This page tracks remote investigator openings that are location-eligible for Connecticut.
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Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review. At IntegrityM, we offer a culture of opportunity, recognition, collaboration, and supporting our community. We thrive off of these fundamental elements that make IntegrityM a great place to work. Our small, flexible workplace offers an exceptional quality of life and promotes corporate-driven sustainability. We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees’ professional development. Large company perks…Small company feel!
Role Description We are seeking a Senior Investigator to join our team. In this role, the Senior Investigator will conduct investigations that support healthcare program integrity initiatives by identifying potential fraud, waste, and abuse (FWA), analyzing complex information, and developing investigative findings. The Senior Investigator will use a variety of investigative techniques and analytical tools to identify subjects, develop cases, document findings, and recommend appropriate administrative or enforcement actions. This position works both independently and collaboratively with investigators, analysts, subject matter experts, and program leadership. Responsibilities - Conduct background research to identify relevant information regarding individuals, organizations, or entities under review. - Conduct investigations involving potential fraud, waste, and abuse. - Analyze healthcare and operational data to identify trends, anomalies, and potential indicators of fraud. - Review applicable laws, regulations, policies, and guidance to support investigative activities. - Collect, review, and analyze records and documentation relevant to investigations. - Conduct interviews and maintain accountability for evidentiary materials in accordance with established procedures. - Document investigative findings and prepare clear, well-supported reports and recommendations. - Coordinate with internal staff, legal counsel, government stakeholders, and law enforcement agencies, as appropriate. - Collaborate with investigators, analysts, program managers, and subject matter experts to develop investigative strategies and resolve cases. - Enter and maintain investigative information in case management and tracking systems. - Present investigative findings and recommendations to management and clients. - Assist with identifying emerging fraud schemes and recommending new investigative priorities. - Prepare recurring and ad hoc reports regarding investigative activities and case status. - Meet established quality standards and project deadlines. Qualifications - Bachelor's degree in criminal justice, law enforcement, healthcare administration, data analysis, or a related field, or equivalent combination of education and relevant experience. - Two or more years of experience supporting healthcare program integrity, fraud investigations, Medicare, Medicaid, commercial healthcare, or other government healthcare programs. - Experience conducting fraud, waste, and abuse investigations preferred. - Strong investigative, analytical, and problem-solving skills. - Experience reviewing healthcare claims, enrollment records, medical records, or other complex documentation. - Experience analyzing complex data and identifying patterns or anomalies. - Strong written, verbal, and interpersonal communication skills. - Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) preferred (or may be required based on contract requirements). - Ability to maintain confidentiality and exercise sound judgment. - Ability to work independently and collaboratively within a team environment. - Strong organizational skills with the ability to prioritize multiple assignments and meet deadlines. - Proficiency with Microsoft Office applications, including Word and Excel. - Passion for supporting healthcare program integrity and IntegrityM's mission, vision, and values. Benefits - Vacation - Sick leave - Paid holidays - Health insurance - Dental insurance - Vision insurance - Short- and long-term disability - Life insurance - Employee assistance plan - 401(K) retirement plan - Educational benefits
CVS Health is a leading healthcare company operating CVS Specialty, CVS Pharmacy, CVS MinuteClinic, and CVS Caremark. In 2018, CVS combined forces with healthca
• Conduct investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse • Recover lost funds • Comply with federal and state regulations mandating fraud plans and practices
USC is a leading private research university located in Los Angeles, with a diverse community of students, faculty, and staff across multiple campuses and global locations. USC offers a dynamic work environment and the opportunity to contribute to meaningful work that supports education, research, and service. ITS is focused on creating a workplace where employees can develop their skills, take pride in their work, and grow within the organization. USC’s ITS organization represents a diverse and collaborative team committed to delivering secure and innovative IT services.
