CoventBridge Group

Role Description The Medicaid Medical Review RN (Medical Reviewer III) will primarily be responsible for conducting clinical reviews of medical records during the course of fraud investigations or other program integrity initiatives such as requests for information or in support of proactive data analysis efforts. In addition, this position applies Medicare and Medicaid guidelines in making clinical determinations as to the appropriateness of payment coverage. In assuming this position, you will be a critical contributor to meeting CoventBridge Group's objective: To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse. This position will report directly to the Medical Review Supervisor and will work in our Grove City, OH office. If not local, remotely from a home office. At this time, CoventBridge is not considering candidates who require visa sponsorship, currently or in the future, including but not limited to H-1B, H-2B, E-3, TN, O-1, F-1 (OPT/CPT, or J-1 Visa Statuses.) Qualifications - Graduate from an accredited school of nursing and have an active license as a Registered Nurse (RN) required - Preference given to BSN or higher prepared nurses with recent medical review claims experience in Medicare or Medicaid reviews Requirements - 2 years minimum experience with a state Medicaid agency or Managed Care Organization focused in Medicaid - 2 years minimum of working knowledge of ICD 10-CM/CPT coding experience - 4 years minimum experience auditing claims history or provider files to determine if the claim was payable and if any signs of fraud, waste or abuse are noted - Knowledge of, and the ability to correctly identify, Medicare and Medicaid coverage guidelines - Advance knowledge of medical terminology and experience in the analysis and processing of Medicare claims, utilization review/ quality assurance procedures, ICD 10-CM and CPT coding, Medicare coverage guidelines and payment methodologies (i.e., Correct Coding Initiative, DRG's, Prospective Payment Systems and Ambulatory Surgical center), NCPCP and other types of prescription drug claims - Ability to read Medicaid claims, both paper and electronic, and a basic knowledge of Medicaid is required - Should possess excellent verbal and written communication skills with an ability to write professional summary reports - Knowledge of and ability to use Microsoft Word, Excel, and Internet applications - Able to efficiently organize and manage workload and assignments - Must have and maintain a valid driver's license for the state of residence as on-site audits are part of the role as a nurse reviewer Benefits - Medical, Dental, Vision plans - Life, LTD and STD paid by the employer - 401(k) with company match up to 4% - Paid Time Off and company paid holidays - Tuition assistance after 1 year of service

Role Description As a Desktop Investigator, you will conduct investigative assignments primarily by phone and online research. Depending on the assignment, the employee may perform a combination of some or all of the following duties: - Review case documentation, client instructions, and prior reports to plan investigative strategies. - Conduct research using public and private databases, social media, and open-source tools. - Make up to 75 outbound calls per day to collect information from medical providers, employers, and third parties. - Support field investigators with insights, updates, and case coordination. - Write detailed, accurate, and unbiased reports that clearly document findings and conclusions. - Maintain organized, up-to-date records within the case management system. Every case presents a new challenge — and your work will directly impact client outcomes. Qualifications - Hold or qualify for a valid Private Investigator’s License (as required by state). - Communicate clearly and professionally in both written and verbal formats. - Demonstrate persistence and professionalism when speaking with third parties. - Analyze and interpret complex or conflicting information with accuracy. - Prioritize multiple cases while maintaining attention to detail and deadlines. - Work independently with integrity, initiative, and sound judgment. Requirements - Earned an associate’s degree or higher. - Understand basic medical terminology or have exposure to the healthcare industry. - Thrived in a fast-paced, high-volume investigative environment. Benefits - Base Rate: $18.00/hr - Company Paid Training - Remote Work Flexibility - Medical, Dental, Vision Insurance - Company-paid Life, LTD and STD Insurance - 401(k) with 4% Company Match - Paid Time Off with Company Paid Holidays - Tuition Assistance After 1 Year

