Private Detectives and Investigators

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 is responsible for maintaining an effective anti-money laundering (AML) program for monitoring, detecting and reporting suspicious activity to appropriate regulatory agencies. As a member of the Enterprise Financial Crimes Compliance division, you will be part of the bank’s second line of defense to prevent individuals and businesses from using U.S. Bank products and services for illegal purposes. The Law Enforcement Engagement Team responds to various law enforcement related and other requests from external (i.e. law enforcement and government personnel) parties and internal U.S. Bank departments. As a Law Enforcement Engagement Team Investigator/Analyst, you will be responsible for the timely response to law enforcement requests that are connected to violations of U.S. laws. You will be required to access bank systems to retrieve data and evidence that is shared with law enforcement according to regulatory and legal requirements. The principal responsibility of the position is to ensure that requests are retrieved, processed, and tracked to fulfillment within established guidelines. As an Investigator/Analyst, you will also conduct complex and high-profile enterprise-wide investigations of unusual activity and prepare Suspicious Activity Reports (SARs) to be filed with the Financial Crimes Enforcement Network (FinCEN). An intermediate understanding of applicable laws, regulations, financial services and regulatory trends that impact their assigned line of business is required.

**Basic Qualifications**

- Bachelor's degree, or equivalent work experience

- Typically, more than two years of applicable experience

**Responsibilities:**

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

+ Process and accurately respond to requests in a timely manner and in accordance with applicable law and U.S. Bank

+ Respond verbally and in writing to external parties including government and law enforcement personnel as well as U.S. Bank internal departments

+ Utilize a combination of manual and automated tools to compile information potentially related to a particular law enforcement request

+ Conduct comprehensive case investigations which includes analyzing transaction information, researching customer data, examining open source and media checks, and recommending a SAR or no SAR be filed

+ Working cooperatively with internal departments to obtain and analyze necessary information related to case investigations

+ Preparing quality investigative documentation which includes detailed case notes and attachments of internal and external research

+ Handle highly sensitive information with complete discretion

+ Escalate unusual activity for further review or investigation as needed

+ Perform other duties as assigned

**Preferred Skills/Experience**

+ Strong analytical skills

+ Strong problem-solving skills

+ Ability to adapt to a changing environment and handle multiple priorities

+ Effective oral and written communication skills

+ Strong attention to detail

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

+ Knowledge of Bank Secrecy Act (BSA)/AML laws and regulations

+ Knowledge of Actimize case management system

+ Knowledge of retail banking, lending and bank operations processes

**This role is considered hybrid and requires working three days a week from a designated U.S. Bank location, with flexibility on work location for the other two working days.**

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 - $86,240.00

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.**

Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required.

We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must.

Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments.

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 .

The Claims Investigator should demonstrate proficiency in the following areas:

+ AOE/COE, Auto, or Homeowners Investigations.

+ Writing accurate, detailed reports

+ Strong initiative, integrity, and work ethic

+ Securing written/recorded statements

+ Accident scene investigations

+ Possession of a valid driver’s license

+ 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

We are an equal opportunity employer.

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**Your opportunity**

_At Schwab, you’re empowered to make an impact on your career. Here, innovative thought meets creative problem solving, helping us “challenge the status quo” and transform the finance industry together._

Please note: This position is only avaliable in Phoenix, AZ.

**Group Overview**

The Visa Fraud Investigations team (VFI) is a department within the Financial Crimes Risk Management Enterprise. This department consists of two groups, Visa Fraud Investigations and Visa Risk Oversight & Monitoring (VROM). Our charter is to protect our client’s and the firm’s assets by preventing and mitigating fraud losses. VFI is responsible for conducting Visa fraud investigations and pursuing recovery efforts of unauthorized debits to client accounts. VROM is responsible for reviewing alerts related to potential fraud, mitigating risk through trends and oversight. Types of case investigations and alerts include Visa debit card transactions for both the Bank and Broker Dealer products.

**Responsibilities**

The Senior Specialist is responsible for reviewing potential fraud alerts and conducting Visa debit card investigations. Senior Specialists for the VROM/VFI team must demonstrate initiative with minimal direct supervision when addressing their daily responsibilities. All assigned must be completed within well-defined regulatory guidelines in an environment that is fast paced and demanding. Consistency in exercising good judgment and decision making with respect to risk and fraud issues is key. The ability to effectively manage alert and case workloads and additional daily responsibilities at a high level of proficiency and quality is required.

