Fire Inspectors and Investigators

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.**

This position is full time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime.

We offer 4 weeks of on-the-job training. The hours of training will be aligned with your schedule.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

**Primary Responsibilities:**

+ Triage claims data to send for medical coding review to ensure adherence to PHI policies

+ Review medical records to gather relevant facts to drive investigations and communications

+ Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance

+ Utilize appropriate systems to monitor and document status of investigations

+ Monitor investigation status throughout the process

+ Collaborate with a variety of external sources to identify current and emerging patterns and schemes related for Fraud and Abuse.

+ Generally, work is self-directed and not prescribed

+ Work with less structured, more complex issues

+ Serve as a resource to others

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

**Required Qualifications:**

+ High School Diploma / GED

+ Must be 18 years of age OR older

+ 2+ years of experience with claims processing, provider medical records, or insurance billing practices

+ 1+ years of experience using claim platforms

+ Intermediate experience with Microsoft Office- Microsoft Excel (sort and filter data) and Microsoft Word (create and edit documents)

+ Ability to work full time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime.

**Preferred Qualifications:**

+ Experience working in health care industry

+ 1+ years of experience using claim platforms such as UNET, Pulse, NICE, Facets, or USP

+ Experience working with claims and/or recovery

+ Organization affiliation and/or certification with any of the following: Association of Certified Fraud Examiners (ACFE), Certified Fraud Examiner (CFE), National Health Care Anti-Fraud Association (NHCAA), Accredited Healthcare Fraud Investigator (AHFI), International Association of Special Investigation Units (IASIU), Certified Insurance Fraud Investigator (CIFI), Certified Insurance Fraud Analyst (CIFA), Certified Insurance Fraud Representative (CIFR)

**Telecommuting Requirements:**

+ Ability to keep all company sensitive documents secure (if applicable)

+ Required to have a dedicated work area established that is separated from other living areas and provides information privacy.

+ Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

**Soft Skills:**

+ Strong written and verbal communication skills

+ Ability to work in a team environment

+ Self-sufficient

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $23.41 - $41.83 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

**_Application Deadline_** _: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants._

_At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission._

_UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._

_UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

**Date Posted:**

2025-07-16

**Country:**

United States of America

**Location:**

VA108: 1100 Wilson Blvd, Arlington 1100 Wilson Boulevard

, Arlington, VA, 22209 USA

**Position Role Type:**

Hybrid

**U.S. Citizen, U.S. Person, or Immigration Status Requirements:**

This job requires a U.S. Person. A U.S. Person is a lawful permanent resident as defined in 8 U.S.C. 1101(a)(20) or who is a protected individual as defined by 8 U.S.C. 1324b(a)(3). U.S. citizens, U.S. nationals, U.S. permanent residents, or individuals granted refugee or asylee status in the U.S. are considered U.S. persons.

For a complete definition of “U.S. Person” go here.
https://www.ecfr.gov/current/title-22/chapter-I/subchapter-M/part-120/subpart-C/section-120.62

**Security Clearance:**

None/Not Required

At Raytheon, the foundation of everything we do is rooted in our values and a higher calling – to help our nation and allies defend freedoms and deter aggression. We bring the strength of more than 100 years of experience and renowned engineering expertise to meet the needs of today’s mission and stay ahead of tomorrow’s threat. Our team solves tough, meaningful problems that create a safer, more secure world.

We have an exciting opportunity for a **Senior Manager, Global Trade Investigations** who will manage internal investigations related to regulatory and policy violations specific to Global Trade (GT) compliance areas such as International Traffic in Arms Regulations (ITAR), Export Administration Regulation (EAR), Arms Export Control Act (AECA), U.S Customs & Border Patrol (USCBP), Office of Foreign Asset Control (OFAC), and Antiboycott.

**What You Will Do:**

+ Manage a dynamic caseload of internal regulatory and policy violation investigations.

+ Monitor and manage legal approval requests.

+ Provide consistent interpretation of ITAR, EAR, USCBP, OFAC, ATF, and Antiboycott to Business Unit employees.

+ Provide Subject Matter Expert guidance on Export/Import Regulations.

+ Provide Global Trade guidance on process, policy, regulations and/or other GT compliance matters to GT Team and/or to the other business stakeholders.

+ Manage closure of corrective action and process improvement tasks.

+ Key Performance Indicator innovator and monitor, such as metrics related to violation trends, risk areas, etc.

+ Develop and/or propose new processes (i.e., command media updates, tool enhancements, etc.) and/or new or revised processes due to regulatory changes, corporate initiatives/directives, corrective actions as a result of monitoring, etc.

+ Potential roles on Corporate Steering Committees/Task Teams to engage in developing and/or influence policy & process changes that may impact the Business.

+ Engage in Corporate GT projects.

**Qualifications You Must Have:**

+ Typically requires a University Degree or equivalent experience and minimum 10 years prior relevant experience, or an Advanced Degree in a related field and minimum 7 years’ experience

+ Experience with the AECA, ITAR, and EAR as well as the United States Munitions List (USML) and Commercial Control List (CCL) classification determination processes, export and import regulatory requirements

+ Experience with Global Trade licensing requirements and processes

+ Experience in Global Trade, legal, international business, contracts, supply chain, or engineering

**Qualifications We Prefer:**

+ Experience leading investigations, maintaining legal privilege and briefing senior stakeholders

+ Extensive knowledge of Global Trade systems such as DECCS, SNAP-R, OCR EASE, RGEMS and/or SAP systems

+ Experience making improvements to processes and/or systems to enhance performance of job area

+ Experience developing and conducting training

+ Excellent interpersonal, communication and writing skills and the ability to manage and prioritize multiple tasks

+ Experience operating with non-US trade regulations

**What We Offer**

Our values drive our actions, behaviors, and performance with a vision for a safer, more connected world. At RTX we value: Trust, Respect, Accountability, Collaboration, and Innovation.

