Creating the best insurance experience possible.
Senior Investigator
Location
United States
Posted
1 day ago
Salary
$78.7K - $132.7K / year
Seniority
Senior
No structured requirement data.
Job Description
Senior Investigator
ICW Group
Role Description The Senior Special Investigation Unit (SIU) Investigator works to detect, prevent, and investigate suspected fraudulent claims for all lines of insurance, with focus aligned to enterprise risk priorities. This position exists to protect company assets through examining potential fraudulent cases. The work is aligned to either Desk or Field investigative assignments. Essential Duties and Responsibilities - Leads Complex and Major Case Investigations - Conducts advanced, large-scale investigations involving organized fraud rings, provider fraud schemes (medical, legal, and ancillary services), referral/kickback schemes. - Identifies patterns of coordinated activity across multiple claims to detect systemic and enterprise-level fraud risks. - Independently manages complex, multi-jurisdictional cases from inception to resolution. - Interviews claimants, witnesses, employers, medical providers, and legal representatives, utilizing advanced interviewing and interrogation techniques. - Develops and secures recorded statements, affidavits, and evidence to support investigative findings. - Performs on-site investigations, clinic inspections, and surveillance coordination as appropriate. - Data Analysis & Intelligence Development - Interprets and synthesizes large volumes of data from multiple sources, including claims systems, billing records, social media, and third-party databases. - Identifies anomalies, trends, and networks/relationships indicative of fraud through link analysis and data correlation. - Develops actionable intelligence packages to support internal stakeholders and external enforcement actions. - Provider & Organized Fraud Focus - Identifies and investigates fraud involving service providers, legal entities, and billing schemes, including upcoding, billing irregularities, and treatment patterns inconsistent with injuries. - Coordinates with internal and external experts to evaluate medical necessity, treatment patterns, and provider networks. - Fraud Detection & Case Development - Evaluates referrals for fraud indicators and determines appropriate investigative strategies. - Builds comprehensive case files supported by well-documented evidence, timelines, and investigative summaries. - Ensures all findings meet standards required for regulatory reporting, civil litigation, and criminal prosecution. - Collaborates with Legal & Regulatory Entities - Partners closely with law enforcement, district attorneys, regulatory agencies, and legal counsel to advance cases. - Presents investigative findings in a professional manner for case review, prosecution, or civil recovery actions. - Maintains detailed knowledge of relevant laws, regulations, and evidentiary standards. - Case Management & Reporting - Produces clear, concise, and defensible investigative reports covering all aspects of the case lifecycle. - Maintains accurate documentation in case management systems and ensures timely progression of cases. Supervisory Responsibilities This role does not have supervisory responsibilities. Qualifications - Bachelor’s degree with a major in Criminal Justice, Business, Accounting, Information Systems, or closely related (or an equivalent combination of education/experience). - Minimum of 5 years’ related work experience required. The Senior SIU Field Investigator requires experience specifically in investigations and/or law enforcement. Certificates, Licenses, Registrations - Private Investigator's License or fraud related certificates (CFE, CIFI) preferred. - Requires valid Driver’s license. Knowledge and Skills - Good computer skills in Microsoft Office/Outlook and expertise using investigative case management software/tools (such as Polonious or similar). - Experience with case management systems and investigative tools. - Fundamental knowledge of claims management processes and claims handling. - Knowledge of Unfair Claims Practices Act, Legislative, and Insurance Department regulatory requirements. - Familiarity with civil/criminal investigation procedures and the legal system. - Demonstrated experience with managing relationships to complete thorough investigations. - High level of critical thinking, attention to detail, and independent judgment. - Excellent written/verbal and presentation skills. - Experience with advanced investigative and interviewing skills. - Ability to analyze and interpret large, complex data sets. - Strong knowledge of fraud schemes, claims handling, legal procedures, and medical/services billing. - Ability to present information within a courtroom setting. Physical Requirements Office environment – no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear. Work Environment This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment. Benefits - Challenging work and the ability to make a difference. - You will have a voice and feel a sense of belonging. - We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match. - Bonus potential for all positions. - Paid Time Off. - Paid holidays throughout the calendar year. - Want to continue learning? We’ll support you 100%.