**Key Responsibilities include but are not limited to:**

+ Reviewing and disposition potential alerts for Visa and BillPay transactions which are received in real-time.

+ Conducting standard Visa debit card fraud investigations that the VFI team receives during the normal course of business.

+ Ensure that all assigned alerts and cases are worked accurately and within well-defined regulatory target dates and in accordance with the regulations that govern them.

+ Support other individuals with their work when the need emerges.

**Key Factors for Success in This Role**

+ Organizational skills: ability to anticipate, improvise, and adapt for efficient resolutions. Consistently manage workloads effectively. Ability to marshal resources to get things done. Can orchestrate multiple activities at once to accomplish a goal. Use resources effectively and efficiently. Arrange information and files in a useful manner. Ensure that all follow-up responsibilities are completed timely and with limited direct supervision.

+ Quality: ability to problem solve with results-oriented style delivering good quality and timeliness. Demonstrated skills in the areas of critical thinking and judgment as they relate to assessing and mitigating risk to our clients and the firm (with respect to Visa debit card transactions)

+ Communication skills: work effectively across functions, maintain composure in stressful situations, and diffuse tense situations comfortably.

+ Client Focus: dedicated to meeting the expectations and requirements of internal and external clients. Act with the client in mind. Build and maintain efficient relationships with clients and gain their trust and respect.

+ Investigation Mindset: ability to uncover situations that don’t fit within normal standards. Find fraud trends while reviewing large amounts of alerts.

\#FCRM

**What you have**

Required Qualifications:

+ 1 - 3 years financial services/banking experience with direct customer contact servicing Visa Check Card preferred. Minimum of 6 months of investigative experience in the areas of: Visa Alerts review or Visa Check Card investigations required.

+ Demonstrated personal initiative to work through new and unfamiliar issues with mentorship while demonstrating good judgment and decision making with respect to risk issues.

+ Demonstrated work history of working well with others in a team environment.

+ Effective skills in the management of personal workloads with an emphasis on producing quality work with minimal errors in a demanding environment.

+ Strong verbal and written communication skills.

+ Detailed knowledge of Schwab systems related to both the Broker Dealer and the Schwab Bank sides of the business with respect to Visa debit card transactions is required (System knowledge to include, but not limited to: Visa CATS (Client Administrative Tools & Services), Visa Online, Client Central, Legacy and various other systems that are used to review and research payment transactions

+ Working knowledge of Regulation E a must.

+ Required experience within financial industry.

Preferred Qualifications:

+ Familiarity with financial industry operations preferred.

**What’s in it for you**

At Schwab, we’re committed to empowering our employees’ personal and professional success. Our purpose-driven, supportive culture, and focus on your development means you’ll get the tools you need to make a positive difference in the finance industry. Our Hybrid Work and Flexibility approach balances our ongoing commitment to workplace flexibility, serving our clients, and our strong belief in the value of being together in person on a regular basis.

We offer a competitive benefits package that takes care of the whole you – both today and in the future:

+ 401(k) with company match and Employee stock purchase plan

+ Paid time for vacation, volunteering, and 28-day sabbatical after every 5 years of service for eligible positions

+ Paid parental leave and family building benefits

+ Tuition reimbursement

+ Health, dental, and vision insurance

What’s in it for you:

At Schwab, we’re committed to empowering our employees’ personal and professional success. Our purpose-driven, supportive culture, and focus on your development means you’ll get the tools you need to make a positive difference in the finance industry. Our Hybrid Work and Flexibility approach balances our ongoing commitment to workplace flexibility, serving our clients, and our strong belief in the value of being together in person on a regular basis.

We offer a competitive benefits package that takes care of the whole you – both today and in the future:

401(k) with company match and Employee stock purchase plan

Paid time for vacation, volunteering, and 28-day sabbatical after every 5 years of service for eligible positions

Paid parental leave and family building benefits

Tuition reimbursement

Health, dental, and vision insurance

Schwab is an affirmative action employer, focused on employing and advancing in employment, qualified women, racial and ethnic minorities, protected veterans, and individuals with disabilities in the workplace. If you have a disability and require reasonable accommodations in the application process, contact Human Resources at applicantaccessibility@schwab.com or call 800-275-1281.