Whether you’re just starting out on your career journey or are an experienced professional, we offer a robust total rewards package that goes above and beyond with compensation; healthcare, wellness, retirement, and work/life benefits; career development and recognition programs. Some of the benefits we offer include parental (including paternal) leave, flexible work schedules, achievement awards, educational assistance, and child/adult backup care.

**Learn More & Apply Now!**

Please consider the following role type definition as you apply for this role.

+ Hybrid: Employees who are working in Hybrid roles will work regularly both onsite and offsite. Ratio of time working onsite will be determined in partnership with your leader. Please see requisition details for approved work locations.

Raytheon Sites Virtual Tour | Raytheon (https://careers.rtx.com/global/en/raytheon-sites-virtual-tour) - With more than 50 Raytheon locations across the U.S., our team of difference-makers are building advanced technologies that power smarter, more connected defense solutions. Explore some of our key facilities to see how we’re delivering for all those who defend us.

The salary range for this role is 137,000 USD - 275,000 USD. The salary range provided is a good faith estimate representative of all experience levels.

RTX considers several factors when extending an offer, including but not limited to, the role, function and associated responsibilities, a candidate’s work experience, location, education/training, and key skills.

Hired applicants may be eligible for benefits, including but not limited to, medical, dental, vision, life insurance, short-term disability, long-term disability, 401(k) match, flexible spending accounts, flexible work schedules, employee assistance program, Employee Scholar Program, parental leave, paid time off, and holidays. Specific benefits are dependent upon the specific business unit as well as whether or not the position is covered by a collective-bargaining agreement.

Hired applicants may be eligible for annual short-term and/or long-term incentive compensation programs depending on the level of the position and whether or not it is covered by a collective-bargaining agreement. Payments under these annual programs are not guaranteed and are dependent upon a variety of factors including, but not limited to, individual performance, business unit performance, and/or the company’s performance.

This role is a U.S.-based role. If the successful candidate resides in a U.S. territory, the appropriate pay structure and benefits will apply.

RTX anticipates the application window closing approximately 40 days from the date the notice was posted. However, factors such as candidate flow and business necessity may require RTX to shorten or extend the application window.

_RTX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or veteran status, or any other applicable state or federal protected class. RTX provides affirmative action in employment for qualified Individuals with a Disability and Protected Veterans in compliance with Section 503 of the Rehabilitation Act and the Vietnam Era Veterans’ Readjustment Assistance Act._

**Privacy Policy and Terms:**

Click on this link (http://www.rtx.com/privacy/Job-Applicant-Privacy-Notice) to read the Policy and Terms

Raytheon Technologies is An Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status, age or any other federally protected class.

At U.S. Bank, we’re on a journey to do our best. Helping the customers and businesses we serve to make better and smarter financial decisions and enabling the communities we support to grow and succeed. We believe it takes all of us to bring our shared ambition to life, and each person is unique in their potential. A career with U.S. Bank gives you a wide, ever-growing range of opportunities to discover what makes you thrive at every stage of your career. Try new things, learn new skills and discover what you excel at—all from Day One.

**Job Description**

Partners with their assigned Line of Business, other Risk/Compliance/Audit (RCA) professionals, and RCA Managers to, depending on their function, create, implement, maintain, review or oversee an effective risk management framework. Participates in projects and/or activities that ensure compliance with applicable federal, state, and local laws and regulations. Identifies gaps and inform solutions that minimize losses resulting from inadequate internal processes, systems or human errors. Identifies, responds and/or escalates risks as appropriate. Serves as a functional liaison between the Line of Business and the Lines of Defense.

Basic Qualifications

- Bachelor's degree, or equivalent work experience

- Typically more than two years of applicable experience

Preferred Skills/Experience

- Intermediate knowledge of applicable laws, regulations, financial services, and regulatory trends that impact their assigned line of business

- Intermediate understanding of the business line’s operations, products/services, systems, and associated risks/controls

- Basic knowledge of Risk/Compliance/Audit competencies

- Strong analytical, process facilitation and project management skills

- Effective presentation, interpersonal, written and verbal communication skills

- Proficient computer navigation skills using a variety of software packages, including Microsoft Office applications and word processing, spreadsheets, databases, and presentations

If there’s anything we can do to accommodate a disability during any portion of the application or hiring process, please refer to our disability accommodations for applicants (https://careers.usbank.com/global/en/disability-accommodations-for-applicants) .

**Benefits:**

Our approach to benefits and total rewards considers our team members’ whole selves and what may be needed to thrive in and outside work. That's why our benefits are designed to help you and your family boost your health, protect your financial security and give you peace of mind. Our benefits include the following (some may vary based on role, location or hours):

+ Healthcare (medical, dental, vision)

+ Basic term and optional term life insurance

+ Short-term and long-term disability

+ Pregnancy disability and parental leave

+ 401(k) and employer-funded retirement plan

+ Paid vacation (from two to five weeks depending on salary grade and tenure)

+ Up to 11 paid holiday opportunities

+ Adoption assistance

+ Sick and Safe Leave accruals of one hour for every 30 worked, up to 80 hours per calendar year unless otherwise provided by law

U.S. Bank is an equal opportunity employer. We consider all qualified applicants without regard to race, religion, color, sex, national origin, age, sexual orientation, gender identity, disability or veteran status, and other factors protected under applicable law.

