Fire Inspectors and Investigators

*FINANCIAL CRIMES INVESTIGATOR SENIOR*

WHAT IS THE OPPORTUNITY?

Responsible for performing analysis on clients' transactions identified through the bank's anti-money laundering (AML) system to ensure compliance with BSA and USA Patriot Act.

What you will do

* Perform analysis on clients' transactions identified through the monitoring system that involves various transaction types including but not limited to cash, wire transfers, remote deposit capture and loans.

* Perform timely investigations with well-reasoned and supported decision making.

* Utilize a variety of internal bank systems and external research tools to investigate, research, and prepare documentation related to anti-money laundering investigations consistent with resolution of investigation.

* Conducts follow-up with line colleagues for any missing or necessary information. Completes required training.

*Must-Have**

* Bachelor's Degree or equivalent

* 5-7 years' experience in Banking Services, branch operations, risk management, or other related function.

* Three years BSA/AML experience.

*Skills and Knowledge*

* Analytical skills, solid understanding of deposit and loan transactions, use of good judgment, attention to detail, internet savvy, solid knowledge of Bank Secrecy Act and USA PATRIOT acts.

*Compensation*

Starting base salary: $71,869 - $114,797 per year. Exact compensation may vary based on skills, experience, and location. This job is eligible for bonus and/or commissions.

**To be considered for this position you must meet at least these basic qualifications*

The preceding job description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this job.

*Benefits and Perks*

At City National, we strive to be the best at whatever we do, including the benefits and perks we offer our colleagues. Get an inside look at our (https://image.emails.cnb.com/lib/fe5e15707c640c78771c/m/10/cbedd856-c2fc-491b-a625-3ab7a0fd9a65.pdf).

ABOUT CITY NATIONAL

City National Bank, a subsidiary of Royal Bank of Canada, is the largest bank headquartered in Los Angeles with $92.03 billion in assets as of April 30, 2024. Founded in 1954, City National provides personalized banking, investment and trust services in select markets including Los Angeles, Orange County, San Diego, the San Francisco Bay Area, New York City, Nashville, Atlanta, Delaware, Las Vegas, Washington D.C. and Miami.* In addition, the company and its investment affiliates manage or administer $96.83 billion in client investment assets. City National is dedicated to strengthening communities, and in 2023 alone, the company made more than $11 million in charitable contributions to nonprofits that support the communities it serves.

*City National Bank does business in Miami and the state of Florida as CN Bank.

For more information about City National, visit (https://www.cnb.com/).

*EQUAL OPPORTUNITY EMPLOYER & REASONABLE ACCOMMODATION*

City National Bank is an equal opportunity employer committed to promoting and maintaining a diverse, equitable and inclusive working environment where differences are valued and encouraged. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status or any other basis protected by the laws or regulations in the locations where we operate or in our Code of Conduct. (https://image.emails.cnb.com/lib/fe5e15707c640c78771c/m/1/159726e0-aeb1-4058-9052-d7a2d69626b8.pdf)

If you are a qualified individual with a disability or a disabled veteran, you have the right to request a reasonable accommodation for any part of the employment process. Please contact us via (mailto:[email protected]) or leave a message at (213) 673-9139. These contact methods are dedicated to applicants whose disability prevents them from successfully applying online. Only messages left for this purpose will be returned. Responses may take up to two business days.

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

The Fraud and Waste Professional 2 conducts investigations of allegations of fraudulent and abusive practices. The Fraud and Waste Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

**Where You Come In**

The Fraud and Waste Professional 2 coordinates investigation with internal and external entities including compliance, internal business partners, and law enforcement. Assembles evidence and documentation to support successful adjudication, where appropriate. Prepares complex investigative and audit reports. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

**What Humana Offers**

We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education

**Use your skills to make an impact**

**WORK STYLE:** Remote, work at home with minimal travel (for on-sites, conferences, trainings, and/or meetings)

**WORK HOURS:** Monday-Friday, 8 hours/day, 5 days/week. Must start between 6AM-9AM (in the employee's time zone), some flexibility might be possible, depending on business needs.