Title: Desktop Investigator Location: US-MI-Grand Rapids Job ID 2026-6143 Category Investigations Overview Desktop Investigator - Remote Full-Time / Hourly Uncover the Story Behind Every Claim At CoventBridge Group, every case tells a story — and as a Desktop Investigator, you’ll be the one uncovering the truth. From your home office, you’ll dig into insurance and fraud investigations using research tools, phone work, and your own investigative instincts. Join the global leader in full-service investigations — where precision, integrity, and curiosity drive everything we do. At this time, CoventBridge is not considering candidates who require visa sponsorship, currently or in the future, including but not limited to H-1B, H-2B, E-3, TN, O-1, F-1 (OPT/CPT, or J-1 Visa Statuses.) Responsibilities/ Requirements What You’ll Do As a Desktop Investigator, you will conduct investigative assignments primarily by phone and online research. Depending on the assignment, the employee may perform a combination of some or all of the following duties: · Review case documentation, client instructions, and prior reports to plan investigative strategies. · Conduct research using public and private databases, social media, and open-source tools. · Make up to 75 outbound calls per day to collect information from medical providers, employers, and third parties. · Support field investigators with insights, updates, and case coordination. · Write detailed, accurate, and unbiased reports that clearly document findings and conclusions. · Maintain organized, up-to-date records within the case management system. Every case presents a new challenge — and your work will directly impact client outcomes. Requirements Basic Qualifications: · Hold or qualify for a valid Private Investigator’s License (as required by state). · Communicate clearly and professionally in both written and verbal formats. · Demonstrate persistence and professionalism when speaking with third parties. · Analyze and interpret complex or conflicting information with accuracy. · Prioritize multiple cases while maintaining attention to detail and deadlines. · Work independently with integrity, initiative, and sound judgment. Preferred Qualifications: · Earned an associate’s degree or higher. · Understand basic medical terminology or have exposure to the healthcare industry. · Thrived in a fast-paced, high-volume investigative environment. Benefits Compensation & Benefits: We invest in our employees because great work requires great rewards. Here’s what you can expect when you join our team: · Base Rate: $18.00/hr · Company Paid Training · Remote Work Flexibility · Medical, Dental, Vision Insurance · Company-paid Life, LTD and STD Insurance · 401(k) with 4% Company Match · Paid Time Off with Company Paid Holidays · Tuition Assistance After 1 Year The hourly rate for this role is $18 per hour. This is the highest rate we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs. Pursuant to the respective Fair Chance Ordinances of both Los Angeles and San Francisco, we will consider for employment qualified applicants with arrest and conviction records. About Us: CoventBridge Group is a global leader in full-service investigations providing Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs. The company provides top tier data privacy and security practices, deploys robust case management technology customized to clients’ needs and delivers worldwide coverage via its 700+ employees and affiliates worldwide. CoventBridge is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics and maintains a drug-free workplace. CoventBridge is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; 888-932-7364; humanresources@coventbridge.com. https://coventbridge.com/licensing/ Apply for this job online Email this job to a friend Share on your newsfeed

Role Description As a Claims Investigator, you’ll combine analytical skill with real-world investigation techniques to uncover facts, document findings, and deliver objective results. You will: - Conduct complex field investigations involving multiple claim types. - Submit daily updates summarizing your progress and observations. - Manage your time effectively to maintain client billable hour expectations. - Write detailed, professional statements and investigative summaries. - Deliver clear, client-ready reports that meet CoventBridge’s quality standards. - Perform scene investigations, background checks, and courthouse research. - Operate safely and remain alert while driving during field assignments. Your curiosity and persistence will turn each case into a story built on truth and