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Weekend Fraud Nurse Investigator Jobs (NOW HIRING)

Son

Provider Fraud Investigator

Lincoln, NE · On-site

$25.61/hr

JR2026-00028695 Provider Fraud Investigator (Evergreen) (Open) Applications No Longer Accepted On ... nursing, business or public administration, management, program analysis or evaluation of data ...

Highmark Health

Investigator

New York, NY

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 ...

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 ...

Highmark Health

Investigator

Pittsburgh, PA · On-site

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 ...

Highmark Health

Investigator

Pittsburgh, PA · On-site

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 ...

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Weekend Fraud Nurse Investigator information

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

As of Sep 2, 2026, the average hourly pay for weekend 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 does a Weekend Fraud Nurse Investigator do?

A Weekend Fraud Nurse Investigator is a registered nurse who works primarily on weekends to review medical claims and healthcare records for signs of fraud, waste, or abuse within healthcare systems. Their responsibilities include analyzing patient histories, verifying medical necessity, and collaborating with other investigators to ensure claims are valid. They may also conduct interviews, prepare detailed reports, and help implement fraud prevention strategies. This role is essential in helping healthcare organizations maintain compliance and protect resources.

What are some unique challenges faced by Weekend Fraud Nurse Investigators, and how can applicants prepare for them?

Weekend Fraud Nurse Investigators often handle urgent cases with limited weekday support, requiring them to make independent decisions and prioritize cases efficiently. They must be comfortable working autonomously, reviewing medical records for inconsistencies, and communicating findings to both medical and investigative teams. Familiarity with fraud detection protocols and strong critical thinking skills are essential, as weekend shifts may require quick responses to time-sensitive claims. Prospective applicants should be prepared to handle a varied caseload and collaborate remotely with other investigators or supervisors as needed.

What are the key skills and qualifications needed to thrive as a Weekend Fraud Nurse Investigator, and why are they important?

To thrive as a Weekend Fraud Nurse Investigator, you need a clinical nursing background, strong analytical abilities, and a solid understanding of healthcare fraud detection, typically supported by an RN license and experience in case review. Familiarity with claims management systems, medical billing software, and fraud investigation tools like data analytics platforms is essential. Attention to detail, critical thinking, and effective communication are key soft skills that set top performers apart in this role. These skills are crucial for accurately identifying fraudulent activities, ensuring compliance, and protecting healthcare resources.

What is the difference between Weekend Fraud Nurse Investigator vs Weekend Fraud Nurse Investigator?

AspectWeekend Fraud Nurse Investigator

Since the question compares the same job title, there is no difference between Weekend Fraud Nurse Investigator and itself. Both roles typically require nursing credentials, involve investigating healthcare fraud cases, and are used in healthcare insurance industries during weekend shifts. They focus on detecting and preventing fraudulent activities within healthcare organizations, often working in environments like insurance companies or healthcare providers. The roles are similar in responsibilities, work environment, and employer usage, making them essentially identical in scope and function.

What cities are hiring for Weekend Fraud Nurse Investigator jobs?

Cities with the most Weekend Fraud Nurse Investigator job openings:

What are the most commonly searched types of Fraud Nurse Investigator jobs?

The most popular types of Fraud Nurse Investigator jobs are:

What states have the most Weekend Fraud Nurse Investigator jobs?

States with the most job openings for Weekend Fraud Nurse Investigator jobs include:

Weekend Fraud Nurse Investigator jobs near you

Nurse Investigator

The Health Plan of West Virginia Inc

Charleston, WV • On-site

Full-time

Posted 12 days ago

Job description

The Nurse Investigator works as part of the Special Investigations Unit (SIU) team, detecting and investigating suspected fraud, waste, and abuse (FWA). This position is responsible for conducting both pre-payment and post-payment reviews to ensure program integrity, and to support fraud, waste, and abuse detection and investigation efforts. This position serves as the SIU’s subject matter expert in terms of clinical reviews, coding and documentation, conducting medical chart reviews and billing audits. The successful candidate will utilize their unique blend of coding, claims payment, clinical, and payment integrity/investigations expertise to assist the SIU in achieving its mission to prevent, detect, investigate, and resolve healthcare fraud, waste, and abuse.

Required:

  1. Registered Nurse;
  2. Certified Coder (or eligible within 12 months)or similar certification;
  3. Basic knowledge of ICD-9/10, CPT, HCPCS, DRG and/or Rev codes;
  4. Proficiency with Office products, including Word and Excel;
  5. Critical problem-solving skills and attention to detail.

Desired:

  1. Healthcare investigations, program integrity, or similar experience;
  2. 3 years Medical Claims or multi-discipline clinical experience;
  3. Regulatory experience relevant to healthcare;
  4. Experience with WV Medicaid, Medicare Advantage, and/or Fully-Funded Commercial Health Insurance;
  5. Familiarity with CMS regulations.

Responsibilities:

  • Conducting full investigations which may include data analysis, research, contract review, medical records review, interviews of patients/witnesses/providers, site visits, consulting with other subject matter experts, coordination with law enforcement or regulatory agencies, and other necessary investigative activities;
  • Analyzing and synthesizing information from multiple sources including claims data, contracts, enrollment data, provider manuals, educational materials, bulletins, medical records, employee records, and state and federal regulations, to determine impact on claims payments as it relates to SIU cases or leads;
  • Creating plans of investigation, determining scope, timing, and direction of investigation;
  • Ensuring investigations are completed in a lawful, ethical, and appropriate manner;
  • Properly documenting all investigative actions and decisions in the case management/tracking system;
  • Ensuring all investigative actions and decisions are executed expeditiously, with integrity and discretion;
  • Serve as a subject matter expert for medical reviews, coding, and documentation;
  • Review and analyze healthcare claims, medical records, physician statements, care management reports, and other documentation which requires interpretation and understanding of state and federal regulations, standards of care, applicable benefit language, and reimbursement language to determine medical necessity, billing appropriateness, and sufficiency of documentation in the evaluation of cases for potential fraud, waste, or abuse;
  • Investigate, analyze, and render opinions on the delivery and billing of health care services
  • Conduct audits of medical charts and claims records;
  • Utilize knowledge of healthcare coding, medical policies, and other relevant guidelines to assess claims submissions and make appropriate recommendations to the SIU, claims examiners, and other relevant stakeholders;
  • Prepare findings identifying overpayments and/or inappropriate billing, documenting findings in a Word document, and overpayment calculations in a spreadsheet;
  • Prepare case reports for submission to regulatory and/or investigative agencies;
  • Speak and act confidently when conveying information, including explaining overpayment determinations which may include court testimony;
  • Coordinate with internal partners including Operations, Compliance, QI, Credentialing, and Provider Delivery Services to gather information relevant to the investigation;
  • Maintain licensure and certification, completing required continuing education.




8:00am to 5:00pm
40