Senior Medical Investigator

2 weeks ago


San Antonio TX, United States USAA Full time

Why USAA?At USAA, we have an important mission: facilitating the financial security of millions of U.S. military members and their families. Not all of our employees served in our nation’s military, but we all share in the mission to give back to those who did. As a dedicated SIU field investigator, within defined guidelines and framework, you will help protect USAA and our members from potential fraudulent claims by investigating complex fraud investigations with significant financial impact to USAA. This may involve working with Legal Counsel, government agencies and outside consultants in compliance with state laws and regulations for an assigned operational specialty team.

This is a field-based role in Texas . Leads the execution of fraud prevention strategies and investigative operations.
Leads high exposure, high profile and critical work assignments, and special investigations involving sophisticated niche fraud referrals, (examples: organized provider rings, staged accidents, large losses of significant exposure and broad scale PIP/Casualty Schemes) across multiple entities or functions.
Applies advanced knowledge of P&C insurance industry products, services, and processes in investigating claims. This includes P&C insurance policy contracts and coverages and claims handling process and procedures.
Applies advanced knowledge of state laws and regulations pertaining to insurance fraud in investigating claims.
Processes large quantities of unstructured detailed information with high levels of accuracy by collecting evidence of potential fraud through field or remote interviews and thorough searches of investigative databases, internal resources, Internet resources, public records, and forensic tools.
Makes appropriate and prompt decisions to identify potential complex fraud within defined guidelines.
Serves as subject matter authority for team members including providing expert mentorship and training for fraud investigations.
Develops and maintains external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection, and prevention.
Ensures risks associated with business activities are effectively identified, measured, supervised, and controlled in accordance with risk and compliance policies and procedures.

4 years of P&C SIU/Fraud investigation experience; OR 6 years relevant fraud industry investigation experience.
~ Expert knowledge and understanding of fraud investigations as well as application of case law and state laws and regulations .
~ Ability to capture broad range of evidence and draw conclusions based on the objective details related to the applicability of fraud.
~ Experience using computers and various software packages to enter and extract data for analysis from relevant data sources and systems.
~ Knowledge of city, state and local regulations, legal concepts, understanding of contracts, case law, medical treatment, and medical terminology.
~ Experience in concurrent handling of specialty/complex/litigated claims/cases as well as mediation/arbitration/trial preparation and participation.  

Experience investigating staged accidents and reviewing medical bills
Experience working in projects within SIU
Compensation: USAA has an efficient process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.

Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.


  • Senior Investigator

    7 days ago


    San Antonio, Texas, United States USAA Full time

    About the RoleUSAA is seeking a highly skilled and experienced Senior Investigator to join our team. As a Senior Investigator, you will play a critical role in protecting USAA and our members from potential fraudulent claims by investigating complex fraud investigations with significant financial impact.Key ResponsibilitiesLead the execution of fraud...


  • San Antonio, Texas, United States Texas Department of Aging & Disability Services Full time

    Job Overview: Senior Child Welfare Investigator This role, guided by a child placement supervisor, entails performing sophisticated social work related to protective services, intake, child maltreatment investigations, foster care, and adoption processes. Responsibilities include assessing situations of family emotional and/or physical distress that may...


  • San Antonio, Texas, United States United Services Automobile Association - USAA Full time

    Job SummaryAs a dedicated Senior Fraud Investigator within the Claims Operations team at United Services Automobile Association (USAA), you will play a critical role in protecting the organization and its members from potential fraudulent claims. This involves conducting complex fraud investigations with significant financial impact to USAA.Key...


  • San Antonio, Texas, United States General Dynamics Full time

    Key Responsibilities for this Role Location: USA TX Home Office (TXHOME) Employment Type: Full time Job Reference: RQ179043 Type of Employment: Regular Required Clearance Level: Top Secret Clearance Level to Obtain: Top Secret Suitability Requirement: Public Trust/Other Required: Job Family: SCA Qualifications: Essential Skills: Effective...


  • San Antonio, Texas, United States United Services Automobile Association - USAA Full time

    About the RoleAs a dedicated Senior Fraud Investigator, you will play a critical role in safeguarding USAA and its members from potential fraudulent claims. Within defined guidelines and framework, you will investigate complex fraud investigations with significant financial impact to USAA.Key ResponsibilitiesConduct thorough investigations into complex fraud...

  • Field Investigator

    7 days ago


    San Antonio, Texas, United States USAA Full time

    About the RoleUSAA is seeking a highly skilled and experienced Senior Investigator to join our team. As a Senior Investigator, you will play a critical role in protecting USAA and our members from potential fraudulent claims by investigating complex fraud investigations with significant financial impact.Key ResponsibilitiesLead the execution of fraud...