evidence. Qualifications - Hold a valid (state) Investigator license (or eligibility for licensure in surrounding states). - Demonstrate at least 1 year of field investigations experience, including face-to-face statements and report writing. - Travel across multiple states as needed to complete case assignments. - Investigate claims related to product, auto, general liability, Workers’ Compensation, disability, life insurance, and contestable death cases. - Adapt to variable schedules — including nights and weekends when required. - Maintain a reliable, fuel-efficient vehicle and required insurance coverage. - Equip yourself with a digital recorder, laptop (Windows OS), and necessary investigative tools. Requirements - A minimum of 3-5 years of Claims, SIU, or adjusting experience. - An Associate’s or Bachelor’s degree in Criminal Justice or a related field. - Strong report writing skills. - Understand investigative processes, insurance law, and claim procedures. - Excel in report writing and typing (50+ WPM) with accuracy and attention to detail. - Thrive under pressure and maintain professionalism in sensitive situations. - Demonstrate self-motivation, accountability, and sound judgment. Benefits - Home-based work and flexible scheduling. - Competitive pay with monthly vehicle allowance. - Paid time off. - Company fuel card and company-issued cell phone. - Medical, Dental, Vision plans. - Employer-paid Life, LTD, STD insurance. - 401(k) with company match. - Travel and report writing compensation. - Licensing fees paid by company. - Paid ongoing career advancement training. - Expense reimbursement with minimal out-of-pocket expenses. The salary range for this role is $28-$31 per hour. This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs. Pursuant to the respective Fair Chance Ordinances of both Los Angeles and San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Role Description Are you a licensed healthcare professional (RN or NP) with a passion for uncovering the truth behind medical claims? We’re seeking an experienced Investigative Clinician to join our team and support a major national client in evaluating the medical validity of insurance claims. This role blends clinical expertise with investigative acumen to detect, prevent, and resolve fraudulent, exaggerated, or non-medically necessary claims. As an integral member of the Special Investigations Unit (SIU), you’ll collaborate closely with adjusters, legal teams, and investigators to analyze medical documentation and uncover inconsistencies or red flags. If you thrive in a fast-paced, analytical environment and want to make a real impact in the fight against insurance fraud, we want to hear from you. Qualifications - Active U.S. license as a healthcare professional (RN, NP, MD, or equivalent, no LPN's). - At least 3–5 years of hands-on clinical experience. - Prior work experience in insurance claims review, utilization management, or healthcare fraud investigation highly preferred. - Proficient in reviewing electronic health records (EHRs), ICD-10, CPT coding, and medical billing practices. - Exceptional critical thinking, detail orientation, and analytical skills. - Strong verbal and written communication skills, including report writing. - Ability to work independently and manage multiple concurrent assignments in a remote environment. Requirements - Conduct thorough reviews of medical records, treatment plans, and billing documentation to assess accuracy, consistency, and medical necessity. - Identify patterns of overutilization, upcoding, or potential fraud and abuse. - Provide clinical expertise to claims investigators, legal personnel, and other stakeholders in evaluating questionable claims. - Interview claimants, healthcare providers, and related parties as needed to clarify details and verify medical facts. - Prepare clear, detailed, and objective clinical summary reports with findings and recommendations. - Deliver expert clinical opinions regarding treatment appropriateness and outcomes. - Remain up-to-date with current clinical practices, fraud trends, billing guidelines, and relevant regulations. - Participate in depositions or testify as a clinical expert in support of litigation efforts, when required. Benefits - Career development training - Medical, Dental, Vision plans - Life, LTD and STD paid by the employer - 401(k) with company match - Paid vacation - Paid Paternity/Maternity Leave, after 1 year of service - Tuition assistance after 1 year of service The salary range for this role is between $80,000.00 - $110,000.00 annually. This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs.