Join the Canacre team in an exciting role working on leading edge infrastructure projects.

We are technical experts in land, energy, and transportation development delivering accurate, innovative, and agile solutions to our partners. We provide land acquisition, geospatial mapping, data management, web-based GIS, community relations, land feasibility studies, and permitting services. Canacre’s clients include developers, large scale service providers, and government entities that are involved in the planning and development of energy projects, rights of way, resources, and infrastructure across Canada and the United States. Canacre works on large-scale wind and solar power projects, high-voltage transmission lines, pipeline projects, municipal roads projects, and groupings of cellular towers and rooftop antennas.

At Canacre, we act with honesty and integrity within a culture where trust, collaboration, and teamwork flourish. We commit to diversity, inclusivity and the celebration of successes. Our vision is to foster an environment that promotes inspired and empowered team members who make an impact.

This position will be field based with approximately 25% of time in the field within the U.S. Southwest.

The Archaeological Principal Investigator will primarily be responsible for conducting desktop-based reviews for historical resource potential, archaeological field assessments, and monitoring in support of energy development projects in compliance with federal, provincial, and local regulations.

In addition, your role will be to:

+ Oversee and assign responsibilities to archaeological field leads

+ Oversee archaeological fieldwork projects ensuring safety and quality standards

+ Direct and position archaeological field leads for archaeological projects including records reviews, surveys, testing, data recovery and monitoring projects

+ Oversee and contribute to written reports including monitoring reports, survey reports, and formal updates on cultural resource efforts

+ Author and/or employ Historic Properties Treatment Plans, Monitoring and Discovery Plans, or Work Plans

+ Coordinate with archaeological field monitors and construction personnel to provide necessary information and facilitate regular communication among all parties

+ Inspect areas of concern identified by field monitors and make appropriate recommendations to construction personnel, as required

+ Review field reports for quality, consistency, and accuracy

+ Assist with level of effort and cost estimates for projects involving archaeology

+ Contribute to cost estimates and written proposals that involve archaeological tasks

Qualifications:

+ Master's degree in archaeology, anthropology, or related field of study and minimum 5 years professional management experience in a archaeology

+ Ability to obtain State and Federal archaeological permits as a (Principal Investigator) within the U.S. Southwest, South, and/or Great Basin

+ Experience leading fieldwork and reporting efforts on State and Federal lands in the southwestern United States related to transmission line construction projects

+ Demonstrated experience overseeing field and reporting work and coordinating other field-based resource teams

+ Strong working knowledge of cultural resource legislation and regulations

+ Strong analytical, problem-solving skills, prioritizing, analytical, communication and decision-making skills

+ Ability to manage multiple projects and staff with minimal supervision

+ Ability to build strong, lasting relationships with key stakeholders

+ Experience authoring documents and data in Microsoft Office, Google Earth, ArcGIS Online, and ArcGIS FieldMaps/Survey123

+ Member of the Register of Professional Archaeologists

+ Valid Driver’s License, with ability to maintain insurability under the company’s insurance carrier

At Canacre, our benefits program is one of the ways in which we reinforce the value we place on employees and the role they play in helping us achieve our goals. Canacre offers comprehensive health and dental coverage, paid time off, and disability insurance. Other benefits include a 401(k) Savings Plan employer matching program, Employee Assistance Program, flexible work arrangement and a variety of wellness programs.

Given the volume of applications we typically receive, we are unable to respond to all applicants, however, you will be contacted if your experience is a suitable match with one of our upcoming projects.

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**About the Role**

Uber is a technology company that is changing the way the world thinks about transportation. Whether it's heading home from work, getting a meal delivered from a favorite restaurant, or a way to earn extra income, Uber is becoming part of the fabric of daily life. We're making cities safer, smarter, and more connected.

As **Senior Manager, Special Investigations and Insurance Fraud** , you will be a pivotal player in shaping and optimizing Uber's insurance fraud strategy through data-driven insights. You and your team will be key members of the growing **US&C Claims** team, operating as a senior manager and reporting to the **Director, Claims Services** . Your expertise will be crucial in leading efforts around Carriers, Major case investigation, fraud operations team.

