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Workers Comp Fraud Investigator Jobs (NOW HIRING)

Uphold

Fraud Investigations Manager

Clearwater, FL · On-site +1

This role is responsible for managing Fraud Investigators and Analysts, driving high-quality, in ... Comfortable working in a fast-paced, evolving regulatory and risk environment Reporting Structure ...

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

As of Jun 13, 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.

How much do fraud investigators earn?

Workers compensation fraud investigators typically earn between $45,000 and $70,000 annually, depending on experience, location, and employer. Advanced roles or those with specialized skills and certifications can earn higher salaries, often exceeding $80,000 per year.

What is the highest paying investigator job?

Workers compensation fraud investigators with advanced experience, specialized skills, or supervisory roles tend to earn the highest salaries in the field. Senior investigators or those working for large organizations can make over $70,000 annually, especially with certifications and extensive casework experience.

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.

Do companies hire private investigators for workers' comp?

Workers' compensation fraud investigators often hire private investigators to gather evidence on suspicious claims. Private investigators use surveillance, interviews, and record checks to verify claim validity and detect fraud. These investigations require skills in observation, report writing, and sometimes licensing or certification depending on the jurisdiction.

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 qualifications do I need to be a fraud investigator?

Workers' compensation fraud investigators typically need a high school diploma or equivalent, with many employers preferring candidates with a bachelor's degree in criminal justice, law enforcement, or a related field. Relevant experience in law enforcement, insurance, or investigations, along with strong analytical skills and knowledge of investigative techniques, are important. Certifications such as the Certified Fraud Examiner (CFE) can enhance job prospects, and some roles may require a valid driver's license and background checks.

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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Workers Comp Fraud Investigator jobs near you
Infographic showing various Workers Comp Fraud Investigator job openings in the United States as of June 2026, with employment types broken down into 3% As Needed, 54% Full Time, 33% Part Time, 9% Temporary, and 1% Contract. 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.
Healthcare Fraud Investigator

Healthcare Fraud Investigator

Contact Government Services, LLC

Los Angeles, CA

Full-time

Posted 17 days ago

Job description

Healthcare Fraud Investigator
Employment Type: Full-Time, Mid-Level
Department: Litigation Support

CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project in Nashville, TN. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently, accurately, and under pressure, and be enthusiastic about learning and applying knowledge to provide excellent litigation support to the client. 

CGS brings motivated, highly skilled, and creative people together to solve the government’s most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities.

Responsibilities will Include:
- Review, sort, and analyze data using computer software programs such as Microsoft Excel.
- Review financial records, complex legal and regulatory documents and summarize contents, and conduct research as needed. Preparing spreadsheets of financial transactions (e.g., check spreads, etc.).
- Develop HCF case referrals including, but not limited to:
- Ensure that HCF referrals meet agency and USAO standards for litigation.
- Analyze data for evidence of fraud, waste and abuse.
- Review and evaluate referrals to determine the need for additional information and evidence, and plan comprehensive approach to obtain this information and evidence.
- Advise the HCF attorney(s) regarding the merits and weaknesses of HCF referrals based upon applicable law, evidence of liability and damages, and potential defenses, and recommend for or against commencement of judicial proceedings.
- Assist the USAO develop new referrals by ensuring a good working relationship with client agencies and the public, and by assisting in HCF training for federal, state and local agencies, preparing informational literature, etc.
- Assist conducting witness interviews and preparing written summaries.

Qualifications:
- Four (4) year undergraduate degree or higher in criminal justice, finance, project management, or other related field.
- Minimum three (3) years of professional work experience in healthcare, fraud, or other related investigative field of work.
- Proficiency in Microsoft Office applications including Outlook, Word, Excel, PowerPoint, etc.
- Proficiency in analyzing data that would assist in providing specific case support to the Government in civil HCF matters (E.g., Medicare data, Medicaid data, outlier data).
- Communication skills: Ability to interact professionally and effectively with all levels of staff including AUSAs, support staff, client agencies, debtors, debtor attorneys and their staff, court personnel, business executives, witnesses, and the public. Communication requires tact and diplomacy.
- U.S. Citizenship and ability to obtain adjudication for the requisite background investigation.
- Experience and expertise in performing the requisite services in Section 3.
- Must be a US Citizen.
- Must be able to obtain a favorably adjudicated Public Trust Clearance.
Preferred qualifications:
- Relevant Healthcare Fraud experience including compliance, auditing duties, and other duties in Section 3.
- Relevant experience working with a federal or state legal or law enforcement entity.

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