**Required Qualifications – What it takes to Succeed**

+ Minimum of an Associate’s degree

+ Minimum 2 years of investigative and/or claims experience

+ Knowledge of healthcare payment methodologies

+ Strong organizational, interpersonal, and communication skills

+ Inquisitive nature with ability to analyze data to metrics

+ Computer literate (MS Word, Excel, Access)

+ Strong personal and professional ethics

+ Ability to travel up to 5%, to attend trainings and meetings, as required

**Preferred Qualifications**

+ **STRONGLY PREFERRED:** Bilingual in Spanish

+ Bachelor's degree and/or additional degrees and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI).

+ Understanding of healthcare industry, claims processing and investigative process development.

+ Experience in a corporate environment and understanding of business operations

**Additional Information - How we Value You**

**Work at Home Requirements**

• WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

• Satellite and Wireless Internet service is NOT allowed for this role.

• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

**Additional Information - How We Value You**

• Benefits starting day 1 of employment

• Competitive 401k match

• Generous Paid Time Off accrual

• Tuition Reimbursement

• Parental Leave

**Interview Format**

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue (formerly known as Modern Hire), a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

\#ThriveTogether #WorkAtHome

**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: 03-13-2025

**About us**

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

**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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

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 https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

**Position Summary**

As a Senior Manager, Colleague Relations, you are responsible for the execution and ownership of investigating Employee Relations concerns and providing expert consultant and guidance to managers and employees. You will work to proactively support and maintain a positive employment climate, during the course of your investigation. You will lead complex and sensitive cases including Title VII, workplace violence, and other concerns.

As directed by the Director of the Colleague Relations Investigator Team, you will partner and provide guidance, as necessary, to the Employee Relations Advisors who also oversee cases in the same business units.

This role will also be expected to have market oversight and report on ER activity and trends. In addition, you will be expected to identify root causes and recommend appropriate solutions to assist with improving workplace culture.

This role also has responsibility to give recommendations on keeping applicable CVS policies up to date, compliant, maintained, and appropriate for the achievement of business needs and CVS culture.

You will accomplish this through:

+ Conducting a fair and unbiased, thorough, independent, and timely investigation that meets the standards of CVS expectations, principles, and practices

+ Objectively making credibility assessments and determinations based on evidence gathered.

+ Investigating workplace complaints of violations of policy for which failure to investigate might subject CVS to serious legal or financial risk

+ Applying knowledge of employment harassment and discrimination laws, whistle-blowing laws, rules of evidence, and other laws pertaining to investigation plans, investigations, reports and recommendations

+ Timely responding to inquiries from employees and managers regarding matters involving employment practices, policies, employment laws and compliance guidelines

+ Providing guidance and mentorship to leaders and colleagues on all Employee Relations issues, policy interpretation and questions

+ Responding to employee issues and questions, providing feedback to managers to ensure appropriate action is taken

+ Navigating a case management system and working with appropriate partners to ensure consistency of recommendations and guidance provided.

+ Employee Relations Process Delivery

+ Employee Relations Tracking and Solutions

+ Participate and facilitate training and education, as needed

**Required Qualifications**

+ At least 7 years of relevant overall experience

+ At least 5 years Human Resources experience

+ Willingness to travel up to 10%

**Preferred Qualifications**

+ 5-10 yeas of Employee Relations experience

+ PHR/SPHR certification(s)

**Education**

Bachelor's Degree or equivalent relevant Employee Relations or Human Resources work experience

**Pay Range**

The typical pay range for this role is:

$75,400.00 - $182,549.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 03/19/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

**Description**

Are you looking to join an innovative engineering consulting firm with a strong field services team that supports clients in over 35 different industries? Entrust Solutions Group has embraced growing markets such as renewables, power engineering services, EV infrastructure, data analytics, and geospatial with cutting edge engineering, consulting, and automation services.

We have a current need for a Utility Inspector Trainer based in **Phoenix, AZ.**

**Responsibilities:**

+ Responsible for working with field utility inspectors for on-the-job training, effectively evaluating employee task knowledge, communicating proper techniques, and lead group training.

+ Provide training, testing, evaluation, proctoring and auditing of Company, Client and Contractor Employees for Operator Qualification, and Non-Operator Qualification tasks (not limited to the following):o Initial - Operator Qualification (OQ)o Initial – Pipe Joining Qualification (PJQ Steel & Plastico Requalification(s) for OQ and PJQo Other Trainings as required

+ Maintain the Operator Qualification program for company and clients OQ assessments, as needed, to ensure employees are properly qualified and meet qualification requirements.