While a background in Special Investigations is important, this role also emphasizes strong analytical skills and the ability to leverage data to drive strategic decisions. We're looking for a highly influential and proactive leader who is detail-oriented, moves with pace, and is capable of driving significant change to reduce the cost of insurance through identifying fraud, and taking action to eliminate or mitigate the impact thus continuing to keep Safety First. The ideal candidate has a strong understanding of the role of claims and fraud investigations within the insurance ecosystem, proven experience in developing and utilizing claims reporting and analytics, and is ready to "go get it." This role requires someone who can shape strategy, think big, and understand detail (#SeeTheForestAndTheTrees), all while operating with a high level of autonomy.

Uber embraces a hybrid work model, where employees are in office three days a week. This approach promotes a balanced and productive work environment that accommodates both individual preferences and organizational needs.

What You'll Do

+ **SIU/Fraud Parternships:** Serve as the primary point of contact for all external claims SIU partners - Carrier SIU teams, industry groups such as NICB and the Coalition Against Insurance Fraud, and various law enforcement agencies.

+ **Major Case Investigations:** Drive claims outcomes on major case investigations, including EUO and litigation support. Leverage claims expertise and advanced analytical capabilities to identify complex relationships and fraud schemes. Utilize data visualization tools to effectively communicate complex data findings.

+ **Operational Performance and Collaboration:** Develop, implement, and monitor operational health metrics and key performance indicators (KPIs) in collaboration with internal investigations and carrier partner SIU teams. Provide regular updates to key stakeholders, highlighting trends and areas for improvement. Provide expert consultation to external insurance partners on data and reporting best practices, and collaborate on data-driven performance improvement initiatives. Provide data-driven input into the design, documentation, and deployment of SIU processes, ensuring alignment with the various stakeholders.

+ **Fraud Operations:** Manage the fraud operations team responsible for responding to carrier partner SIU inquiries, drive investigation and outcomes on non-major case issues including account review and actioning.

Basic Qualifications

+ 8+ years of experience in Claims and/or Fraud Investigations.

Preferred Qualifications

+ 5+ years experience leading claims or fraud teams

+ Experience managing complex investigations and supporting various forms of fraud related litigation.

+ **Analytical and Data Strategy Expertise:** Deep familiarity with designing, developing, and utilizing claims-related data, reporting, and analytics; proven experience in developing and implementing fraud strategies, including tool selection and vendor management; able to understand and interpret complex metrics and KPIs.

+ **Influence, Communication, and Collaboration:** Exceptional ability to influence stakeholders at all levels, build strong relationships with internal and external partners, and adapt presentations and messaging to different levels of audience, from individual contributors to senior executive leaders.

+ **Strategic Thinking and Execution:** Proven ability to shape strategy, think big, and understand detail, demonstrating a balance of strategic vision and tactical execution; strong attention to detail while maintaining a fast pace to deliver high-quality results efficiently; highly independent and proactive, with a strong understanding of industry trends and a passion for leveraging data to drive change.

+ **Change Management Expertise:** Significant experience driving major change across large, complex organizations.

For Chicago, IL-based roles: The base salary range for this role is USD$162,000 per year - USD$180,000 per year. For New York, NY-based roles: The base salary range for this role is USD$180,000 per year - USD$200,000 per year. For Phoenix, AZ-based roles: The base salary range for this role is USD$144,000 per year - USD$160,000 per year. For San Francisco, CA-based roles: The base salary range for this role is USD$180,000 per year - USD$200,000 per year. For all US locations, you will be eligible to participate in Uber's bonus program, and may be offered an equity award & other types of comp. You will also be eligible for various benefits. More details can be found at the following link https://www.uber.com/careers/benefits.

Uber is proud to be an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law. We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. If you have a disability or special need that requires accommodation, please let us know by completing this form- https://docs.google.com/forms/d/e/1FAIpQLSdb_Y9Bv8-lWDMbpidF2GKXsxzNh11wUUVS7fM1znOfEJsVeA/viewform

The City of Chandler Police Department, Intelligence Analysis Unit, is currently seeking qualified individuals interested in joining our team as an Investigative Analyst. This is a full-time, non-exempt position with benefit. The Investigative Analysts work a 4/10 schedule but may be required to work various schedules which include days, swings, nights, weekends and holidays. The position is regular full-time, subject to a six (6) month probationary period.

