate virtually with claims adjusters and legal teams, and may conduct online research or surveillance as part of an investigation. The role is primarily independent, requiring excellent time management, but also involves regular communication with supervisors and team members to discuss cases and share findings. This structure allows for flexible work hours, but also demands a high level of organization and self-discipline.

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

To thrive as a Remote Insurance Investigator, you need a solid grasp of investigative techniques, analytical thinking, and a background in insurance claims, often supported by a degree in criminal justice or a related field. Familiarity with case management software, claims databases, and sometimes certifications such as CIFI (Certified Insurance Fraud Investigator) are commonly expected. Strong attention to detail, effective written and verbal communication skills, and self-motivation are crucial soft skills for this remote position. These skills enable investigators to efficiently detect fraud, manage complex caseloads, and communicate findings professionally from a remote work environment.

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Remote Insurance Investigator jobs near you
Infographic showing various Remote Insurance Investigator job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 72% Full Time, 22% Part Time, and 5% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $53,602 per year, or $25.8 per hour.

Investigator, Special Investigative Unit Coding (Remote)

Molina Healthcare

New York, NY • On-site, Remote

$21.82 - $51.06/hr

Full-time

Posted 10 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 199 frontline employees who took The Breakroom Quiz

171st 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

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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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