457 Investigations jobs in the United States
Investigations Coordinator
Posted 3 days ago
Job Viewed
Job Description
This job is responsible for assisting in the processing and investigation of non-complex health care claims to determine the legitimacy of claim charges. The incumbent will also conduct or assist with provider and subscriber investigations to verify the validity of services and charges; will monitor internal referrals from sources such as claims, customer service, Medicare C&D Compliance, and Fraud Hotlines; will alert Investigators of the need for further analysis; will perform claims system extracts and create reports, graphs and charts to support case documentation; will prepare necessary correspondence to set and monitor provider and member claim system flags; will work with external vendors to recover confirmed over payments, coordinate payment of vendor invoices and coordinate request for an independent review determination; will participate in various internal committees as assigned; will update departmental tracking logs such as consultant listings, provider/member flag tracker and certified mail; and will input and maintain current case information in applicable case management tracking systems.
Essential Responsibilities- Claims Reviews/Investigation: Arrange for collection of claims and supporting data from internal and external sources including providers, customers and accounts; Review claims and supporting documentation to verify the legitimacy of medical and drug claim charges; Work with external vendors to recover confirmed facility and professional provider over-payments.
- Investigation Support: Assist with investigations: Assist in the interviews of customers and providers to obtain information in suspected fraud waste and abuse cases; Prepare reports and other information to document audit findings.
- Calculate over-payments in established fraud, waste and abuse cases. Identify all suspect activity included in the case, determine what lines of business were involved in the suspect activity, and measure over-payment by means of sampling or complete review.
- Data Analysis: Perform claims system extracts and create reports, graphs, and charts to support case documentation; Review reports and other information to identify claims and related documents requiring investigations based on pre-determined criteria, including review of suspect claims, Fraud Hot Line and internal referrals.
- Update departmental tracking logs such as consultant listings, provider/member flag tracking, record request tracking, vendor related, certified mail, etc.
- Maintain current case related information on all applicable case management tracking systems.
- Set and update member flags and monitor claims that suspend due to the flag.
- Other duties as assigned or requested.
Required: Associate's Degree
Substitutions: 3 years of related and progressive experience in lieu of Associate's degree
Preferred: None
ExperienceRequired: 3 years in Healthcare, Finance, provider office or related industry
Preferred: Experience in processing Blue Card, Local and FEP claims; Experience in working with SAS
Licenses or CertificationsRequired: None
Preferred: Certified Professional Coder (CPC)
SkillsDemonstrated proficiency in using Excel and Word; Knowledge of medical terminology; Demonstrated strong multi-tasking and organizational skills; Demonstrated strong verbal and written communication skills; Demonstrated proficiency in using OSCAR, INSINQ, ICIS, and COR or experience with other claims related processing platforms
Physical, Mental Demands and Working ConditionsPosition Type: Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum: $21.53 Pay Range Maximum: $32.30 Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
Investigations Coordinator
Posted 3 days ago
Job Viewed
Job Description
This job is responsible for assisting in the processing and investigation of non-complex health care claims to determine the legitimacy of claim charges. The incumbent will also conduct or assist with provider and subscriber investigations to verify the validity of services and charges; will monitor internal referrals from sources such as claims, customer service, Medicare C&D Compliance, and Fraud Hotlines; will alert Investigators of the need for further analysis; will perform claims system extracts and create reports, graphs and charts to support case documentation; will prepare necessary correspondence to set and monitor provider and member claim system flags; will work with external vendors to recover confirmed over payments, coordinate payment of vendor invoices and coordinate request for an independent review determination; will participate in various internal committees as assigned; will update departmental tracking logs such as consultant listings, provider/member flag tracker and certified mail; and will input and maintain current case information in applicable case management tracking systems.
Essential Responsibilities:
- Claims Reviews/Investigation: Arrange for collection of claims and supporting data from internal and external sources including providers, customers and accounts; Review claims and supporting documentation to verify the legitimacy of medical and drug claim charges; Work with external vendors to recover confirmed facility and professional provider over-payments.
- Investigation Support: Assist with investigations: Assist in the interviews of customers and providers to obtain information in suspected fraud waste and abuse cases; Prepare reports and other information to document audit findings.
- Calculate over-payments in established fraud, waste and abuse cases. Identify all suspect activity included in the case, determine what lines of business were involved in the suspect activity, and measure over-payment by means of sampling or complete review.
- Data Analysis: Perform claims system extracts and create reports, graphs, and charts to support case documentation; Review reports and other information to identify claims and related documents requiring investigations based on pre-determined criteria, including review of suspect claims, Fraud Hot Line and internal referrals.