Why work for Chandler?

* Diverse and inclusive environment
* Up to 8 hours paid time off annually to volunteer in the community
* Dress code is business casual, with jeans on Fridays
* 3 medical plans to choose from along with dental and vision coverage
* Accrue 122 hours paid vacation in your first year, eligible for use immediately following accrual
* Accrue 96 hours paid sick leave in your first year, eligible for use immediately following accrual
* 12 paid holidays per year, plus Winter Break at the end of the year
* Become part of the Arizona State Retirement System with a 100% city contribution match
* City contributions of 1% gross wages per pay period to deferred compensation
* Robust Employee Wellness program with $350 incentive
* Professional development opportunities
* Tuition reimbursement up to $5,250 annually, $3,200 for part-time employees
* Free Tumbleweed Recreation Center membership

Who we are

The City of Chandler Police Department, consisting of 362 sworn officers and 177 civilians, serves a growing population of close to 287,945 residents. The organization is divided into three main divisions, one bureau, and many sections/units. The Patrol Operations Division consisting of three precincts, 1) Main Station - Downtown & North Chandler, 2) Desert Breeze - West Chandler, and 3) Chandler Heights - South Chandler, work in concert with the Criminal Investigations Division, Operational Support Division, and Professional Services Division to meet the needs of the community. The members of the Chandler Police Department are dedicated to the advancement of community policing and the development of a partnership with our citizens. Our mission is, “To maintain a safe, vibrant community through meaningful engagement and continuous organizational improvement.” We are committed to being a world-class leader in law enforcement. We will pursue and engage the best trained, equipped, and committed professionals who demonstrate the highest standards of performance and best policing practices in partnership with the community.

Who we are looking for

Our ideal candidate will have a passion for customer service, teamwork, and collaboration. This role performs non-sworn investigative duties in support of police criminal investigations including performing background research regarding criminal histories and searching linkages among people, cars, and homes to assist detectives and officers. We are looking for an individual who enjoys working in a fast-paced environment; and, the successful candidate must be able to do the following:

* Collect, compile, and organize criminal intelligence information; generates intelligence data for support in investigations; reads and records various intelligence, analytical and administrative information.
* Prepare and deliver clear, concise intelligence products including bulletins, briefings, charts, and reports for department personnel and partner agencies
* Work directly with detectives and patrol officers to research, analyze, evaluate and correlate criminal intelligence information; determines source reliability, content and validity; develops investigative leads and links
* Assist in the coordination of major investigations; prioritizes data; conducting analysis; analyzes call-logs.
* Provide exceptional customer service and responds to internal and external inquiries.
* Update and maintain law enforcement databases/records.
* Make appropriate recommendations for improvement in intelligence analysis practices and procedures.

To view the complete job description, please click here.

Minimum qualifications

* Must possess a High School or GED equivalency.
* Must have 4-years of previous experience related to area of assignment, or
* Any equivalent combination of experience and training which provides the knowledge and abilities necessary to perform the work.
* Must possess a valid Arizona driver’s license, with an acceptable driving record
* Must be able to obtain a DPS Level B Terminal Operator Certification within 6 months of hire.

Desired qualifications

* Associates degree is preferred

Supervision

Work is performed under the direct supervision of a civilian supervisor or Police Sergeant. This position does not supervise others.

Application Process

* NeoGov Application
* Spark Hire Virtual Interviews
* Preliminary Background Questionnaire Submittal & Review
* Oral Board Interview
* Background Interview
* Interview with Chief of Police

This is a full-time, non-exempt position with benefits, with a varied work schedule. A register of qualified candidates will be active for 4 months should another position become available.

The City of Chandler will conduct a pre-employment background check as a condition of employment. An offer of employment is contingent upon acceptable results. All applicants hired will be required to be fingerprinted with successful results as a condition of continued employment.