Overview Claims Investigator – Part Time Jacksonville, FL Uncover the Truth. Protect the Integrity. Advance Your Career. At CoventBridge Group, every claim tells a story — and as a Claims Investigator, you’ll be the one uncovering it. Using your investigative instincts, field experience, and attention to detail, you’ll help clients get the answers they need and ensure claims are resolved with accuracy and fairness. Join a global leader in full-service investigations, where integrity meets action, and every day brings a new case — and a new challenge. At this time, CoventBridge is not considering candidates who require visa sponsorship, currently or in the future, including but not limited to H-1B, H-2B, E-3, TN, O-1, F-1 (OPT/CPT, or J-1 Visa Statuses.) Responsibilities/ Requirements What You’ll Do: As a Claims Investigator, you’ll combine analytical skill with real-world investigation techniques to uncover facts, document findings, and deliver objective results. You will: · Conduct complex field investigations involving multiple claim types. · Submit daily updates summarizing your progress and observations. · Manage your time effectively to maintain client billable hour expectations. · Write detailed, professional statements and investigative summaries. · Deliver clear, client-ready reports that meet CoventBridge’s quality standards. · Perform scene investigations, background checks, and courthouse research. · Operate safely and remain alert while driving during field assignments. Your curiosity and persistence will turn each case into a story built on truth and evidence. What You’ll Bring: We’re looking for investigators who are driven, professional, and dedicated to uncovering facts with accuracy and integrity. · Hold a valid (state) Investigator license (or eligibility for licensure in surrounding states). · Demonstrate at least 1 year of field investigations experience, including face-to-face statements and report writing. · Travel across multiple states as needed to complete case assignments. · Investigate claims related to product, auto, general liability, Workers’ Compensation, disability, life insurance, and contestable death cases. · Adapt to variable schedules — including nights and weekends when required. · Maintain a reliable, fuel-efficient vehicle and required insurance coverage. · Equip yourself with a digital recorder, laptop (Windows OS), and necessary investigative tools. What You’ll Need: To qualify for this position, applicants must possess the following: · A minimum of 3-5 years of experience in Claims, SIU, or adjusting. · An Associate’s or Bachelor’s degree in Criminal Justice or a related field. · Strong report writing skills. · Understand investigative processes, insurance law, and claim procedures. · Excel in report writing and typing (50+ WPM) with accuracy and attention to detail. · Thrive under pressure and maintain professionalism in sensitive situations. · Demonstrate self-motivation, accountability, and sound judgment. Benefits We believe great work deserves great rewards. Here’s what you can expect when you join our team: · Home-based work and flexible scheduling · Competitive pay with monthly vehicle allowance · Company fuel card and company-issued cell phone · Employer-paid Life, LTD, STD insurance · 401(k) with company match · Travel and report writing compensation · Licensing fees paid by company · Paid ongoing career advancement training · Expense reimbursement with minimal out-of-pocket expenses About Us: CoventBridge Group is a global leader in full-service investigations providing: Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs. The company provides top tier data privacy and security practices, deploys robust case management technology customized to clients’ needs and delivers worldwide coverage via its 700+ employees and affiliates worldwide. CoventBridge is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics and maintains a drug-free workplace. CoventBridge is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; 888-932-7364; humanresources@coventbridge.com. CoventBridge Group Inc. Florida License # A1000233

Overview Claims Investigator – Full Time Seattle, WA Uncover the Truth. Protect the Integrity. Advance Your Career. At CoventBridge Group, every claim tells a story — and as a Claims Investigator, you’ll be the one uncovering it. Using your investigative instincts, field experience, and attention to detail, you’ll help clients get the answers they need and ensure claims are resolved with accuracy and fairness. Join a global leader in full-service investigations, where integrity meets action, and every day brings a new case — and a new challenge. At this time, CoventBridge is not considering candidates who require visa sponsorship, currently or in the future, including but not limited to H-1B, H-2B, E-3, TN, O-1, F-1 (OPT/CPT, or J-1 Visa Statuses.) Responsibilities/ Requirements What You’ll Do: As a Claims Investigator, you’ll combine analytical skill with real-world investigation techniques to uncover facts, document findings, and deliver objective results. You will: · Conduct complex field