  • Senior Investigator

    7 days ago


    San Antonio, Texas, United States CAPPS, Inc. Full time

    Job DescriptionJob Summary:The Medicaid Fraud Control Unit (MFCU) Division of the Office of the Attorney General (OAG) is seeking a highly skilled and experienced Senior Investigator to perform advanced criminal investigations of Medicaid provider fraud and nursing home related investigations.Key Responsibilities:Conduct complex criminal investigations of...


  • San Antonio, Texas, United States Texas Department of Aging & Disability Services Full time

    Job Overview: Senior Child Protection Investigator This role, under the guidance of a child placement supervisor, engages in comprehensive social work pertaining to protective services, intake, child maltreatment investigations, foster care, and adoption processes. The responsibilities include assessing appropriate interventions to address family emotional...


  • San Antonio, Texas, United States Texas Department of Aging & Disability Services Full time

    Job Overview: Senior Child Protection Investigator This role, guided by a child placement supervisor, entails performing specialized social work focused on protective services, intake processes, investigations of child abuse or neglect, as well as foster care and adoption services. Responsibilities include evaluating situations that may lead to emotional...


  • San Antonio, TX, United States USAA Full time

    Why USAA?At USAA, we have an important mission: facilitating the financial security of millions of U.S. military members and their families. Not all of our employees served in our nation’s military, but we all share in the mission to give back to those who did. As a dedicated Senior Property Adjuster, you will work within established guidelines and...


  • San Francisco, United States The Ladders Full time

    Senior Financial Investigator (SFI) and Financial Investigator (FI): Organizes and conducts detailed examinations of information generated during complex financial criminal/civil investigations and information available through alternative sources for the purpose of conducting financial analyses of personal/business assets of targeted...


  • San Francisco, United States Pacific Gas and Electric Company Full time

    Requisition ID # 156131  Job Category: Human Resources  Job Level: Individual Contributor Business Unit: Human Resources & Enterprise Change Ofc Work Type: Hybrid Job Location: Oakland Department Overview The Human Resources (HR) department is committed to providing PG&E employees with the tools, information, and services to help...

  • Senior Investigator

    8 hours ago


    San Antonio, Texas, United States CAPPS, Inc. Full time

    About the RoleWe are seeking a highly skilled and experienced Investigator to join our Medicaid Fraud Control Unit (MFCU) team at CAPPS, Inc. As an Investigator, you will play a critical role in conducting complex criminal investigations of Medicaid provider fraud and nursing home related investigations.Key ResponsibilitiesConduct advanced criminal...


  • San Antonio, United States Raba Kistner Inc. Full time

    Job DescriptionJob DescriptionRaba Kistner, Inc. is a premier Engineering Consulting and Program Management firm. Our purpose is to build a better and more sustainable world for our employees, their families, our clients, and the communities we serve. Our Core Values are:Community “We care for our communities”Integrity “We act with integrity”Passion...


  • San Antonio, United States Texas Department of Aging & Disability Services Full time

    Job Description: IMPORTANT NOTICE: This is a specialized position requiring previous experience as a police officer. This is not an entry-level opportunity. CRITICAL REQUIREMENTS: Prior Law Enforcement/Police Experience: Applicants must have significant prior experience in law enforcement roles. This includes experience at the federal level or as a...


  • SAN ANTONIO, United States USAA Full time

    Why USAA?At USAA, we have an important mission: facilitating the financial security of millions of U.S. military members and their families. Not all of our employees served in our nation’s military, but we all share in the mission to give back to those who did. We’re working as one to build a great experience and make a real impact for our members.We...


  • San Antonio, Texas, United States Golden Visions Senior Living Full time

    Job SummaryWe are seeking a compassionate and skilled Certified Medication Aide to join our team at Golden Visions Senior Living. As a Medication Aide, you will play a vital role in providing exceptional care and support to our residents, ensuring their physical, emotional, and social needs are met.Key ResponsibilitiesDevelop and Implement Care Plans:...

  • CPI Investigator III

    1 month ago


    San Antonio, United States Texas Department of Aging & Disability Services Full time

    Job Description: CPI Investigator III The position, under the direction of a child placement supervisor, performs advanced social work related to protective services, intake, child abuse or neglect, investigation, foster care and adoptions. Work involves making determinations of appropriate actions necessary to resolve family emotional and/or physical...


  • San Diego, California, United States Department of Justice Full time

    Job Overview Are you passionate about combating fraud in the healthcare sector? Do you possess strong analytical and quantitative abilities? The Division of Medi-Cal Fraud and Elder Abuse Investigation is seeking skilled investigative auditors who are dedicated to uncovering fraudulent activities and safeguarding vulnerable populations. Key Responsibilities...


  • SAN ANTONIO, United States USAA Full time

    Why USAA?Let’s do something that really matters.At USAA, we have an important mission: facilitating the financial security of millions of U.S. military members and their families. Not all of our employees served in our nation’s military, but we all share in the mission to give back to those who did. We’re working as one to build a great experience and...