Related Guides
Related Categories
Related Job Pages
More Pricing Analyst Jobs
• Provide proactive outbound and inbound support to retailers in the vehicle segment (independent dealerships). • Manage a portfolio of approximately 65–70 retailers, building and maintaining ongoing close relationships. • Work on prospecting, negotiating with and retaining partners, encouraging the adoption and use of Itaucred products. • Support retailers in arranging financing, resolving blockers with internal areas (credit, pricing, etc.). • Conduct remote visits (phone calls, video calls and messages) to monitor operations and strengthen relationships. • Identify opportunities to increase market share and monetize the portfolio. • Perform analyses of the retailer’s and business’s profile to inform commercial decisions. • Ensure the quality of information and communications with partners, representing the Itaú brand professionally. • Organize and prioritize portfolio tasks to ensure efficient delivery within available time.
Senior Pricing Analyst
NavaBuilding simple, effective government services. Want to contribute? We're hiring!
• Lead end-to-end pricing efforts for federal and state government solicitations, including Requests for Proposal (RFPs), Requests for Quotation (RFQs), and Requests for Information (RFIs), by working closely with business development, program delivery, and other key stakeholders. • Build and refine accurate pricing models that address specific solicitation requirements while answering critical questions that company leadership raises during the bid process. This includes performing cost-volume analysis, ensuring competitive proposals, and confirming price proposals are fully compliant. • Ensure all pricing proposals adhere to applicable FAR, DFARS, Cost Accounting Standards (CAS), and other government regulations, often in partnership with the Contracts and Finance teams. • Prepare cost estimates for labor, materials, subcontractors, travel, and other direct/indirect costs on pricing proposals, which includes assisting with development and documentation of Basis of Estimates (BOEs) that substantiate cost estimates, often under tight timelines. • Communicate internally with company business partners and externally with team partners, subcontractors, and prime contractors • Provide strategic support, thought partnership, and financial modeling to support evaluation of specific, company-level issues and financial questions. • Use data, financial systems, and business insight to evaluate trends in company financial performance and how changes would affect business and pricing decisions. • Develop a range of pricing strategies in collaboration with Capture, Contracts, and Finance teams to enhance competitiveness while ensuring profitability. • Identify financial risks associated with proposal submissions and recommend mitigation strategies.
Pricing Strategy Manager
SailPointAt SailPoint, we believe enterprise security must start with identity at the foundation. Today’s enterprise runs on a diverse workforce of not just human but also digital identities—and securing them all is critical. Through the lens of identity, SailPoint empowers organizations to seamlessly manage and secure access to applications and data at speed and scale. Our unified, intelligent, and extensible platform delivers identity-first security, helping enterprises defend against dynamic threats while driving productivity and transformation. Trusted by many of the world’s most complex organizations, SailPoint secures the modern enterprise.