- Update departmental tracking logs such as consultant listings, provider/member flag tracking, record request tracking, vendor related, certified mail, etc.
- Maintain current case related information on all applicable case management tracking systems.
- Set and update member flags and monitor claims that suspend due to the flag.
- Other duties as assigned or requested.
Education:
Required: Associate's Degree
Substitutions: 3 years of related and progressive experience in lieu of Associate's degree
Preferred: None
Experience:
Required: 3 years in Healthcare, Finance, provider office or related industry
Preferred: Experience in processing Blue Card, Local and FEP claims; Experience in working with SAS
Licenses or Certifications:
Required: None
Preferred: Certified Professional Coder (CPC)
Skills:
Demonstrated proficiency in using Excel and Word; Knowledge of medical terminology; Demonstrated strong multi-tasking and organizational skills; Demonstrated strong verbal and written communication skills; Demonstrated proficiency in using OSCAR, INSINQ, ICIS, and COR or experience with other claims related processing platforms
Language (Other than English): None
Travel Requirement: 0% - 25%
Physical, Mental Demands and Working Conditions:
Position Type: Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum: $21.53
Pay Range Maximum: $32.30
Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@ California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J
Investigations Coordinator
Posted 3 days ago
Job Viewed
Job Description
**Must reside in the state of Connecticut**
A Career With Purpose: Join Us as an Investigations Coordinator
Do you have a knack for getting to the heart of a matter and a passion for protecting others? Do you want to use your investigative talents to make a real-world difference? At Mosaic, we're looking for an
Investigations Coordinator to join our team and help us uphold our mission of empowering people to live meaningful lives in caring communities.
This isn't just a job; it's a calling to serve as a guardian for the people we support. As an Investigations Coordinator, you will lead complex, high-stakes internal investigations. You'll dive deep into allegations of abuse, neglect, and exploitation, acting with both professionalism and a commitment to our core values of
belonging, connection, faithfulness, and grit .
Here's What You'll Be Doing:- Lead with Impact: Take charge of internal investigations from start to finish, developing the strategy and scope for each case. You'll lead multiple investigations at once in a dynamic, fast-paced environment.
- Find the Truth: Identify, contact, and interview victims, witnesses, and alleged perpetrators. You'll collect, analyze, and interpret data to uncover the facts.
- Protect and Report: Evaluate investigative findings and prepare detailed reports for stakeholders, including company leadership and regulatory agencies. Your work will ensure our compliance with federal and state regulations and help protect our organization from potential legal action.
- Build a Better Process: Assist in developing and enhancing our investigations processes and policies, ensuring our team is always operating at its best.
SCHEDULE: Monday - Friday business hours
SALARY: $60,000 - $62,500
Commitment to Mosaic Values:
At Mosaic, we believe in creating a workplace where everyone has the chance to contribute and succeed. This commitment is not just a policy, it's the way we work. It's good for the workforce, it's good for Mosaic, and it's the right thing to do.
Who We're Looking For:You are a meticulous, organized, and independent thinker who can work both autonomously and as part of a team. You possess excellent written and verbal communication skills.
To be successful in this role, you will have:
- A bachelor's degree in Business, Political Science, Human Services, or a related field, or equivalent experience. A master's degree (MBA, MHA, JD, or similar) is preferred.
- A minimum of three years of related administrative or organizational experience with increasing responsibilities.
- Experience in a healthcare or I/DD (Intellectual and Developmental Disabilities) setting is a plus.
- A certification in LRA Consulting's Conducting Serious Incident Investigations / Level I, or the ability to obtain it within the first year of employment.
If you are ready to use your skills to make a tangible difference and become a guardian of our mission, we encourage you to apply.
Investigations Consultant

Posted 16 days ago
Job Viewed
Job Description
Highmark Inc.
**Job Description :**
**JOB SUMMARY**
This job is responsible for development and implementation of strategic audit plans utilizing numerous inputs including contracts, industry trends and revenue maximization schemes. The incumbent will also work with other audit team members and external vendors to develop specific auditing techniques to identify overbilling and potential recoveries/ savings. Will be called upon as a subject matter expert for investigations providing guidance and mentoring to investigative team. Must be able to testify in a court of law, prepare cases for referral to various federal, state and local law enforcement entities and work with those agencies through closure of the case. Conduct audits for proactive and investigative purposes to comply with internal audit and regulatory requirements.
**ESSENTIAL RESPONSIBILITIES**
+ Analyze and evaluate claim processes specific to professional, hospital, ambulatory surgical center, home health and durable medical equipment to identify key areas of risk exposure and develop plans to mitigate risks and maximize financial recoveries/savings.