Applicants for employment and volunteer opportunities should be aware of the City of Chandler’s policies concerning the use of drugs and alcohol. These policies have not been altered by the passage of Proposition 207. The use of recreational marijuana is a violation of the city’s Drug Free Workplace Policy. Certain positions within the city are required to submit to a pre-employment drug test. A positive result for drugs tested under the policy, including recreational marijuana, may be grounds for withdrawal of an offer of employment or volunteer opportunity. The examination process may vary if determined necessary.

**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.

**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.

**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.

**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.

**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 draw conclusions on allegations of FWA and/or may determine appropriateness of care. 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 Officers in order to achieve and maintain appropriate anti-fraud oversight.

**Job Duties**

+ Responsible for developing leads presented to the SIU to assess and determine whether potential fraud, waste, or abuse is corroborated by evidence.

+ Conducts both preliminary assessments of FWA allegations, and end to end full investigations, including but not limited to witness interviews, background checks, data analytics to identify outlier billing behavior, contract and program regulation research, provider and member education, findings identification and communications development, and recommendations and preparation of overpayment identifications and closure of investigative cases.

+ Completes investigations within the mandated period of time required by either state and/or federal contracts and/or regulations.

+ Conducts both on-site and desk top investigations.

+ Conducts low to medium, and extensive investigations, including reviews of medical records and data analysis, and makes determinations as to whether the investigation and/or audit identified potential fraud, waste, or abuse.

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

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

+ Prepares appropriate FWA referrals to regulatory agencies and law enforcement.

+ Documents appropriately all case related information in the case management system in an accurate manner, including storage of case documentation following SIU related requirements. Prepares detailed preliminary and extensive investigation referrals to state and/or federal regulatory and/or law enforcement agencies when potential fraud, waste, or abuse is identified as required by regulatory and/or contract requirements.

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

+ Interacts with regulatory and/or law enforcement agencies regarding case investigations.

+ Prepares audit results letters to providers when overpayments are identified.

+ Works may be remote, in office, and on-site travel within the state of New York as needed.

+ Ensures compliance with applicable contractual requirements, and federal and state regulations.

+ Complies with SIU Policies as and procedures as well as goals set by SIU leadership.

+ Supports SIU in arbitrations, legal procedures, and settlements.

+ Actively participates in MFCU meetings and roundtables on FWA case development and referral

**JOB QUALIFICATIONS**

**Required Education**

Bachelors degree or Associate’s Degree, in criminal justice or equivalent combination of education and experience

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

+ 1-3 years of experience, unless otherwise required by state contract

+ Proven investigatory skill; ability to organize, analyze, and effectively determine risk with corresponding solutions; ability to remain objective and separate facts from opinions.

+ Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations.

+ Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace.

+ Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems.

+ Understanding of datamining and use of data analytics to detect fraud, waste, and abuse.

+ Proven ability to research and interpret regulatory requirements.

+ Effective interpersonal skills and customer service focus; ability to interact with individuals at all levels.

+ Excellent oral and written communication skills; presentation skills with ability to create and deliver training, informational and other types of programs.

+ Advanced skills in Microsoft Office (Word, Excel, PowerPoint, Outlook), SharePoint and Intra/Internet as well as proficiency with incorporating/merging documents from various applications.

+ Strong logical, analytical, critical thinking and problem-solving skills.

+ Initiative, excellent follow-through, persistence in locating and securing needed information.

+ Fundamental understanding of audits and corrective actions.

+ Ability to multi-task and operate effectively across geographic and functional boundaries.

+ Detail-oriented, self-motivated, able to meet tight deadlines.

+ Ability to develop realistic, motivating goals and objectives, track progress and adapt to changing priorities.

+ Energetic and forward thinking with high ethical standards and a professional image.

+ Collaborative and team-oriented

**REQUIRED LICENSE, CERTIFICATION, ASSOCIATION** :

+ Valid driver’s license required.

**PREFERRED EXPERIENCE** :

At least 5 years of experience in FWA or related work.

**PREFERRED LICENSE, CERTIFICATION, ASSOCIATION** :

+ Health Care Anti-Fraud Associate (HCAFA).

+ Accredited Health Care Fraud Investigator (AHFI).

+ Certified Fraud Examiner (CFE).

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: $21.82 - $51.06 / HOURLY

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

**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.

**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.