investigations involving multiple claim types. · Submit daily updates summarizing your progress and observations. · Manage your time effectively to maintain client billable hour expectations. · Write detailed, professional statements and investigative summaries. · Deliver clear, client-ready reports that meet CoventBridge’s quality standards. · Perform scene investigations, background checks, and courthouse research. · Operate safely and remain alert while driving during field assignments. Your curiosity and persistence will turn each case into a story built on truth and evidence. What You’ll Bring: We’re looking for investigators who are driven, professional, and dedicated to uncovering facts with accuracy and integrity. · Hold a valid (state) Investigator license (or eligibility for licensure in surrounding states). · Demonstrate at least 1 year of field investigations experience, including face-to-face statements and report writing. · Travel across multiple states as needed to complete case assignments. · Investigate claims related to product, auto, general liability, Workers’ Compensation, disability, life insurance, and contestable death cases. · Adapt to variable schedules — including nights and weekends when required. · Maintain a reliable, fuel-efficient vehicle and required insurance coverage. · Equip yourself with a digital recorder, laptop (Windows OS), and necessary investigative tools. What You’ll Need: To qualify for this position, applicants must possess the following: · A minimum of 3-5 years of Claims, SIU, or adjusting experience. · An Associate’s or Bachelor’s degree in Criminal Justice or a related field. · Strong report writing skills. · Understand investigative processes, insurance law, and claim procedures. · Excel in report writing and typing (50+ WPM) with accuracy and attention to detail. · Thrive under pressure and maintain professionalism in sensitive situations. · Demonstrate self-motivation, accountability, and sound judgment. Benefits Benefits We believe great work deserves great rewards. Here’s what you can expect when you join our team: · Home-based work and flexible scheduling · Competitive pay with monthly vehicle allowance · Paid time off · Company fuel card and company-issued cell phone · Medical, Dental, Vision plans · Employer-paid Life, LTD, STD insurance · 401(k) with company match · Travel and report writing compensation · Licensing fees paid by company · Paid ongoing career advancement training · Expense reimbursement with minimal out-of-pocket expenses The salary range for this role is $27-$30 per hour. This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs. About Us: CoventBridge Group is a global leader in full-service investigations providing: Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs. The company provides top tier data privacy and security practices, deploys robust case management technology customized to clients’ needs and delivers worldwide coverage via its 700+ employees and affiliates worldwide. CoventBridge is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics and maintains a drug-free workplace. CoventBridge is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; 888-932-7364; humanresources@coventbridge.com. CoventBridge (USA) Inc. Washington License # 1844

Overview Claims Investigator – Part Time Olympia, WA Uncover the Truth. Protect the Integrity. Advance Your Career. At CoventBridge Group, every claim tells a story — and as a Claims Investigator, you’ll be the one uncovering it. Using your investigative instincts, field experience, and attention to detail, you’ll help clients get the answers they need and ensure claims are resolved with accuracy and fairness. Join a global leader in full-service investigations, where integrity meets action, and every day brings a new case — and a new challenge. At this time, CoventBridge is not considering candidates who require visa sponsorship, currently or in the future, including but not limited to H-1B, H-2B, E-3, TN, O-1, F-1 (OPT/CPT, or J-1 Visa Statuses.) Responsibilities/ Requirements What You’ll Do: As a Claims Investigator, you’ll combine analytical skill with real-world investigation techniques to uncover facts, document findings, and deliver objective results. You will: · Conduct complex field investigations involving multiple claim types. · Submit daily updates summarizing your progress and observations. · Manage your time effectively to maintain client billable hour expectations. · Write detailed, professional statements and investigative summaries. · Deliver clear, client-ready reports that meet CoventBridge’s quality standards. · Perform scene investigations, background checks, and courthouse research. · Operate safely and remain alert while driving during field assignments. Your curiosity and persistence will turn each case into a story built on truth and evidence. What You’ll Bring: We’re looking for investigators who are driven, professional, and dedicated to uncovering facts with accuracy and integrity. · Hold a valid (state) Investigator license (or eligibility for licensure in surrounding states). · Demonstrate