+ Work with audit teams and external audit vendors to identify overbilling, determine data analysis routines and audit approaches.
+ Work with operational areas to recover identified overpayments, performing a follow-up review to ensure that the claims were adjusted correctly, resulting in expected recovery/savings.
+ Perform claims system extracts and create reports, graphs, and charts to timely identify trends and patterns of potential healthcare fraud, waste and abuse. Communicate findings to company management of various areas including provider relations, reimbursement etc.
+ Calculate overpayments in established fraud, waste or abuse cases. Identify all fraudulent activity included in the case, determine what lines of business were involved in the fraudulent activity, and measure overpayment by means of sampling or complete review. Negotiate settlements with providers.
+ Maintain current case related information on all applicable case management tracking systems.
+ Provide investigative support and mentoring to investigative team members.
+ Function as a project lead for special investigation projects of varying complexity.
+ Other duties as assigned or requested.
**EDUCATION**
**Required**
+ Bachelor's degree in Accounting, Finance, Business Administration, Nursing, IT or Related Field
**Substitutions**
+ 6 years of related and progressive experience in lieu of Bachelor's degree
**Preferred**
+ Master's degree in Fraud, Forensics Accounting, Business or related field
**EXPERIENCE**
**Required**
+ 7 years of in the Health Insurance industry and/or Healthcare Fraud investigations
+ 3 years in leading projects of varying size and complexity
**Preferred**
+ 5 years in Financial Analysis in an acute care hospital or health insurance setting
+ 5 years in professional billing, facility Patient Financial Services, HIM, Internal Audit, Professional/Facility Reimbursement or Provider Contracting
**LICENSES or CERTIFICATIONS**
**Required**
+ None
**Preferred**
+ Certified Fraud Examiner (CFE)
+ Certified Professional Coder (CPC)
+ Certified Professional Coder- Hospital(CPC-H)
+ Certified Outpatient Coder (COC)
+ Accredited Healthcare Fraud Investigator (AHFI)
**SKILLS**
+ Must have knowledge of provider facility payment methodology, claims processing systems and coding and billing proficiency
+ Must have understanding of technical and financial aspects of the health insurance industry
+ Strong personal computer skills, along with the ability to use fraud/abuse data mining tools are required
+ Must possess excellent communication skills and be detailed oriented
+ Strong written and oral communication skills
+ Strong relationship building skills
+ Client focused with strong business acumen
+ Self-starter with the ability to work under pressure independently and as part of a team
+ Ability to think strategically and act proactively to create strong trust and confidence with business units
+ Strong innovative problem-solving capabilities
**Language (Other than English):**
None
**Travel Requirement:**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
**Position Type**
Office-based
Teaches / trains others regularly
Frequently
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J
Intern- Investigations

Posted 16 days ago
Job Viewed
Job Description
Dominion Energy is committed to providing reliable, affordable, and increasingly clean energy that powers our customers every day. If you want to work for a purpose-driven company that values safety and collaboration, we're looking for you. You won't just find a job here; you'll find your career. Review the position below and apply today.
At this time, Dominion Energy cannot transfer or sponsor a work visa or employment authorization for this position.
**Job Summary**
**Job Summary**
Dominion Energy's Corporate Security organization is looking to bring on an intern for the summer of 2026. This position will assist the ongoing support, enhancements, and cross-programmatic deployment of a software called Kaseware at Dominion Energy. Kaseware is a case management software that is being used by several different groups at Dominion Energy.
**Required Knowledge, Skills, Abilities & Experience**
- Strong and written communication skills.
- Strong organizational and time management skills.
-Experience in Structured Query Language (SQL) preferred but not required.
- Self-starter; able to work with minimal supervision.
- Attention to detail and ability to work on multiple projects.
- Proficiency with Microsoft Word, Excel and PowerPoint.
- Valid driver's license.
- Must be a full-time student at an accredited four-year college or university.
- Ability to work a flexible schedule as needed.
**Education Requirements**
- Must be a student enrolled at a 4 year institution majoring in an Information Technology, Computer Science, or Law Enforcement/ Security related subject
- Must have an anticipated graduation date in 2028 (Spring or Fall)
- Must have a 3.0 GPA or higher.
**Test Description**
No Testing Required
**Export Control**
Certain positions at Dominion Energy may involve access to information and technology subject to export controls under U.S. law. Compliance with these export controls may result in Dominion Energy limiting its consideration of certain applicants.
