Lead Fraud Investigator
Quick Summary
Bachelor’s Degree 7 years’ law enforcement experience (local, state, or federal) or 7 years fraud investigative experience.
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
This position is responsible for planning and developing investigation tools and techniques to conduct detailed investigations of potentially fraudulent claim activity by members, employees and providers, both internally and externally initiated, and makes recommendations for prosecution, recovery, and litigation. Also, review operational controls, claim system controls and protocols, and recommends enhancements to reduce the potential for fraud.
Requirements
~1 min read- Bachelor’s Degree
- 7 years’ law enforcement experience (local, state, or federal) or 7 years fraud investigative experience. Experience directing complex fraud investigations which result in criminal or civil prosecutions.
- Experience planning and conducting interviews which develop significant information in furtherance of complex fraud, waste, and abuse investigations.
- Familiarity with state and federal laws applicable to health care fraud.
- Ability to develop effective liaison relations which facilitate case identification, investigation, and prosecution.
- Ability to independently prepare reports of interview and other documentation accurately reflecting investigative activity and results.
- Clear and concise verbal and written communication skills.
- Self-motivated, results oriented with demonstrated leadership skills.
- Accredited Health Care Fraud Investigator
- Certified Professional Coder
- Certified Fraud Examiner
- Medicare Advantage Experience
#LI-AS1
#LI-Hybrid
At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.
The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
Flex employees are expected to be in the office a minimum of three days a week. Management will have discretion to modify an employee's weekly schedule for exigent circumstances.
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.
Exact compensation may vary based on skills, experience, and location.
Location & Eligibility
About this job
- Pay per year
- $69,800–$125,900 a year
- 46% above the $67,000 median for Other jobs on Jobera (144,221 salaries).
- Posted
- Today
Listing Details
- Posted
- November 13, 2026
- First seen
- November 13, 2026
- Last seen
- November 13, 2026
Posting Health
- Days active
- 0
- Repost count
- 0
- Trust Level
- 67%
- Scored at
- November 13, 2026
Signal breakdown
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