+ Determine initial training requirements for each employee or contractor personnel and ensures that all training iscompleted satisfactorily in pursuit of new employee development.

**Please note:** **This position will be seasonal.**

**Requirements:**

+ Minimum one year installing/maintaining underground utilities, specifically natural gas distribution system piping and equipment OR performing third party inspection for the installation of these facilities.

+ Knowledge of DOT Operator Qualification Rules and its application to the industry.

+ Required to have a well-developed knowledge, and the successful completion of the following training, certificationand evaluations

ENTRUST Solutions Group, an ENR Top 100 company, is a community of people, 3,000+ strong, who are committed to our clients and each other. We provide comprehensive and dependable engineering, consulting, and automation services to gas and electric utilities, telecommunication service providers, pipeline operators, and industrial companies.

**In return for top talent, ENTRUST Solutions Group offers:**

+ 401(k) retirement program with a company match

+ Career development programs

**To learn more about ENTRUST Benefits and Culture, please visit our company LinkedIn page and follow us at:**
https://www.linkedin.com/company/entrustsolutionsgroup

\#LI-SF1

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

Advance Your Career in Insurance Claims with Allied Universal® Compliance and Investigation Services. Allied Universal® Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our diverse and inclusive team is committed to innovation and excellence, making a significant impact in the insurance industry. If you’re ready to grow with the best, explore a career with us and make a difference. Enjoy comprehensive benefits for most full-time positions, including medical, dental, and vision coverage, life insurance, retirement plans, employee assistance programs, and exclusive perks.

Allied Universal® is hiring a Surveillance Investigator. The Surveillance Investigator will perform discreet mobile and stationary surveillance of a Claimant to confirm current activities and capabilities to assist with the administration of an Insurance claim.

+ **Opportunity awaits – apply now!**

+ **Job flexibility offering** **fieldwork** **!**

+ **Auto and travel allowances** **!**

**RESPONSIBILITIES:**

+ Conduct independent investigations of insurance claims across a range of coverage types, including workers’ compensation, general liability, property and casualty, and disability

+ Utilize various surveillance techniques and equipment to monitor subjects covertly

+ Document and report observations, activities, and any relevant information in a clear and concise manner

+ Collaborate with other investigators and law enforcement agencies as needed to gather information and coordinate efforts

+ Maintain confidentiality and adhere to legal and ethical standards in conducting surveillance operations

**QUALIFICATIONS (MUST HAVE):**

+ High school diploma or equivalent

+ Post offer, must be able to successfully complete the Allied Universal Investigations' training/orientation course

+ Prior educational or professional exposure to witness interviews or video monitoring

+ Prior educational or professional incident reporting and/or investigations experience

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

+ Ability to type reports in Microsoft Word format with minimal grammatical and punctuation errors

+ Proficient in utilizing laptop computers, video cameras and cell phones

+ Capable of maintaining focus and multitasking effectively in a dynamic environment

+ Demonstrated ability to manage stressful situations with composure and professionalism

+ Ability to work in a very independent environment

**PREFERRED QUALIFICATIONS (NICE TO HAVE):**

+ Associate’s Degree or higher, preferably in Criminal Justice

+ Security/Loss Prevention experience

+ Military experience

+ Law enforcement experience

+ Prior insurance investigations experience

**BENEFITS:**

+ Medical, dental, vision, basic life, AD&D, and disability insurance

+ Enrollment in our company’s 401(k)plan, subject to eligibility requirements

+ Seven paid holidays annually, sick days available where required by law

+ Vacation time offered at an initial accrual rate of 3.08 hours biweekly for full time positions. Unused vacation is only paid out where required by law

**Allied Universal® is an Equal Opportunity Employer.** All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: www.aus.com

If you have any questions regarding Equal Employment Opportunity, Affirmative Action, Diversity and Inclusion, have difficulty using the online system and require an alternate method to apply, or require an accommodation at any time during the recruitment and/or employment process, please contact our local Human Resources department. To find an office near you, please visit: www.aus.com/offices .