SailPoint is seeking a Pricing Strategy Manager to lead and optimize value capture across our innovative product portfolio. In this high-impact role, you will craft and execute pricing strategies that drive profitability, improve win rates, and maximize customer value across our solutions. Job Description As a key leader in pricing strategy, you will influence major decisions, such as researching and developing monetization strategy, setting prices for new products, defining product-line packaging, and developing portfolio pricing strategies. They'll lead the analysis, evaluation, and execution of pricing initiatives with product and go-to-market teams. Beyond specific projects, this role will serve as an internal pricing advisor, own the frequent evaluation of our pricing, and lead customer value and willingness-to-pay research and initiatives. This is an exciting opportunity for a pricing professional to shape the future of pricing at SailPoint while working with cross-functional teams and engaging with industry leaders. Responsibilities: - Build and maintain strong relationships with senior management across SailPoint, influencing cross-functional alignment, senior decision-making, and strategic direction. - Serve as a core leader in building a pricing center of excellence that elevates pricing discipline, governance, and best practices across the organization. - Drive pricing strategy for SailPoint's product and services portfolio, including price setting, packaging, and monetization approaches. - Conduct robust pricing and customer analysis, including CLTV, value drivers, customer interviews, and related research. - Gather, analyze, and interpret pricing data across relevant market demographics to identify key trends, pricing insights, and opportunities. - Lead cross-functional strategic pricing initiatives that combine data collection, analysis, monetization research, and clear synthesis of findings for executive audiences. - Assess the performance of pricing initiatives and recommend continuous improvements to enhance business impact and execution. - Orchestrate decision-making related to product strategy and monetization policies and processes across key stakeholders. - Recommend pricing optimization opportunities based on market intelligence, client analytics, and performance trends. Requirements: - Minimum of 7+ years of experience in SaaS pricing and packaging. - Strong business acumen, analytical skills, and ability to work with imperfect information to inform data-driven decision-making, including the ability to make and support strong, financial business cases. - Strong communication and presentation skills to communicate findings to different levels of the organization.. - Tactical creativity to simplify initiatives and successfully scale execution across a growing, global organization. - Comfort working in a high visibility role in a fast-paced environment, with flexibility to quickly respond to market changes and corresponding evolution of company strategy. Education: Bachelor’s degree required. MBA is a plus. Benefits and Compensation listed vary based on the location of your employment and the nature of your employment with SailPoint. As a part of the total compensation package, this role may be eligible for the SailPoint Corporate Bonus Plan or a role-specific commission, along with potential eligibility for equity participation. SailPoint maintains broad salary ranges for its roles to account for variations in knowledge, skills, experience, market conditions and locations, as well as reflect SailPoint’s differing products, industries, and lines of business. Candidates are typically placed into the range based on the preceding factors as well as internal peer equity. We estimate the base salary, for US-based employees, will be in this range from (min-mid-max, USD): $131,000 - $220,896.00Base salaries for employees based in other locations are competitive for the employee’s home location. Benefits Overview 1. Health and wellness coverage: Medical, dental, and vision insurance 2. Disability coverage: Short-term and long-term disability 3. Life protection: Life insurance and Accidental Death & Dismemberment (AD&D) 4. Additional life coverage options: Supplemental life insurance for employees, spouses, and children 5. Flexible spending accounts for health care, and dependent care; limited purpose flexible spending account 6. Financial security: 401(k) Savings and Investment Plan with company matching 7. Time off benefits: Flexible vacation policy 8. Holidays: 8 paid holidays annually 9. Sick leave 10. Parental support: Paid parental leave 11. Employee Assistance Program (EAP) and Care Counselors 12. Voluntary benefits: Legal Assistance, Critical Illness, Accident, Hospital Indemnity and Pet Insurance options 13. Health Savings Account (HSA) with employer contribution SailPoint is an equal opportunity employer and we welcome all qualified candidates to apply to join our team. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other category protected by applicable law. Alternative methods of applying for employment are available to individuals unable to submit an application through this site because of a disability. Contact applicationassistance@sailpoint.com or mail to 11120 Four Points Dr, Suite 100, Austin, TX 78726, to discuss reasonable accommodations. NOTE: Any unsolicited resumes sent by candidates or agencies to this email will not be considered for current openings at SailPoint.
Pricing Specialist
Current LightingImproving lives with the industry's most expansive portfolio of sustainable advanced lighting and intelligent controls.
• Manage pricing activities for the LATAM portfolio • Ensure price accuracy and support special pricing authorizations • Provide analytical insights to support commercial teams • Generate Power BI reports to track quotation trends and pricing behavior • Maintain pricing information in internal systems and update Sales Deals in SAP




