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Sarah Jenkins
Remote Healthcare Fraud Investigator jobs in the United States
Job type
Min. salary, $/year
Level
The need for vigilant fraud detection specialists keeps climbing as insurers and government agencies nationwide work to curb costly abuse within the medical billing system. Currently, 500+ remote healthcare fraud investigator positions are open across the USA, giving skilled professionals the flexibility to safeguard patient care from anywhere in the country. This steady growth reflects a broader shift toward stronger compliance and data-driven oversight nationwide.
Successful investigators bring strong analytical thinking, close attention to detail, and a solid grasp of medical billing, coding, and claims procedures. Familiarity with fraud detection software, data analytics, and regulations such as HIPAA and the False Claims Act is highly valued, along with clear communication skills for collaborating with auditors, legal teams, and law enforcement partners.
Remote work has become the norm for this role, with investigators reviewing cases, analyzing data, and conducting interviews through secure digital platforms rather than traditional offices. Across the USA, insurers, hospitals, and federal agencies continue expanding their teams to counter fraud tied to telehealth and digital claims, making healthcare fraud investigator remote jobs increasingly accessible nationwide.
If you're ready to put your investigative skills to work in a meaningful, fast-growing field, now is the perfect time to explore current openings in this specialty. Global Work AI connects dedicated professionals with organizations seeking talent to protect patients and insurers alike—take the next step in your career today.
Peraton
Evaluate referrals and complaints, develop investigations to identify potential fraud, and analyze claims data for aberrancies. Conduct interviews, report findings, and organize case files. Educate stakeholders on program safeguard matters and document all steps taken in investigations.
remote, NC, United States$39k – $62k/yrFull TimeJunior (<2 years)
CareSource
Lead investigations into fraud, waste, and abuse (FWA) by collaborating with internal and external partners. Utilize data analytics to identify trends and anomalies in billing behavior. Ensure compliance with regulatory reporting and manage case turnaround times.
remote, United States$83k – $133k/yrFull TimeLead / Manager
Ascensus
Lead complex fraud investigations involving multiple accounts and transactions. Identify and analyze emerging fraud trends and risk indicators. Conduct root cause analysis and recommend improvements to fraud controls. Prepare comprehensive case documentation and support high-priority escalations.
remote, MA, United StatesFull TimeSenior (5+ years)
Binance.US
Investigate complex fraud cases including account takeover and identity theft. Secure accounts to prevent financial loss and identify fraud trends for management.
remote, United StatesFull TimeSenior (5+ years)
Zotec Partners
Investigate patient accounts to resolve credit balances, determining necessary refunds or adjustments. Analyze medical billing documentation and data, applying knowledge of various carrier types. Collaborate with team members to ensure timely resolution of issues and meet specific goals.
remote, United StatesFull TimeJunior (<2 years)
Davies
Conduct comprehensive investigations into suspected fraud, misrepresentation, and claim irregularities across multiple insurance lines. Review claim files and supporting documentation to develop investigative strategies.
remote, CA, United States$65k – $82k/yrFull TimeJunior (<2 years)
Jobgether
Manage relationships with healthcare organizations to prevent fraud, waste, and abuse. Support partner onboarding, facilitate data-sharing activities, and ensure accurate integration into a centralized data warehouse.
remote, United States$64k – $86k/yrFull TimeJunior (<2 years)
General Dynamics Information Technology
Manage relationships with Healthcare Fraud Prevention Partnership members, ensuring they utilize membership benefits. Capture and communicate Partner feedback to leadership, assist with onboarding activities, and support HFPP and non-HFPP events.
remote, United States$64k – $86k/yrFull TimeJunior (<2 years)Peraton
Conduct complex investigations of medical service providers, develop cases for law enforcement referrals, and analyze evidentiary patterns. Collaborate with internal and external agencies, prepare investigative reports, and maintain confidentiality of health privacy information.
remote, FL, United States$66k – $106k/yrFull TimeSenior (5+ years)
State of Washington
Evaluate allegations of provider fraud in Washington’s Medicaid program, building cases from start to finish. Design and implement investigative strategies, manage case assignments, and communicate results to stakeholders.
remote, IA, United States$71k – $96k/yrFull TimeJunior (<2 years)
Oscar Health
Detect and investigate fraud, waste, and abuse (FWA) in claims and enrollment data. Analyze data and manage investigative caseload from identification to resolution, including overpayment recovery.
