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How much do siu fraud investigator jobs pay per hour?

As of Aug 29, 2026, the average hourly pay for siu fraud 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 an SIU Fraud Investigator?

SIU Fraud Investigators are specialists who work in a Special Investigations Unit (SIU) within insurance companies or other organizations to detect, investigate, and prevent fraudulent activities. They examine suspicious insurance claims, gather and analyze evidence, conduct interviews, and collaborate with law enforcement when necessary. Their work helps reduce financial losses due to fraud and ensures claims are processed fairly and accurately.

How does an SIU Fraud Investigator typically collaborate with other departments during an investigation?

SIU Fraud Investigators frequently work alongside claims adjusters, legal teams, and law enforcement to thoroughly assess potentially fraudulent claims. This collaboration involves sharing evidence, coordinating interviews, and sometimes participating in joint investigations to ensure all aspects of a case are covered. Effective communication and teamwork are essential, as investigators may need to present findings in meetings or legal proceedings. Building strong relationships across departments helps streamline processes and contributes to successful case resolutions.

What are the key skills and qualifications needed to thrive as an SIU Fraud Investigator, and why are they important?

To thrive as an SIU Fraud Investigator, you need a solid background in investigative techniques, analytical thinking, and knowledge of insurance regulations, typically supported by a bachelor's degree in criminal justice or a related field. Familiarity with case management systems, fraud detection software, and certifications like CIFI (Certified Insurance Fraud Investigator) are commonly required. Strong interpersonal skills, attention to detail, and effective communication are essential for interviewing witnesses and preparing thorough reports. These skills ensure accurate identification and prevention of fraudulent activities, safeguarding organizational assets and maintaining regulatory compliance.

What is the difference between Siu Fraud Investigator vs Insurance Fraud Investigator?

AspectSiu Fraud InvestigatorInsurance Fraud Investigator
CredentialsTypically requires certifications like CFE or CPIAOften requires similar certifications such as CFE or CPCU
Work EnvironmentGovernment agencies, public sectorInsurance companies, private sector
Industry UsageUsed mainly in government and public fraud casesCommon in insurance industry for claims fraud

The Siu Fraud Investigator and Insurance Fraud Investigator roles share similar credentials and investigative skills. However, Siu Fraud Investigators primarily work within government agencies handling public sector fraud, while Insurance Fraud Investigators focus on detecting fraud within insurance companies. Both roles require similar certifications and investigative techniques, but their work environments and employer types differ.

Are Siu Fraud Investigators in demand?

Siu Fraud Investigators are in increasing demand as organizations seek to prevent and detect insurance fraud and financial crimes. The role often requires strong analytical skills, knowledge of fraud schemes, and familiarity with investigative tools, making it a valuable position in the compliance and risk management sectors.

How to become a SIU fraud investigator?

To become a SIU fraud investigator, candidates typically need a bachelor's degree in criminal justice, law enforcement, or a related field, along with experience in fraud detection or investigations. Strong analytical skills, knowledge of insurance policies, and familiarity with investigative tools are essential. Certifications such as Certified Fraud Examiner (CFE) can enhance prospects in this role.
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Siu Fraud Investigator jobs near you
Infographic showing various Siu Fraud Investigator job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 17% Part Time, and 1% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $64,132 per year, or $30.8 per hour.

Fraud Investigator

Blue Cross and Blue Shield of Kansas City

Kansas City, MO • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 4 days ago

Job description

Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include:
  • Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
  • Annual incentive bonus plan based on company achievement of goals
  • Time away from work including paid holidays, paid time off and volunteer time off
  • Professional development courses, mentorship opportunities, and tuition reimbursement program
  • Paid parental leave and adoption leave with adoption financial assistance
  • Employee discount program

Job Description Summary:
As part of Blue KC's Special Investigations Unit (SIU), the Fraud Investigator conducts reviews to identify potential fraud, waste, and abuse (FWA) and claim overpayments. Assigned cases and projects are generally of moderate complexity and performed with limited oversight.
Job Description
  • Assist in performing ongoing FWA risk assessments, leveraging data analytics to identify trends, patterns, outliers relative to peers and clinical standards, etc. In conjunction with the Manager and/or Senior Investigator, evaluate FWA risks and prioritize for further review, based upon member health/safety and protection of plan assets.
  • Monitor hotlines, internal referrals, external fraud alerts (e.g., CMS, BCBSA), external healthcare anti-fraud workgroups, and other resources for potential FWA schemes.
  • Conduct investigations of fraud, waste and abuse in accordance with SIU policies and procedures. May work with Manager and/or Senior Investigator on larger, more complex, investigations.
  • Create and maintain detailed case files in accordance with SIU policies and procedures, where key investigative activities and outcomes are timely and accurately documented
  • Prepare detailed case reports summarizing investigative findings and recommendations. Present reports to key stakeholders (e.g., Provider Relations, Medical Management, Pharmacy, Claims, Legal)
  • Assist in coordinating responses to subpoenas and preparation of cases for referral to law enforcement and/or regulators.
  • Perform day-to-day activities for vendor-based claim overpayment recovery program (e.g., data file exchanges, proposing / reviewing new audit concepts, coordinating claim adjustments, invoices).
  • Assist in preparing reports for executive updates, Blue KC Audit Committee, BCBSA/FEP surveys, and other reports as needed.
  • Support the FWA training program for Blue KC employees and First Tier, Downstream and Related entities.

Minimum Qualifications
  • Bachelor's degree in criminal justice, finance, accounting, medical or other relevant academic discipline. 1 years investigative experience in the following areas (e.g., medical review, financial, medical analytics, research & adjustment, appeals) that provided the types and levels of knowledge, skills, and abilities required.
  • Strong communication skills with a broad range of individuals and groups (e.g., members, providers, operational areas, medical directors, provider relations, legal counsel, senior management)

Preferred Qualifications
  • Master's degree in criminal justice, finance, accounting, medical or other relevant academic discipline
  • 3 years' experience conducting healthcare FWA investigations at a health insurer; experience analyzing claims data to identify FWA trends and patterns using tools such as Excel and business intelligence platforms (e.g., Power BI, Business Objects).
  • Knowledge of major BCBSKC business systems (e.g., Facets, ITS Host and Home) and operational processes (e.g., Claims Processing, Pharmacy, Provider Contracting/Relations, Member Services, Customer Service)
  • Knowledge of BCBSKC provider contracts, medical policies and member benefits
  • Knowledge of medical terminology and ICD/CPT coding
  • Experience working with the regulators (e.g., CMS, State Department of Insurance) and law enforcement (e.g., FBI, DEA, HHS-OIG, OPM-OIG and/or Department of Justice)
  • Juris Doctorate
  • Coding Certification: AAPC, AHIMA
  • FWA Certification: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI)
  • Medical License: Registered Nurse (RN), Licensed Practical Nurse (LPN), pharmacist, physician

Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.

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