**E-Verify**

U.S. Bank participates in the U.S. Department of Homeland Security E-Verify program in all facilities located in the United States and certain U.S. territories. The E-Verify program is an Internet-based employment eligibility verification system operated by the U.S. Citizenship and Immigration Services. Learn more about the E-Verify program (https://careers.usbank.com/verification-of-eligibility-for-employment) .

The salary range reflects figures based on the primary location, which is listed first. The actual range for the role may differ based on the location of the role. In addition to salary, U.S. Bank offers a comprehensive benefits package, including incentive and recognition programs, equity stock purchase 401(k) contribution and pension (all benefits are subject to eligibility requirements). Pay Range: $66,640.00 - $78,400.00

U.S. Bank will consider qualified applicants with arrest or conviction records for employment. U.S. Bank conducts background checks consistent with applicable local laws, including the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act as well as the San Francisco Fair Chance Ordinance. U.S. Bank is subject to, and conducts background checks consistent with the requirements of Section 19 of the Federal Deposit Insurance Act (FDIA). In addition, certain positions may also be subject to the requirements of FINRA, NMLS registration, Reg Z, Reg G, OFAC, the NFA, the FCPA, the Bank Secrecy Act, the SAFE Act, and/or federal guidelines applicable to an agreement, such as those related to ethics, safety, or operational procedures.

Applicants must be able to comply with U.S. Bank policies and procedures including the Code of Ethics and Business Conduct and related workplace conduct and safety policies.

**Posting may be closed earlier due to high volume of applicants.**

At U.S. Bank, we’re on a journey to do our best. Helping the customers and businesses we serve to make better and smarter financial decisions and enabling the communities we support to grow and succeed. We believe it takes all of us to bring our shared ambition to life, and each person is unique in their potential. A career with U.S. Bank gives you a wide, ever-growing range of opportunities to discover what makes you thrive at every stage of your career. Try new things, learn new skills and discover what you excel at—all from Day One.

**Job Description**

U.S. Bank’s Special Investigations Unit (SIU) is seeking an investigative manager for its Emerging Risk and Trends (ERT) Team. The SIU is part of U.S. Bank’s Enterprise Financial Crimes Compliance (EFCC) organization, a second line of defense responsible for identifying and preventing individuals and businesses from using U.S. Bank products and services for illegal purposes and reporting suspicious activity to FinCEN and law enforcement.

As the Emerging Risk and Trends (ERT) Manager, you will lead a team responsible for exploratory and analytic-driven investigations derived from FinCEN alerts and advisories, internal referrals, law enforcement collaboration, as well as open-source reporting.

The ERT Team is also responsible for collaborating with other financial institutions through the 314(b) process to conduct joint large-scale investigations to identify networks suspected of money laundering, terrorist financing and other financial crimes.

This role reports directly to the Director of the Special Investigations Unit to ensure open communication regarding risks and compliance.

**Responsibilities:**

You’ll contribute to the bank’s overall strategy and risk profile by:

+ Contributing to the framework, policies, procedures and controls for effective identification and mitigation of the financial crime risks

+ Supporting EFCC strategic planning efforts

+ Leading a team of investigators who have the knowledge and skills to normalize and analyze large datasets, investigative complex financial crime transactions, flag anomalies, concisely document their findings and escalate emerging risks

+ Working closely with the EFCC Financial Intelligence Unit (FIU) to integrate emerging risks and trends into transaction monitoring.

+ Coordinating with law enforcement regarding the intake of financial crime intelligence or the sharing identified suspicious activity

+ Providing executive-level briefing to internal and external stakeholders

+ Monitoring changes in legal and regulatory frameworks related to law enforcement cooperation and adapt internal procedures

+ Ensuring confidentiality requirements are observed and data is protected

**Basic Qualifications**

+ Bachelor’s degree or equivalent work experience

+ 10 or more years of experience in an applicable risk management environment

+ Applicable certifications

**Preferred Skills/Experience**

+ 10 years of federal law enforcement experience leading complex financial crime investigations

+ Strong knowledge of AML regulations (BSA, Patriot Act), and FinCEN SAR filing requirements

+ Experience with AML transaction monitoring, anomalous detection, intelligence driven analyses

+ Excellent analytical, communication, and leadership skills

+ Ability to adapt to a changing environment

+ Knowledge of Microsoft Office applications, along with general proficiency in adapting to new software applications

+ Business acumen and credibility to help the business line proactively identify and address changing workforce needs

+ Strong leadership, partnering and coaching skills

+ Expert in applicable laws, regulations, financial services and regulatory trend that impact the line of business

If there’s anything we can do to accommodate a disability during any portion of the application or hiring process, please refer to our disability accommodations for applicants (https://careers.usbank.com/global/en/disability-accommodations-for-applicants) .