Role Description The Office of Civil Rights Compliance at the University of Southern California (USC) is seeking a Senior Investigator to join their team. This is an exciting time at USC when the successful candidate will have an opportunity to contribute their knowledge, skills, and abilities in a fast-paced environment working on a variety of civil rights issues in higher education. In this role, the successful candidate will: - Assess reports of discrimination, harassment, and retaliation regarding protected classes. - Timely conduct and document fair, thorough investigations. - Assist with identifying the need for supportive measures. - Conduct alternative resolutions where appropriate. - Work collaboratively with campus partners, including students, on training, investigations, projects, and initiatives. If you are an experienced investigator with a demonstrated commitment to non-discrimination and equal opportunity for all, who is able to build collaborative relationships, drive change through excellence, and desire a role where you can have a significant impact, we encourage you to send us your resume for consideration. Qualifications - 9 years of experience and Juris Doctor (JD) - Demonstrated commitment to fairness and fostering a culture of belonging and engagement. Requirements - Minimum Education: Master's degree - Minimum Experience: 6 years - Minimum Skills: - Directly related investigation experience in civil rights in employment and/or education at or for an educational institution, large organization, and/or government agency. - Ability to conduct interviews and investigations as an unbiased and neutral party. - Thorough knowledge of state and federal laws (e.g., Title IX, Title VI, Section 504, the ADA, Title VII, FERPA, FEHA), regulations, and policies and procedures governing discriminatory practices and equal opportunity. - Experience developing and presenting educational materials. - Excellent writing skills. - Excellent time management skills, with the demonstrated ability to effectively manage the pressure of multiple, competing deadlines. - Strong interpersonal skills, judgment and independence. - Knowledge of applicable nondiscrimination policies and procedures. - Demonstrated analytical and problem-solving capabilities. - Ability to build trust and rapport easily; strong, compassionate and straightforward. - Demonstrable sound judgment and skill in applying equal opportunity principles and prevailing legal standards to solve complex problems fairly and decisively. - Ability to collaborate with a diverse group of colleagues and stakeholders to resolve case-related challenges. - Ability to present ideas clearly and effectively, both oral and written. - Exceptional interpersonal, communication and emotional intelligence skills. - Ability to manage and work with conflict and with individuals who may be experiencing high levels of stress. - Ability to work independently and efficiently and balance workload. - Ability and desire to work actively, collaboratively and creatively as part of a team. - Ability to accept and implement constructive feedback. Preferred Qualifications - Preferred Education: Juris Doctor (JD) - Preferred Experience: 9 years - Preferred Skills: - Demonstrated commitment to fairness and fostering a culture of belonging and engagement. - Direct involvement or familiarity in work related to investigative reporting, journalism or law enforcement practices. Benefits - Excellent benefits and perks. - Opportunity to work in a dynamic and diverse environment. - Be a member of the Trojan Family – the faculty, staff, students, and alumni who make USC a great place to work. Salary Information The annual base salary range for this position is $98,776 - $139,000. When determining an offer, the University of Southern California considers factors such as the scope and responsibilities of the role, the candidate’s experience, education, training, key skills, internal peer alignment, applicable laws, contractual requirements, grant funding, and market condition.
CVS Health is a leading healthcare company operating CVS Specialty, CVS Pharmacy, CVS MinuteClinic, and CVS Caremark. In 2018, CVS combined forces with healthca
Role Description As an independently owned subsidiary of Aetna and CVS Health, Meritain Health is a leading third-party administrator of self-insured commercial health plans. The SIU Investigator will support Meritain Health’s Network Cost Management team, specifically the Special Investigations Unit (SIU). The SIU Investigator will conduct investigations to effectively pursue the prevention, investigation, and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with state regulations mandating fraud plans and practices. - Must be flexible to work EDT hours (8:00 am - 5 pm EDT). - Conducts investigations of known or suspected acts of healthcare fraud and abuse. - Communicates with federal, state, and local law enforcement agencies as appropriate in matters pertaining to the prosecution of specific healthcare fraud cases. - Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, customer members, etc. - Facilitates the recovery of company and customer money lost as a result of fraud matters. - Provides input regarding controls for monitoring fraud related issues within the business units. - Delivers educational programs designed to promote deterrence and detection of fraud and minimize losses to the company. - Maintains open communication with constituents internal and external to the company. - Uses available resources and technology in developing evidence, supporting allegations of fraud and abuse. - Researches and prepares cases for clinical and legal review. - Documents all appropriate case activity in tracking system. - Makes referrals and deconflictions, both internal and external, in the required timeframe. - Cost effectively manages use of outside resources and vendors to perform activities necessary for investigations. Qualifications - 3+ years of experience working in fraud, waste and abuse investigations and audits. - 3+ years of experience in healthcare/medical insurance claims investigation or professional/clinical experience. - Demonstrated proficiency in Microsoft Office Suite (including Excel, specifically with pivot tables), database search tools, and use of the Intranet/Internet to research information. Requirements - Strong analytical and research skills. - Strong verbal and written communication skills. - Strong customer service skills. - Previous experience as a senior investigator. - Previous experience utilizing QuickBase. - Proficient in researching information and identifying information resources. - Ability to utilize company systems to obtain relevant electronic documentation. - Ability to travel and participate in legal proceedings, arbitrations, depositions, etc. - Ability to interact with different groups of people at different levels and aid on a timely basis. - Previous experience working with a Third-Party Administrator (TPA) and/or Self-Funded Plans in an investigative capacity. - AHFI (Accredited Health Care Fraud Investigator), CFE (Certified Fraud Examiner), and/or CPC (Certified Professional Coder). - Knowledge of CVS/Aetna/Meritain Health’s policies and procedures. Education - Bachelor's Degree or equivalent work experience (high school diploma or GED + 4 years of relevant work experience). Benefits - Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. - Medical, dental, and vision coverage. - Paid time off. - Retirement savings options. - Wellness programs and other resources, based on eligibility.
Aon is in the business of better decisions. At Aon, we shape decisions for the better to protect and enrich the lives of people around the world. As an organization, we are united through trust as one inclusive team and we are passionate about helping our colleagues and clients succeed. Aon values an innovative and inclusive workplace where all colleagues feel empowered to be their authentic selves. Aon is proud to be an equal opportunity workplace. Aon provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, veteran, marital, domestic partner status, or other legally protected status. We are committed to providing equal employment opportunities and fostering an inclusive workplace. If you require accommodations during the application or interview process, please let us know.