**Other Information**
We offer excellent plans and programs for employees. Employees are rewarded with a competitive salary and comprehensive benefits package which may include: health benefits with coverage for families and domestic partners, vacation, retirement plans, paid holidays, tuition reimbursement, and much more. To learn more about our benefits, click here
Dominion Energy is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin and/or status as a protected veteran or individual with a disability.
You can experience the excitement of our company - it's the difference between taking a job and starting a career.
**Top 3 Reasons to Work at Dominion Energy**
**1. Great Work Life Balance**
**About Dominion Energy**
**I am your warm cup of coffee in the morning and I light your home at night. I am the cool breeze from your A/C on the hottest day in summer, and the red coil that heats your soup pot on a frigid winter's day. I am sustainable, reliable and affordable.**
**I am not just any energy. I am Dominion Energy.**
**We're transforming the way we do business to build a more sustainable future for the planet, our customers, our team and our industry. We're shaping the future of energy in America.**
**Join us!**
Facts:
·17,000 employees
·Headquarters: Richmond, VA
·18 states in the US
·$100 billion of assets
·Nearly $35 million in charitable contributions
·100,000+ volunteer hours recorded in the community
**Our Commitment to Net Zero**
Dominion Energy is committed to helping address climate change. We have cut emissions sharply as we aim for Net Zero carbon and methane emissions by 2050. Learn more at.
**Nearest Major Market:** Richmond
**Job Segment:** Summer Internship, Testing, Computer Science, Environmental Engineering, Intern, Entry Level, Technology, Engineering
Analyst, Compliance Investigations
Posted 3 days ago
Job Viewed
Job Description
The Compliance Investigations Team (iTeam) is responsible for investigating reports of potential compliance violations, conducting thorough inquiries, recommending appropriate corrective action, and using data and metrics to inform training, communications and trend analysis.
Role Summary: The Analyst/Senior Analyst will report to the iTeam Director and collaborate closely within the Compliance Department and with other team members throughout the organization. This role involves data analysis, report creation, system administration, and acting as the primary point of contact for the third-party hotline and case management system vendor. The successful candidate will possess strong interpersonal communication skills, critical thinking abilities, and organizational skills, along with basic development skills in Tableau and data analysis capabilities.
Key Responsibilities:
Data Development and Analytics Support (60%):
- Analyze large data sets using advanced Excel functions (VLOOKUP, pivot tables, etc.).
- Develop and create reporting in Tableau.
- Generate weekly, monthly, and ad hoc reports to support the investigations team and special initiatives.
- Create PowerPoint presentations of data and metrics for senior leadership meetings using Tableau and Excel.
- Conduct regular quality assurance reviews of data to ensure accuracy and completeness.
System Administration Enterprise Case Management System (Ethicspoint by NAVEX) (20%):
- Serve as the liaison between the organization and NAVEX to address issues and troubleshoot concerns.
- Provide support and guidance to other lane/tier administrators on best practices and processes.
- Annual invoice and allocation reconciliation.
Investigations Support (5%):
- Conduct basic interviews with teammates, including compliance exit interviews, and track results.
- Assist investigators with ongoing investigations by performing ancillary tasks such as data review.
Additional Responsibilities (15%):
- Act as a backup for other team members by conducting hotline poster audits, monitoring email boxes, and completing compliance hotline triage as needed.
- Lead small-scale compliance projects and assist with large-scale efforts under the direction of the Compliance Director.
- Present data and metrics to senior leadership.
- Monthly team budget and goals tracking.
- Other duties as assigned.
Qualifications:
- Bachelors Degree required.
- 2-4 years of professional experience; compliance and/or health care experience preferred.
- Advanced proficiency in Microsoft Word, Excel, PowerPoint, and Outlook.
- Strong development and reporting skills utilizing Tableau.
- Exceptional organizational skills and strong attention to detail.
- Demonstrated ability to manage time effectively, prioritize tasks, and meet deadlines.
- Strong problem-solving and decision-making skills; ability to identify issues, propose solutions, and implement resolutions promptly.
- Ability to work independently and as part of a team, managing projects and delegating tasks as appropriate.
- Strong interpersonal skills with the ability to interact with all levels of the organization.
- Ability to handle confidential information with discretion.
- Experience in compliance and/or health care industries.
- Experience working with NAVEX and EthicsPoint systems preferred.
Working Conditions:
- Hybrid schedule, Tuesday and Wednesdays in office during core hours (8am-5pm) required and additional days as needed for meetings, trainings and events.
- Ability to work in a fast-paced environment and handle multiple priorities simultaneously.
- This role may require occasional travel for meetings and audits.
