Investigator

• Conduct undercover surveillance on suspected fraud cases
• Adapt to changing environments with quick-thinking and disguises to collect video evidence of a subject's activity
• Work independently in the field with minimal supervision
• Update the Ops team by quick calls/texts
• Use video cameras frequently
• Maintain stakeout positions for extended periods
• Tail subjects by foot and vehicle
• Drive in urban, rural, and suburban communities, sometimes long distances, in all weather conditions

Surveillance Investigator

• Conduct covert, stationary, and mobile surveillance
• Conduct surveillance throughout the home state and surrounding states
• Record subject activity on a video recording device
• Conduct alive-and-well checks, locates, basic scene investigations, paint sample analysis, EDR, and RCS deployments/retrievals
• Prepare and complete written reports of observations
• Upload video evidence and surveillance reports
• Conduct basic claims investigations
• Travel daily within the investigator’s area/territory
• Provide clear reports of activities to the operations team

Field Investigator

• Gather, analyze, and interpret documentation to conduct investigations
• Support investigators in researching and resolving fraudulent activity
• Analyze exposure, provider, and claims data using relevant systems and software
• Manage Special Investigations Unit pended claims to meet SLAs and service standards for ASO accounts and Blue Card requirements
• Ensure timely, accurate, and efficient resolution of pended claims in NASCO and the BPM tool
• Serve as primary contact for fraud claim inquiries and referrals
• Research, document, and track issues in Blue Card admin and/or BPM tools; forward issues and track resolution
• Conduct investigative activities on less complex case reviews, including analyzing coding and preparing, documenting, and assembling evidence for potential prosecution and civil litigation
• Collect and submit information for claim suspension entries via ClearQuest tickets and update claim suspensions
• Create and maintain UCSW/NCompass alerts and handling instructions; share active claim suspension listings for financial reporting and claim savings tracking
• Investigate Fraud Hotline calls, including member and provider outreach, medical-record requests, and claim review
• Follow established procedures and research across multiple systems and tools; share systems and tool knowledge with Investigative and/or PPR staff
• Analyze and review confidential and highly sensitive investigative materials concerning employees, subscribers, providers, and groups
• Assist with claims and/or UCSW/NCompass inventory reports, daily aging reports, and process automation reports
• Collect, collate, analyze, and interpret data and documents for investigations and subpoena fulfillment

Investigator jobs in Connecticut

Surveillance Investigator

Field Investigator

Investigator I