Provides investigative support for special investigation unit (SIU) activities specific to medical provider coding fraud, waste and abuse (FWA). Investigates and resolves instances of health care ...
Provides investigative support for special investigation unit (SIU) activities specific to medical provider coding fraud, waste and abuse (FWA). Investigates and resolves instances of health care ...
Remote (Occasional Travel May Be Required) Clearance: Ability to obtain and maintain a Public Trust Position Overview Praescient Analytics is seeking an experienced Senior Investigative Analyst to ...
Remote (Occasional Travel May Be Required) Clearance: Ability to obtain and maintain a Public Trust Position Overview Praescient Analytics is seeking an experienced Senior Investigative Analyst to ...
Investigator, Special Investigative Unit Coding (Remote)
Long Beach, CA · On-site +1
$19.64 - $42.55/hr
Provides investigative support for special investigation unit (SIU) activities specific to medical provider coding fraud, waste and abuse (FWA). Investigates and resolves instances of health care ...
Investigator, Special Investigative Unit Coding (Remote)
Long Beach, CA · On-site +1
$19.64 - $42.55/hr
Provides investigative support for special investigation unit (SIU) activities specific to medical provider coding fraud, waste and abuse (FWA). Investigates and resolves instances of health care ...
Investigative Analyst
Helena, MT · On-site +1
$61K - $97K/yr
Analyzing evidence obtained from investigators, analysts, and law enforcement officers and collects information relating to this evidence. * Examining books, ledgers, payroll, cost reports, billing ...
Investigative Analyst
Helena, MT · On-site +1
$61K - $97K/yr
Analyzing evidence obtained from investigators, analysts, and law enforcement officers and collects information relating to this evidence. * Examining books, ledgers, payroll, cost reports, billing ...
Investigative Analyst
Anchorage, AK · On-site +1
$52K - $68K/yr
The selectee of this position serves as an Investigative Analyst. You will be responsible for collecting and analyzing a variety of intelligence data, and processing, tracking and inputting warrants ...
Investigative Analyst
Anchorage, AK · On-site +1
$52K - $68K/yr
The selectee of this position serves as an Investigative Analyst. You will be responsible for collecting and analyzing a variety of intelligence data, and processing, tracking and inputting warrants ...
Investigative Analyst (Criminal Analyst)
San Diego, CA · On-site +1
$101K - $156K/yr
Homeland Security Investigations (HSI) Investigative Analyst (Criminal Analyst) Series Requested ... Secret Virtual/Remote: No Only current, full-time federal employees are eligible. Resumes are ...
Investigative Analyst (Criminal Analyst)
San Diego, CA · On-site +1
$101K - $156K/yr
Homeland Security Investigations (HSI) Investigative Analyst (Criminal Analyst) Series Requested ... Secret Virtual/Remote: No Only current, full-time federal employees are eligible. Resumes are ...
Investigative Analyst
Helena, MT · On-site +1
$61K - $97K/yr
Analyzing evidence obtained from investigators, analysts, and law enforcement officers and collects information relating to this evidence. * Examining books, ledgers, payroll, cost reports, billing ...
Investigative Analyst
Helena, MT · On-site +1
$61K - $97K/yr
Analyzing evidence obtained from investigators, analysts, and law enforcement officers and collects information relating to this evidence. * Examining books, ledgers, payroll, cost reports, billing ...
Criminal Analyst (Investigative Analyst)
Charlotte, NC · On-site +1
$91K - $141K/yr
Top Secret Virtual/Remote: No Only current, full-time federal employees are eligible. Resumes ... investigations and have a comprehensive understanding of intelligence analysis and targeting.
Criminal Analyst (Investigative Analyst)
Charlotte, NC · On-site +1
$91K - $141K/yr
Top Secret Virtual/Remote: No Only current, full-time federal employees are eligible. Resumes ... investigations and have a comprehensive understanding of intelligence analysis and targeting.
POST CERTIFIED BACKGROUND INVESTIGATOR, REMOTE (1099)
Los Angeles, CA · Remote
$45 - $55/hr
... investigative case management system. MISSION We're on a mission to help the world make clear and ... This is a remote position.