**Allied Universal® is an Equal Opportunity Employer.** All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: www.aus.com

If you have any questions regarding Equal Employment Opportunity, Affirmative Action, Diversity and Inclusion, have difficulty using the online system and require an alternate method to apply, or require an accommodation at any time during the recruitment and/or employment process, please contact our local Human Resources department. To find an office near you, please visit: www.aus.com/offices .

**Job ID:** 2025-1346000

**Location:** United States-Arizona-Prescott Valley

**Job Category:** Compliance & Investigations

Global Risk and Security (GR&S) at Vanguard enables business strategy, protects client and Vanguard interests (e.g., assets and data), and stewards a strong risk culture. Our teams leverage enterprise-wide insights, deep expertise, and trusted advice so that across Vanguard leaders and crew drive faster, stronger, risk-informed decisions.

Within GR&S, the Enterprise Security and Fraud (ES&F) sub-division is responsible for the global protection of Vanguard crew, property, data, and client assets. We are the trusted advisors that protect the pride of Vanguard with state-of-the-art security and fraud capabilities. We are a world-class destination of highly engaged, passionate, and diverse talent expected to continuously learn and develop in a constantly evolving security landscape.

Our crew are our greatest resource – by joining our team you will build collaborative long-term relationships and enjoy a suite of benefits that includes comprehensive health and wellness care, work-life balance, and an investment in your future at its core.

Fraud Investigation and Prevention Analyst:

+ Manages and leads incident process and handling of fraud investigations. Coordinates the creation and implementation of systems and processes to prevent, detect, and respond to fraud based on fraud intelligence and event analysis. Researches and recommends fraud prevention and detection solutions, focusing on development of automated systems and improvements in anti-fraud controls within business systems and processes.

+ Implements, executes, reviews, and maintains Global Security policy and procedures consistent with global standards and practices. Makes recommendation to management as to the creation of new procedures and archiving outdated procedures.

+ Thoroughly documents case chronology and prepares reports. Reports any trends to management and recommends system/policy/procedure changes to mitigate future fraud.

+ Works with business units and stakeholders to recommend and implement fraud prevention and detection measures and controls. Consults with Vanguard business units on fraud prevention, trends and detection/response issues/questions.

+ Evaluates fraud protection/prevention systems and/or tools for possible implementation. Supports the project team as needed. Analyzes situations, identifies practical solutions and escalates matters as needed.

+ Develops and maintains an established network of internally and externally contacts to gather, exchange, and execute on actionable fraud and security intelligence to best protect Vanguard Crew, information and client assets.

+ Supports the delivery of fraud and enterprise security education, training, and awareness programs. Participates in the development of handbooks and related material. Responsible for department overviews, new hire training and onboarding. Provides guidance, advice, training and mentoring to other members global security and fraud unit in relation on fraud control methods and investigation standards and practices.

+ Participates in special projects and performs other duties as assigned.

What it takes:

+ Minimum of three years related work experience. Two years of fraud investigation and prevention experience.

+ Undergraduate degree or equivalent combination of training and experience.

+ Professional certification (CFE) required.

Special Factors

Sponsorship

Vanguard is not offering visa sponsorship for this position.

About Vanguard

At Vanguard, we don't just have a mission—we're on a mission.

To work for the long-term financial wellbeing of our clients. To lead through product and services that transform our clients' lives. To learn and develop our skills as individuals and as a team. From Malvern to Melbourne, our mission drives us forward and inspires us to be our best.

Our commitment to diversity, equity, and inclusion

Vanguard’s commitment to diversity, equity, and inclusion (DEI) is central to our ability to deliver on our mission. We aspire to create a work environment that is inclusive, equitable, and diverse—one that enables our employees, whom we call crew, to thrive and bring their best selves to work every day on behalf of our clients.

Cultivating DEI lifts our entire organization, and everyone shares accountability for our progress—from our senior leaders who lay the foundation and set the example for inclusive behaviors to crew who are growing in their personal DEI learning experiences.

Together, we’re on a mission. We are fueled by the value of diverse voices and connected through friendships and a culture of care—for our clients, our communities, and each other.

Vanguard’s DEI journey has no finish line. Our commitment is enduring, and we remain focused on the path ahead. To learn more about Vanguard goals and progress toward DEI, download our Diversity, Equity, and Inclusion Report (https://corporate.vanguard.com/content/corporatesite/us/en/corp/who-we-are/we-care-about/diversity-equity-inclusion.html) .