at least 1 year of field investigations experience, including face-to-face statements and report writing. · Travel across multiple states as needed to complete case assignments. · Investigate claims related to product, auto, general liability, Workers’ Compensation, disability, life insurance, and contestable death cases. · Adapt to variable schedules — including nights and weekends when required. · Maintain a reliable, fuel-efficient vehicle and required insurance coverage. · Equip yourself with a digital recorder, laptop (Windows OS), and necessary investigative tools. What You’ll Need: To qualify for this position, applicants must possess the following: · A minimum of 3-5 years of experience in Claims, SIU, or adjusting. · An Associate’s or Bachelor’s degree in Criminal Justice or a related field. · Strong report writing skills. · Understand investigative processes, insurance law, and claim procedures. · Excel in report writing and typing (50+ WPM) with accuracy and attention to detail. · Thrive under pressure and maintain professionalism in sensitive situations. · Demonstrate self-motivation, accountability, and sound judgment. Benefits We believe great work deserves great rewards. Here’s what you can expect when you join our team: · Home-based work and flexible scheduling · Competitive pay with monthly vehicle allowance · Company fuel card and company-issued cell phone · Employer-paid Life, LTD, STD insurance · 401(k) with company match · Travel and report writing compensation · Licensing fees paid by company · Paid ongoing career advancement training · Expense reimbursement with minimal out-of-pocket expenses The salary range for this role is $27-$30 per hour. This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs. About Us: CoventBridge Group is a global leader in full-service investigations providing: Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs. The company provides top tier data privacy and security practices, deploys robust case management technology customized to clients’ needs and delivers worldwide coverage via its 700+ employees and affiliates worldwide. CoventBridge is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics and maintains a drug-free workplace. CoventBridge is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; 888-932-7364; humanresources@coventbridge.com. CoventBridge (USA) Inc. Washington License # 1844

Overview Experienced Investigative Clinician - Insurance Claims Remote Are you a licensed healthcare professional( RN or NP) with a passion for uncovering the truth behind medical claims? We’re seeking an experienced Investigative Clinician to join our team and support a major national client in evaluating the medical validity of insurance claims. This role blends clinical expertise with investigative acumen to detect, prevent, and resolve fraudulent, exaggerated, or non-medically necessary claims. As an integral member of the Special Investigations Unit (SIU), you’ll collaborate closely with adjusters, legal teams, and investigators to analyze medical documentation and uncover inconsistencies or red flags. If you thrive in a fast-paced, analytical environment and want to make a real impact in the fight against insurance fraud, we want to hear from you. Responsibilities/ Requirements Key Responsibilities: - Conduct thorough reviews of medical records, treatment plans, and billing documentation to assess accuracy, consistency, and medical necessity. - Identify patterns of overutilization, upcoding, or potential fraud and abuse. - Provide clinical expertise to claims investigators, legal personnel, and other stakeholders in evaluating questionable claims. - Interview claimants, healthcare providers, and related parties as needed to clarify details and verify medical facts. - Prepare clear, detailed, and objective clinical summary reports with findings and recommendations. - Deliver expert clinical opinions regarding treatment appropriateness and outcomes. - Remain up-to-date with current clinical practices, fraud trends, billing guidelines, and relevant regulations. - Participate in depositions or testify as a clinical expert in support of litigation efforts, when required. Essentials for this Role: - Active U.S. license as a healthcare professional (RN, NP, MD, or equivalent, no LPN's). - At least 3–5 years of hands-on clinical experience. - Prior work experience in insurance claims review, utilization management, or healthcare fraud investigation highly preferred. - Proficient in reviewing electronic health records (EHRs), ICD-10, CPT coding, and medical billing practices. - Exceptional critical thinking, detail orientation, and analytical skills. - Strong verbal and written communication skills, including report writing. - Ability to work independently and manage multiple concurrent assignments in a remote environment Preferred Qualifications - Certification in fraud investigation (e.g., Certified Fraud Examiner – CFE, Accredited Health Care Fraud Investigator – AHFI, or similar). - Familiarity with claims management platforms and case tracking systems. - Working knowledge of state and federal healthcare