Quick apply
POST CERTIFIED BACKGROUND INVESTIGATOR, REMOTE (1099)
Los Angeles, CA · Remote
$45 - $55/hr
... investigative case management system. MISSION We're on a mission to help the world make clear and ... This is a remote position.
Investigative Analyst - SME
Ontario, CA · On-site +1
$75K - $163K/yr
Summary This position serves as Investigative Analyst with the Pipeline and Hazardous Materials Safety Administration (PHMSA), Office of Hazardous Materials Safety, (OHMS), Operations System Division ...
Investigative Analyst - SME
Ontario, CA · On-site +1
$75K - $163K/yr
Summary This position serves as Investigative Analyst with the Pipeline and Hazardous Materials Safety Administration (PHMSA), Office of Hazardous Materials Safety, (OHMS), Operations System Division ...
Supervisory Investigative Analyst
Washington, DC · On-site +1
$143K - $187K/yr
Summary This position is in the Office of Investigations (INV). The mission is to conduct worldwide criminal, civil, and administrative investigations impacting Department programs, personnel and ...
Supervisory Investigative Analyst
Washington, DC · On-site +1
$143K - $187K/yr
Summary This position is in the Office of Investigations (INV). The mission is to conduct worldwide criminal, civil, and administrative investigations impacting Department programs, personnel and ...
POST CERTIFIED BACKGROUND INVESTIGATOR, REMOTE (1099)
Los Angeles, CA · On-site +1
$45 - $55/hr
... investigative case management system. MISSION We're on a mission to help the world make clear and ... Remote (California-based) Independent Contractor Relationship (1099) This is a 1099 independent ...
POST CERTIFIED BACKGROUND INVESTIGATOR, REMOTE (1099)
Los Angeles, CA · On-site +1
$45 - $55/hr
... investigative case management system. MISSION We're on a mission to help the world make clear and ... Remote (California-based) Independent Contractor Relationship (1099) This is a 1099 independent ...
Investigative Forensic Support Analyst
Clinton Township, MI · Remote
$90K - $105K/yr
Vision insurance Join Magnus Management Group LLC as an Investigative Forensic Support Analyst ... This is a remote position.
Quick apply
Investigative Forensic Support Analyst
Clinton Township, MI · Remote
$90K - $105K/yr
Vision insurance Join Magnus Management Group LLC as an Investigative Forensic Support Analyst ... This is a remote position.
Senior Clinical Coder (Inpatient Facility Coding) - Remote
Sarasota, FL · Remote
$80K - $90K/yr
This is a fully remote opportunity with long-term potential for permanent employment. Position ... Ability to successfully complete a background investigation Preferred Experience * Managed Care or ...
Quick apply
Senior Clinical Coder (Inpatient Facility Coding) - Remote
Sarasota, FL · Remote
$80K - $90K/yr
This is a fully remote opportunity with long-term potential for permanent employment. Position ... Ability to successfully complete a background investigation Preferred Experience * Managed Care or ...
INVESTIGATIVE ANALYST: SOCIAL MEDIA
Miami, FL · Remote
$15/hr
We are passionate investigators for discovery and truth. * Community and Employee Partnerships: We ... This is a remote position.
Quick apply
INVESTIGATIVE ANALYST: SOCIAL MEDIA
Miami, FL · Remote
$15/hr
We are passionate investigators for discovery and truth. * Community and Employee Partnerships: We ... This is a remote position.
Remote, Full-Time * PTO * Flex Time * STD/LTD * Life Insurance * Health, Vision, and Dental ... Our team of investigative experts blends cutting-edge technology with industry insight to deliver ...
Remote, Full-Time * PTO * Flex Time * STD/LTD * Life Insurance * Health, Vision, and Dental ... Our team of investigative experts blends cutting-edge technology with industry insight to deliver ...
SIU, Investigator
Buffalo, NY · Remote
$50K - $65K/yr
Review policy documents, databases, and other investigative sources. * Identify red flags, compensability issues, and misrepresentation. * Prepare clear, detailed, and accurate written investigative ...
Quick apply
SIU, Investigator
Buffalo, NY · Remote
$50K - $65K/yr
Review policy documents, databases, and other investigative sources. * Identify red flags, compensability issues, and misrepresentation. * Prepare clear, detailed, and accurate written investigative ...