Role Description As a Global Special Investigator, you will support Aon's global investigations program by leading complex inquiries involving employee misconduct, workplace violence, insider threats, financial crimes, data loss incidents, and other matters that may impact the firm's people, property, information, or reputation. Working closely with business leaders, Legal, Human Resources, Internal Audit, Cyber Security, and external law enforcement agencies, you will help identify, assess, and mitigate enterprise risks while delivering actionable intelligence and investigative findings. - Conducts complex investigations in all divisions and business units and is responsible for conducting internal investigations either directly or as a SME capacity in all markets. - Apply your expertise in qualitative and quantitative analysis, data mining, and the presentation of data to provide insight into internal risks and risk mitigation. - Mitigate threats to company assets; manage crises and deliver threat assessment services by collecting, evaluating and disseminating accurate and timely information to appropriate managers. - Conduct interviews with colleagues and contractors for suspected violations of policy. - Investigate possible violations of Aon’s codes and policies (finance, HR, conduct) or other business conditions (theft, vandalism, physical harm) and provide appropriate reports to management summarizing the findings. - Develop relationships with domestic and international law enforcement and government counterparts, as well as private sector peers. - Develop protocols and practices to assess and mitigate threats to company assets; manage crises and deliver threat assessment services by collecting, evaluating and disseminating accurate and timely information to appropriate managers. Qualifications - 10+ years of experience with investigations in a private sector/public sector environment. Private sector experience must indicate deep investigative experience. - Prior experience conducting diverse investigations ranging from workplace violence, threat mitigation, financial crimes, corrupt practices, thefts and insider threats. - Experience leading interviews including non-confrontational interviewing techniques. - Ability to work nights/weekends. - Other duties as assigned. Requirements - BS/BA or equivalent practical experience and investigative or interview certification through a national or international accredited organization. - For positions in San Francisco and Los Angeles, we will consider for employment qualified applicants with arrest and conviction record in accordance with local Fair Chance ordinances. Benefits - Aon offers a comprehensive package of benefits for full-time and regular part-time colleagues, including, but not limited to: - A 401(k) savings plan with employer contributions. - An employee stock purchase plan. - Consideration for long-term incentive awards at Aon’s discretion. - Medical, dental and vision insurance. - Various types of leaves of absence. - Paid time off, including 12 paid holidays throughout the calendar year. - 15 days of paid vacation per year. - Paid sick leave as provided under state and local paid sick leave laws. - Short-term disability and optional long-term disability. - Health savings account. - Health care and dependent care reimbursement accounts. - Employee and dependent life insurance and supplemental life and AD&D insurance. - Optional personal insurance policies. - Adoption assistance. - Tuition assistance. - Commuter benefits. - An employee assistance program that includes free counseling sessions. - Eligibility for benefits is governed by the applicable plan documents and policies.
We make a difference by simplifying the healthcare experience, for all of us, one person at a time.
• Extensive investigations into patient accounts that may require refunds • Utilize knowledge of all carrier types, including commercial and governmental • Apply high-level understanding of medical accounts receivable • Other duties as assigned
• Conduct complex investigations into intellectual property infringement using advanced OSINT techniques and digital intelligence tools • Gather and analyze information from online sources, including websites, social media, forums, and dark web environments • Identify counterfeit, trademark, and copyright infringement operations by uncovering hidden infrastructure, networks, and key actors • Perform code review, network traffic analysis, and technical investigations to understand illicit websites, applications, and devices • Develop and utilize automation scripts (e.g., Python) to streamline investigative processes • Prepare comprehensive investigative reports, criminal referrals, and actionable recommendations to support enforcement and legal action • Collaborate with analysts, investigators, attorneys, law enforcement, and clients to advance investigations and achieve case objectives • Present findings to stakeholders, translating complex technical information into clear, actionable insights
• Proactively detect and reacquire bad actors on our platform. • Investigate potentially policy-violating activity by querying internal data sources (using SQL and Python) and cross-referencing open source information (OSINT). • Document and share investigative findings with internal stakeholders.
Enabling a high-quality and viable healthcare system
• Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse. • Proactively monitors provider activity to identify patterns, anomalies, and emerging trends that may warrant further investigation. • Utilizes data analytics, claims review, and industry intelligence to detect potential fraud, waste, abuse, or non-compliance. • Leverages claims data, dashboards, and predictive models to identify providers exhibiting atypical billing patterns or potential fraud, waste, and abuse. • Analyze information gathered by investigation and report findings and recommendations as a written summary and/or presentation. • Conducts investigation-related training. • Supports legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions. • Maintain current knowledge of relevant laws, regulations and standards. • Complete all responsibilities as outlined on annual Performance Plan. • Complete all special projects and other duties as assigned.
Open Source, Python, SQL