**Benefits:**

Our approach to benefits and total rewards considers our team members’ whole selves and what may be needed to thrive in and outside work. That's why our benefits are designed to help you and your family boost your health, protect your financial security and give you peace of mind. Our benefits include the following (some may vary based on role, location or hours):

+ Healthcare (medical, dental, vision)

+ Basic term and optional term life insurance

+ Short-term and long-term disability

+ Pregnancy disability and parental leave

+ 401(k) and employer-funded retirement plan

+ Paid vacation (from two to five weeks depending on salary grade and tenure)

+ Up to 11 paid holiday opportunities

+ Adoption assistance

+ Sick and Safe Leave accruals of one hour for every 30 worked, up to 80 hours per calendar year unless otherwise provided by law

U.S. Bank is an equal opportunity employer. We consider all qualified applicants without regard to race, religion, color, sex, national origin, age, sexual orientation, gender identity, disability or veteran status, and other factors protected under applicable law.

**E-Verify**

U.S. Bank participates in the U.S. Department of Homeland Security E-Verify program in all facilities located in the United States and certain U.S. territories. The E-Verify program is an Internet-based employment eligibility verification system operated by the U.S. Citizenship and Immigration Services. Learn more about the E-Verify program (https://careers.usbank.com/verification-of-eligibility-for-employment) .

The salary range reflects figures based on the primary location, which is listed first. The actual range for the role may differ based on the location of the role. In addition to salary, U.S. Bank offers a comprehensive benefits package, including incentive and recognition programs, equity stock purchase 401(k) contribution and pension (all benefits are subject to eligibility requirements). Pay Range: $126,820.00 - $149,200.00

U.S. Bank will consider qualified applicants with arrest or conviction records for employment. U.S. Bank conducts background checks consistent with applicable local laws, including the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act as well as the San Francisco Fair Chance Ordinance. U.S. Bank is subject to, and conducts background checks consistent with the requirements of Section 19 of the Federal Deposit Insurance Act (FDIA). In addition, certain positions may also be subject to the requirements of FINRA, NMLS registration, Reg Z, Reg G, OFAC, the NFA, the FCPA, the Bank Secrecy Act, the SAFE Act, and/or federal guidelines applicable to an agreement, such as those related to ethics, safety, or operational procedures.

Applicants must be able to comply with U.S. Bank policies and procedures including the Code of Ethics and Business Conduct and related workplace conduct and safety policies.

**Posting may be closed earlier due to high volume of applicants.**

**Job Description:**

Select Health is a not-for-profit community health plan serving more than 1 million members in the Intermountain west. Select Health’s line of businesses (LOB) includes Medicare, Medicaid, FEHB, Marketplace Qualified Health Plans and fully funded and self-funded Commercial plan. An Investigator in the Special Investigations Unit at Select Health receives and investigates allegations of Fraud Waste and Abuse (FWA) by gathering evidence through data analytics, records reviews, investigative interviews or by many other means, then presents findings in writing and orally to Select Health senior leadership as well as law enforcement agencies. This position is directly responsible for helping to protect billions of premium dollars used to pay claims, ensuring claims are paid appropriately and accurately.

**This role is remote the candidate must be able to work remotely and be okay to have virtual interactions with the team via teams. including on camera meetings and have a room that is isolated from outside traffic with a professional background.**

**We are committed to offering flexible work options where approved and stated in the job posting. However, we are currently not considering candidates who reside or plan to reside in the following states: California, Connecticut, Hawaii, Illinois, New York, Rhode Island, Vermont, and Washington.**

**Essential Functions**

+ Receives referrals through various sources and investigates potential Fraud Waste and Abuse allegations, seeking evidence by means of data analytics, records reviews, investigative interviews, surveillance, onsite audits and many other methods.

+ Presents investigative findings to executive leadership along with recommended corrective action plans to implement with subjects of investigations. These plans can vary greatly but often include provider education, overpayment collection, contract terminations and fraud referrals to law enforcement and other regulators.

+ Prepares detailed investigative reports for local and federal law enforcement agencies as well as for other regulatory agencies.

+ Assists local and federal law enforcement agencies or other regulators in supporting investigative efforts where Select Health may have exposure to the Fraud Waste or Abuse being investigated. This may be anything from sharing investigative findings, sharing industry knowledge up to and including testifying in court to work performed on specific investigations.

+ Ensures all regulatory and contract requirements are met in regard to work done in the Special Investigations Unit. Also assists in audit preparation and interviews when regulators or the Intermountain Internal Audit team audits Select Health’s Fraud Waste and Abuse program.

+ Prepare and present Fraud Waste and Abuse awareness training for new customer service agents, other departments within Select Health and Intermountain and at seminars and conferences.

+ Builds and maintains strong working relationships with other departments within Select Health critical to the success of the Special Investigations Unit. This position will also build and maintain these same working relationships with other insurance companies’ Special Investigations Units as well as Law Enforcement Agencies within the Select Health service area.

**Skills**

+ Analytical Thinking

+ Interpersonal Communication

+ Investigative Interviewing

+ Computer Literacy

+ Criminal Justice

+ Legal

+ Project Management

+ Insurance Fraud

+ Law Enforcement

+ Accounting

**Qualifications**

Minimum Qualifications

Eight years of professional experience in medical insurance, insurance fraud, law enforcement or related field. College degrees can also be counted towards years of professional experience when obtained through an accredited institution and is verified

Experience requiring effective problem-solving, critical thinking, process analysis, and other strong analytical skills.

Experience in managing or planning work assignments that require strong interpersonal and organizational skills and managing time effectively with minimum supervision.

Demonstrated collaboration, team-orientation, and initiative skills.

Demonstrated ability to interact professionally with mid– to upper-level management of clinics, pharmacies or other organizations.

Demonstrated ability to work independently, adapt to change quickly, deal with ambiguity, and multi-task.