remote, United States$65k – $95k/yrFull TimeSenior (5+ years)
Guidehouse
Conduct identity fraud investigations, analyze account and identity information, and document findings. Utilize investigative tools to identify fraud indicators and manage investigative caseloads.
remote, United States$74k/yrFull TimeJunior (<2 years)
Gainwell Technologies LLC
Lead client support, training, onboarding, and enablement activities for FraudCapture. Manage user account setup, training curriculum, and client communication plans. Oversee defect management and monitor product adoption, training effectiveness, and support trends to enhance client satisfaction.
remote, United States$109k – $156k/yrFull TimeSenior (5+ years)
Mercury
Lead fraud incident management across all Mercury products, mobilizing incident response and coordinating with cross-functional teams. Draft incident reports and memos for bank partners and internal governance, ensuring accurate and timely responses.
remote, United States$139k – $193k/yrFull TimeSenior (5+ years)
Martin’s Point Health Care
Investigate suspected fraud, waste, and abuse (FWA) from intake to resolution, including data analysis, medical record review, and interviews. Develop case plans, analyze claims data, and coordinate with internal departments.
remote, United States$76k – $93k/yrFull TimeSenior (5+ years)
Cotiviti
Investigate and analyze instances of healthcare fraud, waste, and abuse. Conduct interviews and gather information to report findings and recommendations. Provide investigation-related training and support legal proceedings, including testifying in court.
remote, United States$74k – $91k/yrFull TimeSenior (5+ years)State of Michigan
Review and investigate complex activities of Medicaid Managed Care Entities (MCEs) and MI Choice Waiver Agencies regarding fraud, waste, and abuse. Ensure compliance with program integrity requirements, monitor corrective action plans, and advise on regulatory changes.
remote, MI, United States$62k – $91k/yrFull TimeSenior (5+ years)
Allstate
Investigate and analyze complex claims referred to the Special Investigative Unit for potential fraud. Conduct thorough investigations including background searches, scene investigations, and witness interviews. Validate information accuracy and summarize findings in claim system notes.
remote, IL, United States$69k/yrFull TimeJunior (<2 years)
United Auto Insurance
Conduct field and desk investigations to detect fraud on complex claims, including staged accidents and questionable medical treatments. Prepare and submit comprehensive investigative reports, maintain investigation files, and conduct interviews with insureds, claimants, and witnesses.
remote, FL, United StatesFull TimeLead / Manager
Amerihealth Caritas
Conduct comprehensive investigations of fraud, waste, and abuse in healthcare. Perform interviews with providers and members, analyze claims data using fraud detection software, and prepare investigative reports.
remote, United StatesFull TimeMiddle (2-4 years)
Humana
Conduct comprehensive investigations of fraud involving South Carolina's Medicaid Program. Analyze healthcare payment methodologies and billing practices to detect irregularities. Prepare detailed investigative summaries and audit reports.
remote, SC, United States$65k – $89k/yrFull TimeJunior (<2 years)
Manulife
Conduct complex long-term care investigations, develop investigative plans, and manage third-party surveillance vendors. Obtain and review documents, conduct interviews, and produce detailed reports. Communicate findings to management and prepare cases for law enforcement when necessary.
remote, NJ, United States$92k – $160k/yrFull TimeSenior (5+ years)General Dynamics Information Technology
Lead technical tasks related to analyzing claims data and reviewing Medicaid law and policy. Develop data-driven solutions for complex business challenges and collaborate with predictive modeling teams to enhance customer experiences.
remote, United States$153k – $207k/yrFull TimeSenior (5+ years)
Healthcare Fraud Shield
Collaborate with the SIU team to perform quality checks, assist in research, and make coding determinations. Analyze patient medical records for fraud investigations, compare claims information, and document findings in spreadsheets.
remote, United StatesFull TimeJunior (<2 years)United Auto Insurance
Conduct field and desk investigations to detect fraud on complex claims, including staged auto accidents and questionable medical treatment. Prepare and submit comprehensive investigative reports, maintain investigation files, and conduct interviews with insureds, claimants, and witnesses.
remote, TX, United StatesFull TimeSenior (5+ years)
BMC Software
Lead investigations into healthcare fraud, waste, and abuse (FWA), including medical record audits and provider interviews. Prepare investigative reports with findings and recommendations, and maintain records in departmental databases.
