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Workers Comp Fraud Investigator Jobs (NOW HIRING)

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Provider Fraud Investigator

Lincoln, NE

$25.61/hr

JR2026-00028695 Provider Fraud Investigator (Evergreen) (Open) Applications No Longer Accepted On ... Previous experience working with medical claims payment and adjudication, performing financial ...

NBT Bank

BSA Fraud Investigator

Lakeville, CT · On-site

$21.29 - $28.39/hr

Ability to multi-task, working multiple inquiries/investigations simultaneously. Tasks Performed: * 60% Complete case investigations related to external fraud such as ach, wire, counterfeit checks ...

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How much do workers comp fraud investigator jobs pay per hour?

As of Aug 23, 2026, the average hourly pay for workers comp 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 does a workers comp fraud investigator do?

A Workers Comp Fraud Investigator is responsible for investigating suspicious workers' compensation claims to determine if fraud has occurred. They gather evidence, conduct interviews, perform surveillance, and analyze records to verify the legitimacy of claims. Their work helps insurance companies, employers, and law enforcement agencies identify and prevent fraudulent activities, ultimately reducing unnecessary costs and maintaining the integrity of the workers' compensation system. Investigators often prepare detailed reports and may testify in court or administrative hearings regarding their findings.

What are the key skills and qualifications needed to thrive as a workers comp fraud investigator, and why are they important?

To thrive as a Workers Comp Fraud Investigator, you need strong analytical abilities, attention to detail, and a background in criminal justice or insurance investigations, often supported by relevant certifications like Certified Fraud Examiner (CFE). Familiarity with investigative tools, surveillance equipment, claims management software, and legal research databases is typically required. Excellent communication, critical thinking, and interpersonal skills help in interviewing witnesses and compiling clear, concise reports. These skills enable investigators to effectively detect and prevent fraudulent claims, protecting organizations from financial losses and ensuring compliance with legal standards.

What are some typical challenges workers comp fraud investigators face when gathering evidence?

Workers Comp Fraud Investigators often encounter challenges such as uncooperative claimants, limited access to private property, and maintaining strict adherence to legal guidelines during surveillance. They must ensure evidence is collected ethically and will hold up in court, which requires careful documentation and discretion. Additionally, investigators may need to work irregular hours to observe claimants and coordinate closely with insurance adjusters, law enforcement, and sometimes attorneys to build a thorough case.
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What states have the most Workers Comp Fraud Investigator jobs?

States with the most job openings for Workers Comp Fraud Investigator jobs include:

What job categories do people searching Workers Comp Fraud Investigator jobs look for?

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Workers Comp Fraud Investigator jobs near you
Infographic showing various Workers Comp Fraud Investigator job openings in the United States as of August 2026, with employment types broken down into 2% As Needed, 71% Full Time, 19% Part Time, 1% Temporary, 6% Contract, and 1% Nights. Highlights an 97% Physical, 1% Hybrid, and 2% Remote job distribution, with an average salary of $64,132 per year, or $30.8 per hour.

Provider Fraud Investigator

Nebraska State Jobs

Lincoln, NE • On-site

$25.61/hr

Full-time

Life, Retirement, PTO

Posted 9 days ago

Nebraska Department Of Transportation rating

7.5

Company rating: 7.5 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

516th of 849 rated public administrative organizations

Job description

The work we do matters!
Hiring Agency:
Health & Human Services - Agency 25
Location:
Lincoln, NE
Hiring Rate:
$25.606
Job Posting:
JR2026-00028695 Provider Fraud Investigator (Evergreen) (Open)
Applications No Longer Accepted On (If no date is displayed, job is posted as open until closed):
09-08-2026
Job Description:
The Department of Health and Human Services (DHHS), Medicaid and Long-Term Care Division, is looking for a strategic partner with a high personal standard of integrity and a keen eye for detail to join their team as the Provider Fraud Investigator. The successful candidate will participate in and support a culture where employees are highly motivated, energetic, excited, and enthusiastic working for DHHS.
Under limited supervision, investigates suspected Medicaid provider fraud and program abuse by conducting investigations and audits; prepares and writes investigational reports; compiles prosecution materials and reports; coordinates investigations with Office of Inspector General, FBI and other appropriate law enforcement agencies; presents cases to prosecutors and provides expert testimony in all phases of criminal and civil prosecution and administrative actions; monitors, evaluates and enforces Medicaid providers compliance with conditions of participation and relevant rules, regulations and laws; performs related work as required.
"You have the passion; we have the opportunities - let's make a difference for Nebraskans"
As the Provider Fraud Investigator, you will:
  • Protect the Medicaid Program and its clients: this is done by verifying that services are appropriately delivered and reimbursed by qualified professionals.

Hire Rate: $25.606 per hour - non-exempt
Work Schedule: Monday - Friday; 8:00 AM - 5:00 PM
Dress Attire: Business Casual
Driving required
Location: Nebraska State Office Building in Lincoln
Requirements / Qualifications:
Minimum Qualifications: Post high school coursework/training in law enforcement, criminal justice, social/behavioral sciences or health related field, nursing, business or public administration, management, program analysis or evaluation of data systems. OR Experience in conducting fraud investigations, administrative investigations, utilization review, data systems, review of records and reports and evaluating their use and effectiveness, policy planning/analysis, casework, nursing, accounting or billing systems.
Preferred Qualifications:
  • Bachelor's degree in similar fields (Criminal justice, Law, Social Work, or Investigative Methods) or commiserate experience.
  • Previous experience working with medical claims payment and adjudication, performing financial auditing of public accounts or medical facilities

Other: Valid driver's license or the ability to provide independent authorized transportation.
Knowledge, Skills, and Abilities:
Knowledge of: Interview and interrogation techniques; fraud investigation and detection techniques and principles; methods and techniques of program planning.
Ability to: Communicate effectively, prepare objective, factual reports; maintain confidentiality; compile and evaluate data to formulate recommendations and interpret directives; read and understand rules, regulations, and guidelines and apply them to resolve problems; identify and extract pertinent information from records, conversations and observations; make decisions and take action in dealing with problems and situations; plan and organize work; establish and maintain positive relationships with agency staff, service providers and law enforcement agencies.
If you're currently employed by the State of Nebraska, please don't apply through this external career site. Instead, log in to Workday and open the Jobs Hub - Internal Apply app from your home landing page. You can access Workday anytime through the Link web page: https://link.nebraska.gov/
Benefits
We offer a comprehensive package of pay, benefits, paid time off, retirement and professional development opportunities to help you get the most out of your career and life. Your paycheck is just part of your total compensation.
Check out all that the State of Nebraska has to offer! Benefit eligibility may vary by position, agency and employment status. For more information on benefits, please visit: https://statejobs.nebraska.gov/index.html#benefits
Equal Opportunity Statement
The State of Nebraska values our teammates as well as a supportive environment that strives to promote diversity, inclusion, and belonging. We recruit, hire, train, and promote in all job classifications and at all levels without regard to race, color, religion, sex. age, national origin, disability, marital status or genetics.

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