Demonstrated proficiency in word processing and spreadsheets.

Ability to travel when necessary to attend educational opportunities such as conferences and seminars, to attend taskforce meetings or to conduct onsite audits and interviews to support investigations. Occasionally, travel will involve overnight stays.

Preferred Qualifications

Bachelor’s Degree in related field such as Business, Computer Science or Criminal Justice. Degree must be obtained through an accredited institution and is verified.

Certified Health Care Professional

Experience investigating, interviewing and working with law enforcement

Database querying skills, specifically using Standard Query Language (SQL)

Ability to proactively identify fraud schemes or anomalies in billing trends through data analytics

Health care and/or Health Insurance industry knowledge of medical and/or pharmacy claims, payment policies and terminology

Knowledge of federal and state fraud statutes including but not limited to mandatory reporting statutes, False Claims Act, Stark Laws, Anti-Kickback Statutes etc

Excellent problem solving, negotiation, and process improvement skills.

**Physical Requirements**

+ Ongoing need for employees to see and read information, documents, monitors, identify equipment and supplies, and be able to assess customer needs.

+ Frequent interactions with colleagues and providers require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately.

+ Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc.

**Physical Requirements:**

**Location:**

SelectHealth - Murray

**Work City:**

Murray

**Work State:**

Utah

**Scheduled Weekly Hours:**

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$30.55 - $48.12

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here (https://intermountainhealthcare.org/careers/benefits) .

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.

**Become a part of our caring community and help us put health first**

The Fraud and Waste Professional 2 is responsible for conducting comprehensive investigations of reported, alleged, or suspected fraud, waste, or abuse. This role involves varied work assignments that often require interpretation and independent judgement to determine the most appropriate course of action.

The Fraud and Waste Professional 2 works collaboratively with multiple departments to identify trends and analyze claims for potential fraud, waste, and abuse (FWA), ensuring accuracy, appropriate contract interpretation, and compliance with established policies and procedures. This role gathers and organizes evidence and documentation to support successful adjudication, where appropriate. The position requires experience preparing complex investigative and audit reports and presenting case outcomes and making recommendations to senior leadership. Responsibilities include initiating, coordinating, and reviewing audits of provider records to verify billing practices and ensuring compliance with state and federal regulations. The position requires understanding department, segment, and organizational strategy and operating objectives, including their linkages to related areas. The Fraud and Waste Professional 2 makes independent decisions regarding work methods, including in situations with ambiguity, and requires minimal direction, while following established guidelines and procedures.

**Use your skills to make an impact**

**Required Qualifications**

+ Registered and/or Pharmacy Technician Certification and at least 3 years retail, specialty, or mail order pharmacy experience or equivalent experience in FWA investigations

+ At least 3 years of experience with pharmacy and/or medical FWA investigations

+ In-depth knowledge of healthcare industry, claims processing, and payment methodologies

+ Strong organizational, interpersonal, and communication skills

+ Demonstrated ability to work independently, self-motivate, and effectively prioritize cases with minimal oversight

+ Extensive understanding of investigative procedures

+ Strong analytical skills with the ability to create and interpret metrics and data

+ Proficiency in Microsoft Office, particularly Excel

+ High standard of personal and professional ethics

+ Willingness and ability to travel up to 15%

**Preferred Qualifications**

+ CFE and/or AHFI Certifications

+ Bachelor's degree and/or other professional certifications or advanced degrees

+ Experience developing and establishing investigative processes and creating and revising policies and procedures

+ Experience using and/or creating visualizations in Power BI for data analysis and reporting

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

**Scheduled Weekly Hours**

40

**Pay Range**

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$65,000 - $88,600 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

**Description of Benefits**

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 07-22-2025

**About us**

About CenterWell Pharmacy: CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.

About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

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**Equal Opportunity Employer**

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options https://www.partnersinprimarycare.com/accessibility-resources

Description

The Special Projects & Investigations team is looking for an experienced, motivated industry specialist with background in risk, digital fraud, compliance, or cyber investigations who also have advanced data analysis skills (SQL, Python, Machine Learning, Data Science). This role will manage critical and high impact projects and scale their findings through technology and analytics to interpret risks across Amazon’s entire business segment or apply other industry experience to develop feasible, systematic solutions to endemic problems.

The Customer Trust (CT) organization's mission is to keep Amazon stores safe and trustworthy for our buyers, brands and selling partners, by enabling our selling partners to provide great CX while ensuring bad actors are kept out of our stores. The Special Projects & Investigations (SPI) team protects Amazon’s WW stores store by creating projects and programs focused on the detection of abuse at its earliest point and identifying the root causes, vulnerabilities or exploits to systematically address to prevent future abuse. We search out highly skilled candidates who move fast, have an entrepreneurial spirit to create new solutions, a tenacity to get things done, thrive in an environment of ambiguity and change, and are capable of breaking down and solving complex problems. We value individual expression, respect different opinions, and work together to create a culture where each of us is able to contribute fully. The combination of our unique backgrounds and perspectives strengthens our ability to achieve Amazon's mission of being Earth's most customer-centric company.

We catch bad actors and stop online fraud. It’s fun. It’s hard. It matters. We are passionate about protecting our selling partners and customers from bad actors and want a candidate that shares that passion. Amazon is one of the world’s most trusted companies. Help us keep it that way. To achieve this, the ideal candidate should be passionate about use of advanced data analytics and technology approaches to identify patterns and establish connections to uncover process and technology gaps and prevent fraud across Amazon stores worldwide. Your decisions are not only fundamental to helping protect customers and selling partners but will help maintain the health of Amazon’s catalog and product listings ecosystem.