SIU, Investigator
Zionsville, IN · Remote
$50K - $65K/yr
Review policy documents, databases, and other investigative sources. * Identify red flags, compensability issues, and misrepresentation. * Prepare clear, detailed, and accurate written investigative ...
Quick apply
SIU, Investigator
Zionsville, IN · Remote
$50K - $65K/yr
Review policy documents, databases, and other investigative sources. * Identify red flags, compensability issues, and misrepresentation. * Prepare clear, detailed, and accurate written investigative ...
SIU, Investigator
Houston, TX · Remote
$50K - $65K/yr
Review policy documents, databases, and other investigative sources. * Identify red flags, compensability issues, and misrepresentation. * Prepare clear, detailed, and accurate written investigative ...
Quick apply
Apply Early
SIU, Investigator
Houston, TX · Remote
$50K - $65K/yr
Review policy documents, databases, and other investigative sources. * Identify red flags, compensability issues, and misrepresentation. * Prepare clear, detailed, and accurate written investigative ...
Apply Early
Senior Advisor for Investigative Products
Washington, DC · On-site +1
$169K - $197K/yr
Attend investigative work planning meetings, report planning meetings, or other product-oriented ... THIS POSITION IS NOT ELIGIBILE FOR REMOTE TELEWORK. * Applicants must meet all qualifications and ...
Senior Advisor for Investigative Products
Washington, DC · On-site +1
$169K - $197K/yr
Attend investigative work planning meetings, report planning meetings, or other product-oriented ... THIS POSITION IS NOT ELIGIBILE FOR REMOTE TELEWORK. * Applicants must meet all qualifications and ...
Remote Investigative information
See salary details
$32K - $41K
7% of jobs
$41K - $50K
14% of jobs
$51.5K is the 25th percentile. Wages below this are outliers.
$50K - $59K
24% of jobs
The median wage is $63.5K / yr.
$59K - $68K
9% of jobs
$68K - $77K
5% of jobs
$77K - $86K
15% of jobs
$86.8K is the 75th percentile. Wages above this are outliers.
$86K - $95K
3% of jobs
$95K - $104K
6% of jobs
$104K - $113K
4% of jobs
$113K - $122K
12% of jobs
$122K - $131K
0% of jobs
$32K
$75.3K
$131K
How much do remote investigative jobs pay per year?
How does a remote investigative professional typically collaborate with team members and external sources while working off-site?
What are the key skills and qualifications needed to thrive as a Remote Investigator, and why are they important?
What is a Remote Investigative job?
What is the difference between Remote Investigative vs Remote Fraud Analyst?
| Aspect | Remote Investigative | Remote Fraud Analyst |
|---|---|---|
| Required Credentials | Investigative certifications, law enforcement background | Certifications in fraud detection, cybersecurity, or finance |
| Work Environment | Remote, often involves research, interviews, and case analysis | Remote, focuses on analyzing financial data and detecting fraud patterns |
| Employer & Industry Usage | Law enforcement agencies, private investigation firms | Banks, insurance companies, financial institutions |
| Common Search & Comparison | Yes | Yes |
Remote Investigative roles typically involve law enforcement or private investigation work, requiring investigative skills and certifications. Remote Fraud Analysts focus on detecting and preventing financial fraud, often requiring certifications in finance or cybersecurity. While both roles are remote and involve analysis, their industries and specific skill sets differ, making each suitable for different professional backgrounds.
- Remote Travelers Siu Investigator
- Special Investigative Unit Auditor
- Work From Home Barclays Fraud Investigation
- Flexible Digital Fraud Investigator
- Overnight Geico Special Investigations Unit
- Remote International Fraud Investigator
- Entry Level Disability Fraud Investigator
- Special Investigations Unit Insurance
- Disability Fraud Investigator
- No Experience International Private Investigator

Full-time
Posted 25 days ago
Molina Healthcare rating
8.0
Based on 192 frontline employees who took The Breakroom Quiz
143rd of 277 rated insurance
Job description
- Independently re-evaluates medical claims and associated records by applying knowledge of advanced coding, all relevant and 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.
- At least 2 years 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.
- 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).
- 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.
- 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/Access platforms working with large quantities of data.
- Ability to answer questions, identify trends and patterns, and present findings.
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