How We Work

Vanguard has implemented a hybrid working model for the majority of our crew members, designed to capture the benefits of enhanced flexibility while enabling in-person learning, collaboration, and connection. We believe our mission-driven and highly collaborative culture is a critical enabler to support long-term client outcomes and enrich the employee experience.

SIU Investigative Specialist - CF08IE

We’re determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals – and to help others accomplish theirs, too. Join our team as we help shape the future.

The Investigative Specialist is a position within The Hartford’s Special Investigative Unit. We are seeking candidates that have an investigative mindset and interested in advancing their career within The Hartford. This position conducts investigations on suspicious (with red flags noted) Long Term Disability insurance claims. The Investigative Specialist specializes in formulating and implementing the most efficient and effective investigative strategies for documenting claimants’ functionality level, any unreported work activity and unreported “other income” benefits. They specialize in conducting surveillance in a strategic and cost-effective manner and manage all Group Benefit LTD referrals involving surveillance within SIU. They are also SIU liaisons for their assigned regional offices. Job duties include:

+ Review claim referrals and determine whether they are appropriate for additional investigation. This process includes a detailed review of the claim and a wide range of background searches.

+ Proactively review and identify claims that contain red flags. This could include, reviewing analytical reports; conducting database research; collecting all appropriate background information; and conducting analysis to determine if the case would warrant additional investigation.

+ Specialize in formulating and implementing the most efficient and effective investigative strategies for documenting claimants’ functionality level to assist the claims staff in determining if claimants meet the contractual definition of disability and determining if claimants have any unreported work activity or unreported “other income” benefits. This includes communicating with claim handlers to understand the facts and circumstances associated with the loss and reported medical condition(s), policy considerations, and other pertinent issues to design an effective investigative plan. The Investigative Specialist will identify opportunities to schedule roundtable meetings to discuss evidence development and solicit feedback.

+ Prepare and submit investigative reports detailing and documenting all phases of investigations to assist with the resolution of Long-Term Disability claims.

+ Act as SIU liaisons with their assigned regional offices. Responsible for meeting with their assigned claim teams remotely. Required to promote fraud awareness and quality SIU referrals within their assigned regional claim offices.

+ Continually enhance investigative skills and understanding of emerging issues impacting Group Benefits claims.

+ Mentoring new and current SIU Investigative Specialists when needed.

Job Qualifications:

+ Minimum of 3 years insurance claim handling experience required. Long Term Disability claim experience preferred

+ Claims investigative experience required or an equivalent combination of education and experience

+ College degree required with criminal justice emphasis preferred

+ Demonstrated high level of investigative knowledge and mindset

+ Solid understanding of SIU and relevant claim processes, practices and applicable laws and regulations

+ Consistent high level of performance and achievement over career span

+ Ability to lead without having formal authority and to work both independently and in a team environment

+ Ability to manage multiple priorities in a challenging and fast-paced environment

+ Strong analytical and research skills, with an investigative mindset

+ Demonstrated fraud awareness and aptitude

+ Effective interviewing and communication skills (written and verbal)

+ Proven ability to build strong partnerships across segments and function

+ Customer centricity

This role can have a Hybrid or Remote work arrangement. Candidates who live near one of our office locations (Hartford, CT, San Antonio, TX, Lake Mary, FL, Phoenix, AZ, Naperville, IL, Alpharetta, GA) will have the expectation of working in an office 3 days a week (Tuesday through Thursday). Candidates who do not live near an office will have a remote work arrangement, with the expectation of coming into an office as business needs arise.

Compensation

The listed annualized base pay range is primarily based on analysis of similar positions in the external market. Actual base pay could vary and may be above or below the listed range based on factors including but not limited to performance, proficiency and demonstration of competencies required for the role. The base pay is just one component of The Hartford’s total compensation package for employees. Other rewards may include short-term or annual bonuses, long-term incentives, and on-the-spot recognition. The annualized base pay range for this role is:

$69,600 - $104,400

Equal Opportunity Employer/Females/Minorities/Veterans/Disability/Sexual Orientation/Gender Identity or Expression/Religion/Age

About Us (https://www.thehartford.com/about-us) | Culture & Employee Insights (https://www.thehartford.com/careers/employee-stories) | Diversity, Equity and Inclusion (https://www.thehartford.com/about-us/corporate-diversity) | Benefits (https://www.thehartford.com/careers/benefits)

Human achievement is at the heart of what we do.