Key job responsibilities

• Complete risk analyses and manipulate data in complex data sets (SQL, Python, R etc.)

• Use high-level judgment to inform our most complex enforcement decisions

• Identify gaps and risks in Amazon's current mechanisms and policies and recommend solutions to product/policy owning teams.

• Use data and/or technical skills to discover new ways to scale deep dive signals resulting in the identification of many bad actors and sizing the issue

• Owning the complete life cycle of one or more complex problems - from identification through scaling the solutions

• Break problems into manageable pieces, ruthlessly prioritizing, and delivering results in an ambiguous environment

• Conduct large scale deep dives to derive insights about tactics used to conduct abuse on our stores, identifying gaps and risk in Amazon's current mechanisms, systems, and policies

• Write documents for partner teams and executives that identify problems, propose technical solutions, and drive alignment among stakeholders

• Own partnerships with stakeholder teams and guide appropriate trade-offs, clearly communicate goals, roles and responsibilities.

A day in the life

Your day might involve diving deep into data to uncover emerging fraud patterns, collaborating with teams across Amazon to implement protective solutions, or developing new detection methods. You'll balance independent analytical work with team collaboration, sharing insights and supporting colleagues in our shared mission.

About the team

Our team is comprised of practitioners of fraud and abuse, working to understand bad actor ecosystems using threat intelligence analytics and technical skills. We complement specialized industry skills with broad risk experiences gathered through years of experience to deliver results - we wear a lot of hats and take ownership of hard to solve problem areas whenever possible. We speak 12 languages, write code in 3 (mostly self-taught, on the job), and celebrate learning and taking risks. We encourage experimentation and curiosity while supporting each other to constantly learn and grow.

Our work is to solve hard puzzles and identify what hasn’t already been discovered - typically with data and always with a lot persistence and curiosity. If you like the sound of that, come join us.

Basic Qualifications

• Bachelor’s or postgraduate degree in Information Security, Computer Science, Data Science/Analytics, Engineering, Mathematics, Statistics or related discipline.

• 3+ years of relevant industry experience in risk or fraud investigations, regulatory compliance, ecommerce, analytics, or security

• Proficient with deriving insights from big data using SQL & experience manipulating/processing data with Python

• Proven ability to deliver complex projects across multiple teams

Preferred Qualifications

• Experience working in e-commerce organizations

• Experience working within fraud, compliance, law enforcement, or intelligence organizations

• Experience with AWS services like Redshift, Neptune or Sagemaker

• Masters degree in or practical experience with data science or machine learning

• Excellent written and verbal communication skills to communicate security and business risk to a broad range of technical and non-technical audiences.

• High level of integrity and discretion to handle confidential information.

• Exceptional ownership and bias for action: willing to move quickly and decisively

• Proven ability to problem solve in large/complex/technical systems

Amazon is an equal opportunity employer and does not discriminate on the basis of protected veteran status, disability, or other legally protected status.

Our inclusive culture empowers Amazonians to deliver the best results for our customers. If you have a disability and need a workplace accommodation or adjustment during the application and hiring process, including support for the interview or onboarding process, please visit https://amazon.jobs/content/en/how-we-hire/accommodations for more information. If the country/region you’re applying in isn’t listed, please contact your Recruiting Partner.

Our compensation reflects the cost of labor across several US geographic markets. The base pay for this position ranges from $91,800/year in our lowest geographic market up to $196,300/year in our highest geographic market. Pay is based on a number of factors including market location and may vary depending on job-related knowledge, skills, and experience. Amazon is a total compensation company. Dependent on the position offered, equity, sign-on payments, and other forms of compensation may be provided as part of a total compensation package, in addition to a full range of medical, financial, and/or other benefits. For more information, please visit https://www.aboutamazon.com/workplace/employee-benefits . This position will remain posted until filled. Applicants should apply via our internal or external career site.

Government Solutions & Investigations Associate (#949) - Phoenix

Dorsey & Whitney LLP is seeking a Government Solutions and Investigations associate with one to three years of experience to join our Phoenix office. This associate will have the opportunity to work in all phases of government investigations, internal investigations, and government-facing and other complex litigation, from pleading through trial and appeal and in State and Federal courts throughout the United States. This position will involve significant responsibility over pending cases, investigations experience, compliance advising in various areas including anti-corruption and whistleblowing, and in-court experience and active motion and trial practice. Specifically, this associate will handle the following types of tasks for complex litigation and investigation matters:

- discovery

- oral advocacy

- brief writing

- depositions and witness interviews

- assisting with the analysis and development of compliance programs

- research

- trial preparation

- preparation of investigative reports for clients

The following qualifications are required:

- A JD degree from an ABA-accredited law school

- One to three years of law firm associate experience, with demonstrable skills in fact development, document review, legal writing and time/deadline management