remote, MA, United States$78k – $113k/yrFull TimeMiddle (2-4 years)
CoventBridge Integrity Systems
Evaluate leads, complaints, and investigations to verify potential fraud. Conduct independent reviews and utilize data analysis techniques to detect anomalies in Medicare and Medicaid claims.
remote, OH, United States$70k – $77k/yrFull TimeJunior (<2 years)
GEICO
Conduct investigations of suspected fraud or illegal activities, including interviewing witnesses and gathering evidence. Evaluate information credibility, coordinate with outside agencies, and provide training to claims departments.
remote, NY, United States$37k – $57k/yrFull TimeSenior (5+ years)Gainwell Technologies LLC
Lead client support, training, onboarding, and enablement activities for FraudCapture. Manage client user account setup, training curriculum, and communication plans. Oversee defect management and monitor product adoption, training effectiveness, and support trends to enhance client satisfaction.
remote, United States$109k – $156k/yrFull TimeSenior (5+ years)Cotiviti
Investigate and analyze instances of healthcare fraud, waste, and abuse using data analytics. Monitor provider activity for patterns and anomalies, leveraging claims data and predictive models. Report findings and recommendations through written summaries or presentations.
remote, United States$61k – $81k/yrFull TimeJunior (<2 years)Gainwell Technologies LLC
Analyze Medicaid claims data using established fraud, waste, and abuse (FWA) analytic models. Deliver monthly FWA lead referral reports and produce clear, actionable intelligence for state OIG staff.
remote, United States$69k – $99k/yrFull TimeSenior (5+ years)
Nymbus, Inc.
Lead investigations into complex fraud cases, analyze transactional data to identify patterns, and develop detailed fraud reports for clients. Collaborate with internal teams and clients to ensure accurate documentation and resolution of fraud incidents.
remote, United States$65k – $70k/yrFull TimeSenior (5+ years)Amerihealth Caritas
Establish SIU strategy and governance for fraud prevention and detection; lead investigative teams and manage performance; oversee case lifecycle from intake to closure; direct analytics and surveillance activities; ensure compliance with federal and state regulations; build cross-functional…
remote, United StatesFull TimeDirector
Integrity Management Services, Inc.
Conduct investigations into potential fraud, waste, and abuse in healthcare programs. Analyze healthcare data to identify trends and anomalies, document findings, and prepare reports. Collaborate with internal teams and external stakeholders to develop investigative strategies and present findings.
remote, United States$45k – $65k/yrFull TimeSenior (5+ years)
Horizon Blue Cross Blue Shield of New Jersey
Supervise a team of investigators in detecting fraudulent activities related to health insurance. Guide case management and documentation for fraud cases, coordinating with legal and regulatory agencies. Provide litigation support and represent the company in negotiations and legal proceedings.
remote, CT, United States$87k – $119k/yrFull TimeLead / Manager
Molina Healthcare
Conduct investigations into healthcare fraud, waste, and abuse (FWA), including preliminary assessments, witness interviews, and data analytics. Develop leads, prepare audit reports, and ensure compliance with regulations.
remote, Long Beach, CA, United StatesFull TimeJunior (<2 years)Molina Healthcare
Investigate and resolve healthcare fraud and abuse cases by reviewing medical claims and records. Ensure compliance with CPT guidelines and regulatory requirements while managing caseloads.
remote, Long Beach, CA, United StatesFull TimeJunior (<2 years)
Staffing Solutions Organization LLC (SSO)
Conduct investigations of incidents involving Medicaid recipients and providers, ensuring compliance with health and welfare standards. Review documentation, perform interviews, and accurately document investigative activities. Identify rule violations and develop investigation summary reports.
remote, OH, United States$53k – $55k/yrFull TimeJunior (<2 years)Staffing Solutions Organization LLC (SSO)
Investigate incidents involving Medicaid recipients and providers, ensuring compliance with health and welfare standards. Review documentation, conduct interviews, and accurately document findings. Identify rule violations and develop investigation summary reports.
remote, OH, United States$53k – $55k/yrFull TimeJunior (<2 years)
Centene Corporation
Conduct comprehensive reviews of medical records and documents supporting claims, investigate coding and billing issues, verify service authorizations, ensure accuracy of diagnosis and procedure codes, coordinate medical necessity determinations, develop reports of findings, and assist SIU…
remote, MO, United States$56k – $101k/yrFull TimeJunior (<2 years)10,000,000+ more jobs available!