We believe that with the right encouragement and support, people are capable of achieving amazing things.

We put our belief into action by ensuring individuals and businesses are well protected, and by going even further – making an impact in ways that go beyond an insurance policy.

Nearly 19,000 employees use their unique talents in careers that span a variety of disciplines – from developing the latest technology to creating and promoting our products to evaluating future financial risks.

We’re also committed to programs that drive education and support volunteerism, which put human beings first. We do it because it’s the right thing to do, and because when our customers, communities and employees succeed, we all do.

About Us (https://www.thehartford.com/about-us)

Culture & Employee Insights (https://www.thehartford.com/careers/employee-stories)

Diversity, Equity and Inclusion (https://www.thehartford.com/about-us/corporate-diversity)

Benefits (https://www.thehartford.com/careers/benefits)

Legal Notice (https://www.thehartford.com/legal-notice)

Accessibility StatementProducer Compensation (https://www.thehartford.com/producer-compensation)

EEO

Privacy Policy (https://www.thehartford.com/online-privacy-policy)

California Privacy Policy

Your California Privacy Choices (https://www.thehartford.com/data-privacy-opt-out-form)

International Privacy Policy

Canadian Privacy Policy (https://www.thehartford.com/canadian-privacy-policy)

Unincorporated Areas of LA County, CA (Applicant Information)

Are you a driven Criminal investigator that puts forth a perfect effort in everything you do? Do you want to help the Arizona Department Of Corrections, Rehabilitation & Reentry reimagine corrections in the State of Arizona? Joining our Agency as a Criminal Special Investigator will allow you to perform critical protective and investigative assignments.
The Arizona Department of Corrections, Rehabilitation & Reentry (ADCRR) is looking to hire a qualified Criminal Special Investigator to join our law enforcement agency. Under the direction of a Special Investigations Supervisor, this position will investigate alleged suspected criminal violations of Federal, State, or local laws to determine if the evidence is sufficient to recommend prosecution. Apply today!

Job Duties:
- Investigates/processes crime scenes, compiles investigative findings and presents findings in reports, testifies in administrative and criminal proceedings
- Searches for evidence and collects, records, and submits evidence for analysis
- Performs executive protection, conducts threat assessment investigations, gathers intelligence, and criminal trends
- Provides advance notice to supervisor, affected persons or agencies of impending situations having a potential risk of harm or adverse effect to the security of the Departments operations
- Develops and uses informants or other sources to get leads to information relating to criminal activity, gang activity, and absconded felons
- Maintains surveillance and performs undercover assignments, debrief of previously validated Security Threat Group (STG) members
- Compiles trend analysis, reports, threat assessments certifications of groups and members
- Makes decisions concerning the validation process of STG members, appeals and court proceedings
- Obtains/verifies evidence or establishes facts by interviewing, observing, and interrogating suspects and witnesses and analyzing records
- Obtains and executes search and arrest warrants
- Assist with state, county, federal and municipal agencies and other department units with investigations of all types of crimes
- Attends AZPOST continuing and proficiency training to maintain peace officer certification
- Attends annual Arizona Department of Corrections, Rehabilitation and Reentry (ADCRR) training/meetings
- Drives on State business with possible overnight stays
- Performs other duties appropriate to the assignment as police officer

Knowledge, Skills & Abilities (KSAs):
Knowledge of:

- Federal, State, and Agency laws, rules, regulations, policies, and codes governing investigations and law enforcement operations as they apply to the investigative processes
- Investigative and interviewing techniques and terminology, principles and practices of case management, rules and traditions
- History of prison gangs within the State
- Inmate management and supervision techniques and strategies
- Personal computers and software, as well as specialized systems used in law enforcement

Skill in:

- Applying techniques and methods of work management
- Applying and interpreting Federal, State and agency laws, rules, regulations, codes and policies governing investigation and law enforcement functions
- Investigative and law enforcement techniques and methods
- Written and verbal communication, including proper sentence structure, grammar and punctuation
- Building and maintaining interpersonal relationships
- Organization and time management
- Public speaking and presentation
- Report writing

Ability to:

- Lift/Carry up to 100+ lbs.
- Push/Pull up to 100+ lbs.
- Walk/Run up to 1.00+ miles
- Effectively communicate ideas, techniques, and information to coworkers, management, and judicial entities
- Review investigative case files for accuracy
- Establish cooperative relationships with other law enforcement agencies and outside entities
- Conduct surveillance
- Maintain confidentiality
- Compose written documents and reports

Selective Preference(s):
At least one (1) year of work experience in another law enforcement agency conducting criminal investigations. AZPOST full-authority peace officer certification through completion of a qualified POST secondary certification course of study through a community college or Arizona law enforcement academy

Pre-Employment Requirements:
An active Arizona Peace Officer Standards and Training Board (AZPOST) certification is required within one year of appointment.

Employment is contingent on the selected applicant passing a background investigation, drug test, medical/physical examination, polygraph exam, and psychological evaluation.

In an effort to maintain a safe environment, all employees are required to take a Tuberculosis (TB) test during their New Employee Orientation and every year thereafter.

If this position requires driving or the use of a vehicle as an essential function of the job, then the following requirements apply. Any employee operating a motor vehicle on State business must possess and retain a current, valid class-appropriate driver’s license, complete all required training, and successfully pass all necessary driver’s license record checks. The license must be current, unexpired, and neither revoked nor suspended. Employees who drive on state business are subject to driver’s license record checks, must maintain acceptable driving records, and must complete all required driver training. An employee who operates a personally owned vehicle on state business shall maintain the statutorily required liability insurance (see Arizona Administrative Code (A.A.C.) R2-10-207.11).

If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver’s License Requirements.

All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

Benefits:
We offer an excellent and affordable comprehensive benefits package to meet the needs of our employees:
- Vacation and sick days with 10 paid holidays per year
- Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
- Robust and affordable insurance plan to include medical, dental, life, short-term and long-term disability options
- Exceptional retirement program
- Optional employee benefits such as deferred compensation plans, credit union membership, and a wellness program
- An incentivized commuter club and public transportation subsidy program

Learn more about the Paid Parental Leave pilot program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Retirement:
Positions in this classification participate in the Corrections Officer Retirement Plan (CORP).

Current ADCRR Employees: Consult with your respective Human Resources Liaison if you are in a different retirement plan than the one indicated above.

As a condition of participation in the CORP, you will be required to undergo a medical evaluation.

Contact Us:
The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer. Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by calling (602) 255-2430. Requests should be made as early as possible to allow sufficient time to arrange the accommodation.

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

The Special Investigations Unit is seeking a Manager to lead our team of Certified Professional Coders (CPC).

The Manager is responsible for overseeing and managing coding reviews for fraud detection, investigation, and prevention efforts to safeguard the organization’s resources and reduce healthcare costs. This role involves leading a team of CPC’s, working closely with internal and external stakeholders and ensuring compliance with regulatory requirements. The Manager develops strategies to manage workload, quality of reviews and process improvements.

**Responsibilities:**

Lead and mentor a team certified coders who support fraud detection and prevention efforts.

Establish team goals, monitor performance, and ensure alignment with organizational objectives.

Direct and oversee complex reviews.

Ensure timely and accurate reporting of review findings and coordinate with investigative to take appropriate action.

Conducts team member evaluations and provides performance feedback to staff on an ongoing basis.

Manages workload of their team to ensure equitable distribution and exposure to wide range of cases to match current skills and development needs

Confirm staff are preparing comprehensive reports summarizing investigation outcomes.

Ensure findings comply with state, federal, and industry regulations.

Stay informed about changes in the industry practices related to healthcare coding.

Provide training opportunities for staff to maintain their CEUs.

Assist in preparing documentation for audits, compliance reviews, and regulatory inquiries.

**Required Qualifications:**

Minimum 5+ years of experience in healthcare fraud detection, investigation, or auditing

In-depth knowledge of healthcare systems, claims processing, and regulatory requirements related to healthcare fraud.

Proficient in researching information and identifying information resources

AAPC Coding certification - Certified Professional Coder (CPC)

Strong leadership and team management ability

Excellent communication and presentation skills.

Ability to work cross-functionally with various teams and external partners.

Ability to travel for business needs.

**Preferred Qualifications:**

Registered Nurse (RN)

Previous leadership experience.