- Arizona bar admission or the ability to be admitted to the Arizona bar

- Excellent research and writing skills

- Strong academic performance

Dorsey offers a collaborative and dynamic environment, with competitive compensation and excellent benefits. Our benefits are available to attorneys working 17+ hours/week along with their dependents, including spouses and domestic partners regardless of gender. Dorsey’s benefits package includes: comprehensive medical insurance with coverage for infertility, gender-affirming care, behavioral health, and access to virtual providers; dental insurance; vision insurance; 401(k) retirement savings plan; basic and optional life insurance; short and long-term disability; flexible time off; up to 15 weeks of paid parental leave with up to an additional 6-8 weeks of paid short-term disability for attorneys who give birth; paid holidays; adoption assistance; healthcare, dependent care, and transportation pre-tax reimbursement accounts; back-up child and elder care program; education and college advising program; virtual tutoring; wellbeing programs and activities; mass transit program (certain offices); travel assistance program; 24/7 employee assistance program with access to five confidential visits with a licensed counselor at no cost. Where applicable, attorneys may be eligible for a discretionary bonus and/or a productivity bonus, clerkship bonus, relocation expenses, and bar review expenses. First-year associates are also eligible for a salary advance and bar review stipend. (Some benefits are subject to eligibility criteria and may result in taxable income to the recipient.)

You will receive consideration for employment without regard to race, color, creed, religion, ancestry, sex, national origin, sexual orientation, gender identity, affectional preference, disability, age, marital status, familial status, status with regard to public assistance, military or veteran status, or any other legally-protected status.

Dorsey participates in E-Verify.

About Dorsey

Clients have relied on the international law firm of Dorsey & Whitney LLP since 1912 as a trusted legal advisor and valued business partner. With locations across the United States as well as Canada, Europe and Asia, Dorsey provides an integrated, dedicated approach to its clients' legal and business needs. Dorsey’s diverse client base includes more than one-third of Fortune 100 companies.

Our lawyers apply superb legal knowledge and skills with practical wisdom and a deep understanding of business and industry. We serve clients in nearly all industries, but focus on six key industries in which we have excellent depth and a history of achieving client success:

- Banking and Financial Institutions

- Development and Infrastructure

- Energy & Natural Resources

- Food, Beverage & Agribusiness

- Healthcare

- Technology

Among Dorsey’s many distinguished alumni are U.S. Supreme Court Justice Harry Blackmun, noted law professor and scholar William Prosser, Minnesota’s first woman judge Betty Washburn, former U.S. Vice President and Ambassador to Japan Walter Mondale, U.S. Senator Amy Klobuchar, former Corporation Counsel of the City of New York Zachary Carter, and U.S. Secretary of Agriculture Tom Vilsack. Recognized for our dedication to community, Dorsey has met the ABA Law Firm Pro Bono Challenge every year since the Challenge began in 1993 by devoting more than 3% of billable hours to pro bono work.

One of our greatest strengths is a friendly, cooperative culture that values and appreciates each individual. Dorsey has received external recognition for our welcoming workplace, including:

- Mansfield Certification Plus (Diversity Lab)

- Best Law Firms for Women (Seramount)

- 100% rating on the Corporate Equality Index (Human Rights Campaign)

- Top 100 Adoption-Friendly Workplace (Dave Thomas Foundation for Adoption)

How to Apply

Dorsey accepts online applications at https://www.dorsey.com/careers. We do not accept application materials by mail or email except as a reasonable accommodation for qualified disabled applicants. Dorsey is committed to providing disability and religious-based accommodations, as well as menopause, pregnancy, and lactation-related reasonable accommodations. If you require a reasonable accommodation in connection with the application or interview processes, or you have questions about a workplace reasonable accommodation, please contact us at 612-492-5033.

We are accepting application for this position until September 30, 2025.

Please note that Dorsey is not currently accepting search firm submissions in connection with this opening.

#LI-Hybrid

Seeking experienced Part-Time Private Investigators in the area to conduct SURVEILLANCE as it relates to the investigation of suspect insurance claims. We are seeking individuals who possess proven investigative skill sets within the industry. Honesty, integrity, self-reliance, resourcefulness, independence, discipline, and a calm intensity are a few characteristics of our Investigators and staff. Investigators with Scene Investigation and Recorded Statement experience are encouraged to apply.

If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at www.GoCommand.com .

Requirements:

+ 1+ years of experience as an Surveillance Investigator

+ Must be licensed as a Private Investigator in your state (if required)

+ Flexibility to work varied/irregular hours and days including weekends and holidays

+ Valid state issued driver's license

The Surveillance Investigator should demonstrate proficiency in the following areas:

+ Obtaining quality surveillance video evidence

+ Writing accurate and detailed reports

+ Strong initiative, integrity, and work ethic

+ Securing written/recorded statements

+ Accident scene investigations

+ Ability to prioritize and organize multiple tasks

+ Computer literacy to include Microsoft Word and Microsoft Outlook email

Full-Time benefits Include:

+ Medical, dental and vision insurance

+ 401K

+ Extensive performance bonus program

+ Dynamic and fast paced work environment

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Description

Selling Partner Trust and Store Integrity (TSI) is responsible for creating a trustworthy shopping experience across Amazon stores worldwide by protecting customers, brands, selling partners, vendors and Amazon from fraud, counterfeit, and abuse as well as providing world‐class support and building loyalty with Amazon’s millions of selling partners. The Special Projects & Investigations (SPI) team protects Amazon’s WW stores store by creating projects and programs focused on the detection of abuse at its earliest point and identifying the root causes, vulnerabilities or exploits to systematically address to prevent future abuse. Our growth requires highly skilled candidates who move fast, have an entrepreneurial spirit to create new solutions, a tenacity to get things done, thrive in an environment of ambiguity and change, and are capable of breaking down and solving complex problems. We value individual expression, respect different opinions, and work together to create a culture where each of us is able to contribute fully. The combination of our unique backgrounds and perspectives strengthens our ability to achieve Amazon's mission of being Earth's most customer-centric company.