laws and insurance regulations. Benefits Compensation & Perks That Work For You: We believe great work deserves great rewards. Here’s what you can expect when you join our team: Benefits: - Career development training - Medical, Dental, Vision plans - Life, LTD and STD paid by the employer - 401(k) with company match - Paid vacation - Paid Paternity/Maternity Leave, after 1 year of service - Tuition assistance after 1 year of service The salary range for this role is between $80,000.00 - $110,000.00 annually. This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs. Pursuant to the respective Fair Chance Ordinances of both Los Angeles and San Francisco, we will consider for employment qualified applicants with arrest and conviction records. CoventBridge Group is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics. CoventBridge Group is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge Group will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; 888-932-7364; humanresources@coventbridge.com). https://coventbridge.com/licensing/

Overview Claims Investigator – Part Time Charleston, WV Uncover the Truth. Protect the Integrity. Advance Your Career. At CoventBridge Group, every claim tells a story — and as a Claims Investigator, you’ll be the one uncovering it. Using your investigative instincts, field experience, and attention to detail, you’ll help clients get the answers they need and ensure claims are resolved with accuracy and fairness. Join a global leader in full-service investigations, where integrity meets action, and every day brings a new case — and a new challenge. At this time, CoventBridge is not considering candidates who require visa sponsorship, currently or in the future, including but not limited to H-1B, H-2B, E-3, TN, O-1, F-1 (OPT/CPT, or J-1 Visa Statuses.) Responsibilities/ Requirements What You’ll Do: As a Claims Investigator, you’ll combine analytical skill with real-world investigation techniques to uncover facts, document findings, and deliver objective results. You will: · Conduct complex field investigations involving multiple claim types. · Submit daily updates summarizing your progress and observations. · Manage your time effectively to maintain client billable hour expectations. · Write detailed, professional statements and investigative summaries. · Deliver clear, client-ready reports that meet CoventBridge’s quality standards. · Perform scene investigations, background checks, and courthouse research. · Operate safely and remain alert while driving during field assignments. Your curiosity and persistence will turn each case into a story built on truth and evidence. What You’ll Bring: We’re looking for investigators who are driven, professional, and dedicated to uncovering facts with accuracy and integrity. · Hold a valid (state) Investigator license (or eligibility for licensure in surrounding states). · Demonstrate at least 1 year of field investigations experience, including face-to-face statements and report writing. · Travel across multiple states as needed to complete case assignments. · Investigate claims related to product, auto, general liability, Workers’ Compensation, disability, life insurance, and contestable death cases. · Adapt to variable schedules — including nights and weekends when required. · Maintain a reliable, fuel-efficient vehicle and required insurance coverage. · Equip yourself with a digital recorder, laptop (Windows OS), and necessary investigative tools. What You’ll Need: To qualify for this position, applicants must possess the following: · A minimum of 3-5 years of experience in Claims, SIU, or adjusting. · An Associate’s or Bachelor’s degree in Criminal Justice or a related field. · Strong report writing skills. · Understand investigative processes, insurance law, and claim procedures. · Excel in report writing and typing (50+ WPM) with accuracy and attention to detail. · Thrive under pressure and maintain professionalism in sensitive situations. · Demonstrate self-motivation, accountability, and sound judgment. Benefits We believe great work deserves great rewards. Here’s what you can expect when you join our team: · Home-based work and flexible scheduling · Competitive pay with monthly vehicle allowance · Company fuel card and company-issued cell phone · Employer-paid Life, LTD, STD insurance · 401(k) with company match · Travel and report writing compensation · Licensing fees paid by company · Paid ongoing career advancement training · Expense reimbursement with minimal out-of-pocket expenses About Us: CoventBridge Group is a global leader in full-service investigations providing: Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs. The company provides top tier data privacy and security practices, deploys robust case management technology customized to clients’ needs and delivers worldwide coverage via its 700+ employees and affiliates worldwide. CoventBridge is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics and maintains a drug-free workplace. CoventBridge is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; 888-932-7364; humanresources@coventbridge.com.