AAPC Coding Certification – Certified Professional Biller (CPB), Certified Professional Medical Auditor (CPMA), Certified Outpatient Coder (COC), Certified Risk Adjustment Coder (CRC)

Licensed Clinical Social Worker (LCSW)

Licensed Independent Social Worker (LISW)

Licensed Master Social Worker (LMSW)

**Education**

Bachelor, Associates Degree or work equivalent

Certification as a Certified Professional Coder (CPC)

**Anticipated Weekly Hours**

40

**Time Type**

Full time

**Pay Range**

The typical pay range for this role is:

$54,300.00 - $159,120.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 03/31/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

**JOB DESCRIPTION**

**Job Summary**

The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. The SIU Investigator is responsible for reviewing and analyzing information to make medical determinations as necessary, and applies clinical knowledge to assess the medical necessity, level of services, and/or appropriateness of care in cases. The SIU Investigator is also responsible for recognizing and adhering to national and local coding and billing guidelines in order to maintain coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position may also work with other internal departments, including Compliance, Corporate Legal Counsel, and Medical Affairs, in order to achieve and maintain appropriate anti-fraud oversight.

**Job Duties**

• Perform objective desk and onsite medical record audits to verify if services were supported by documentation, to determine if services were appropriately administered, and/or to validate coding/billing accuracy.

• Conduct interviews of providers and/or health plan members in order to determine whether fraud, waste, or abuse may have occurred.

• Coordinate with various internal customers (e.g., Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims) to gather documentation pertinent to investigations.

• Detect potential health care fraud, waste, and abuse through the identification of aberrant coding and/or billing patterns through utilization review.

• Incorporate leadership and communication skills to work with physicians and other health professionals when investigating cases.

• Generate and provide accurate and timely written reports for internal and/external use detailing audit findings.

• Render provider education on appropriate practices (e.g., coding) as appropriate based on national or local guidelines, contractual, and/or regulatory requirements.

• Identify opportunities for improvement through the audit process and provide recommendations for system enhancement in order to augment investigative outcomes and performance.

Medical Laboratories investigation reviews

**JOB QUALIFICATIONS**

**REQUIRED EDUCATION** :

Graduate from an Accredited School of Nursing.

+ **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** :

+ Five years clinical nursing experience with broad clinical knowledge.

+ Five years experience conducting medical review and coding/billing audits involving professional and facility based services.

+ Knowledge and understanding of medical terminology along with demonstrated knowledge of CPT, ICD-9, HCPCS and DRG requirements.

+ Two years of managed care experience.

**REQUIRED LICENSE, CERTIFICATION, ASSOCIATION** :

Active, unrestricted State Registered Nursing (RN) license in good standing.

**PREFERRED EDUCATION** :

Bachelor’s Degree in Nursing

**PREFERRED EXPERIENCE** :

+ Experience in government programs (i.e., Medicare, Medicaid, & SCHIP).

+ Experience in long-term care.

**STATE SPECIFIC REQUIREMENTS** :

OHIO:

+ Transitions of Care for New Members

+ Molina Healthcare of Ohio follows the transition of care requirements outlined below and in Appendix D of the contract for new members transitioning to the MCO from fee-for-service (FFS) or another MCO. The Transition of Care Coach will coordinate all services with new members to ensure a seamless transition and ensure continuity of care.

+ Provision of Member Information

+ Pre-Enrollment Planning

+ The Molina Transition of Care Coach coordinates with and utilizes data provided by ODM, another MCO, the OhioRISE Plan (when applicable) and or collected by Molina (e.g. through assessments, new member outreach in advance of the member’s enrollment effective date) to identify existing sources of care and to ensure each new member is able to continue to receive existing services without disruption.

+ For OhioRISE Plan enrolled members, Molina will reach out to the OhioRISE Plan and primary care coordination staff to engage the OhioRISE Plan in pre-enrollment planning

+ Continuation of Services for Members

+ Documentation of Transition of Services

+ Transitions of Care Between Health Care Settings

+ Transitions of Care Between Molina Healthcare of Ohio and the OhioRISE Plan

+ Care Coordination Assignment

+ Provision of Member Information

+ Continuation of Services for Members

+ Documentation of Transition of Services

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $77,969 - $128,519 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.