We catch bad actors and stop online fraud; It’s fun! It’s hard! It matters! We are passionate about protecting our selling partners and customers from bad actors and want a candidate that shares that passion. We are looking for an experienced Manager with background in risk, digital fraud, compliance, and/or cyber investigations. You will manage the core investigative function to provide feedback to partner teams by identifying and interpreting risk across Amazon’s global stores. You will set the vision, direction and execution of key deliverables in the risk management space, developing business cases and requirements, and prioritizing competing opportunities. You will work with a wide range of global cross-functional teams and senior leaders to build feedback loops to drive scalable improvement across the broader organization. You will align your team to high impact business areas and executing to high expectations in a fast-paced and highly visible delivery area. The ideal candidate should have a blend of strong individual investigation skills along with experience managing a high performing risk team. You should be passionate about using and understanding data to discover bad actor trends and help us ensure that customers make great purchase decisions and our selling partners using Amazon are successful listing and selling their products. Your decisions and deliverables will help proactively mitigate risk and empower partner teams in making high confidence decisions that are fundamental to protecting Amazon customers, selling partners, and will help maintain the overall health of Amazon's WW stores.

Key job responsibilities

- Lead a high performing risk team by prioritizing high impact investigative leads that drive down business impact metrics

- Work within a sprint process to properly prioritize work and deliver results consistently

- Own end to end investigation flywheel to intake high quality leads from multiple sources to identify abuse and share detailed investigation briefs with partner teams to drive scalable detection and solutions

- Manage a strong risk team with a broad knowledge of abuse/fraud to conduct deep dives to derive insights about tactics used to conduct abuse on our WW stores

- Use high-level judgment to inform our most complex enforcement decisions and understand downstream impact and tradeoffs

- Develop goals, KPIs and metrics to track investigation health, progress, and impact. Effectively communicate challenges/roadblocks, progress and success to business and senior leadership.

- Provide feedback to partner teams and intake sources to improve the quality of leads and investigation outputs

- Break down problems into understandable and manageable pieces, ruthlessly prioritizing, and delivering results in an ambiguous environment

A day in the life

This role is focused on managing a high performing risk team and maintaining the health of the investigative flywheel from threat intelligence leads through long-term scalable detection solutions.

Your day might involve collaborating with partner teams across Amazon to develop and improve the quality and processes for investigation leads, diving deep into data to uncover emerging fraud patterns, or developing new detection methods. You'll balance independent analytical work with team collaboration, sharing insights and supporting internal partner teams to understand their priorities, capabilities, and workflows to see how/if your program should interact with their tools and goals. You will be making decisions that drive the strategic vision of your program in alignment with broader organizational goals and working with partner teams across Amazon to collaborate around strategic initiatives. You are on the front lines of protecting Amazon customers and stopping abuse in our stores.

About the team

Our team is comprised of experts in the risk domains like fraud, cybersecurity, data security, internal risk, threat intelligence, regulatory compliance, vendor risk, etc. with data analysis and/or technical skills. We complement specialized industry skills with broad risk career experience - we wear a lot of hats and take ownership of hard to solve problem areas whenever possible. We speak 12 languages, write code in 3 (mostly self taught, on the job), and celebrate learning and taking risks. We encourage experimentation and curiosity while supporting each other to constantly learn and grow.

Our work is to solve hard puzzles and identify what hasn’t already been discovered - typically with data and always with a lot persistence and curiosity. If you like the sound of that, come join us.

Basic Qualifications

- Bachelor’s or postgraduate degree in Information Security, Computer Science, Data Science/Analytics, Engineering, Mathematics, Statistics or related discipline.

- 5+ years of relevant industry experience, either as an IC or manager, in risk or fraud investigations, regulatory compliance, ecommerce, analytics, or security

- Prior experience managing a high performing team

- Proven ability to deliver complex projects across multiple teams

- High level of integrity and discretion to handle confidential information

- Excellent written and verbal communication skills to communicate security and business risk to a broad range of technical and non-technical audiences, including senior leadership

Preferred Qualifications

- Experience working in e-commerce organizations

- Exceptional ownership and bias for action: willing to move quickly and decisively

- Experience working within fraud, compliance, law enforcement, or intelligence organizations

- 5+ years of high performance team management

- Experience with threat intel collection and combing through multiple leads or large data to identify top priorities

Amazon is an equal opportunity employer and does not discriminate on the basis of protected veteran status, disability, or other legally protected status.

Our inclusive culture empowers Amazonians to deliver the best results for our customers. If you have a disability and need a workplace accommodation or adjustment during the application and hiring process, including support for the interview or onboarding process, please visit https://amazon.jobs/content/en/how-we-hire/accommodations for more information. If the country/region you’re applying in isn’t listed, please contact your Recruiting Partner.

Our compensation reflects the cost of labor across several US geographic markets. The base pay for this position ranges from $119,900/year in our lowest geographic market up to $198,300/year in our highest geographic market. Pay is based on a number of factors including market location and may vary depending on job-related knowledge, skills, and experience. Amazon is a total compensation company. Dependent on the position offered, equity, sign-on payments, and other forms of compensation may be provided as part of a total compensation package, in addition to a full range of medical, financial, and/or other benefits. For more information, please visit https://www.aboutamazon.com/workplace/employee-benefits . This position will remain posted until filled. Applicants should apply via our internal or external career site.