How to Apply: Interested candidates should submit their resume and a cover letter detailing their qualifications and experience related to the role.
#J-18808-LjbffrInvestigations Program Manager

Posted 2 days ago
Job Viewed
Job Description
**170+ Years Strong. Industry Leader. Global Impact.**
At Pinkerton, the mission is to protect our clients. To do this, we provide enterprise risk management services and programs specifically designed for each client. Pinkerton employees are one of our most important assets and critical to the delivery of world-class solutions. Bonded together, we share a commitment to integrity, vigilance, and excellence.
Pinkerton is an inclusive employer who seeks candidates with diverse backgrounds, experiences, and perspectives to join our family of industry subject matter experts.
The Investigations Program Manager, assigned to a specific client, will develop and implement best practices, protocols, and operating procedures for the investigations program, while establishing standards to measure operational efficiency and effectiveness. This role serves as the department's subject matter expert on global investigative strategies, techniques, and training and collaborates with cross-functional teams such as Legal, HR, and Compliance to enhance processes. The Manager also coordinates resources, supervises and mentors the investigation team to ensure timely, professional services aligned with client policies, and prepares detailed reports on findings and recommendations for senior stakeholders.
**Responsibilities**
+ Represent Pinkerton's core values of integrity, vigilance, and excellence.
+ Serve as the subject matter expert for the client's Investigations Program.
+ Maintain strict adherence to all applicable local, state, and federal laws, regulations, and ethical standards governing private investigations, evidence handling, and privacy
+ Maintain close communication with client on all activities involving the Investigations Program.
+ Serve as a working manager responsible for acting as an Investigator for the Phoenix market.
+ Lead and manage investigations into security incidents, online threats, or employee complaints depending on organizational focus such as vandalism, theft, and related incidents.
+ Manage full and part-time Investigators and associated workflows within difference markets.
+ Build robust evidentiary packages to establish proof of criminal activity, suitable for presentation in a court of law, legal proceedings, investigations findings resulting in successful prosecutions.
+ Provide clear, concise, and timely investigative reports and regular updates to the client and collaborate law enforcement agencies.
+ Complete thorough review, analysis, and processing of diverse digital and physical evidence, including but not limited to, photos, videos documents, and physical evidence from a variety of sources and types.
+ Review KPIs on SLAs for weekly, monthly and quarterly business reviews with client stakeholders.
+ Develop and implement the investigation program's best practices, protocols, and program operating procedures.
+ Develop standards for measuring efficiency and effectiveness of investigative operations.
+ Provide guidance and recommendations regarding global investigative strategies, techniques, and education/training.
+ Maintain training and documentation that reflects client requirements, annual updates and provide training for new team members with refresh training annually.
+ Collaborate internally with cross functional groups such as Legal, HR, Compliance, and other business partners to enhance processes, workflows, and tools functionality.
+ Create and implement investigative case strategies based on situational factors.
+ Develop and maintain relationships with international, federal, state, and local law enforcement agencies in all markets.
+ Interface with vendors and clients of domestic and international investigative services.
+ Assist with the coordination of investigative resources through third party investigations, forensic accounting, and intellectual property suppliers.
+ Ensure all services are conducted in a timely and professional manner and aligned with the client's internal policies.
+ Supervise and mentor the investigation team while providing guidance and support to ensure effective case management.
+ Prepare and present reports on investigation findings to senior management and other stakeholders, highlighting key findings and recommendations
+ All other duties, as assigned.
**Qualifications**
Bachelor's degree with at least five years of corporate investigations program management experience and a strong preexisting professional law enforcement network (city, state, and federal).
+ Law enforcement background in criminal investigations and evidence handling, preferred.
+ Professional Certified Investigator (PCI) certification.
+ Understanding of legal limitations and protocols when interacting with law enforcement and conducting investigations.
+ Knowledge of investigative best practices, standards, and policies.
+ Effective written, verbal, and report presentation skills.
+ Knowledge of legal, regulatory, and compliance frameworks relevant to investigations.
+ Able to develop and maintain long-term trusting relationships with internal stakeholders and various law enforcement agencies.
+ Sound independent judgment and decision-making ability.
+ Able to lead a team toward the successful achievement of program objectives.
+ Able to manage multiple projects simultaneously with competing priorities and deadlines.
+ Computer skills: Google Suite, WebWiz, Kaseware and other incident management systems.
**Working Conditions:**
With or without reasonable accommodation, requires the physical and mental capacity to effectively perform all essential functions;
+ Regular computer usage.
+ Occasional reaching and lifting of small objects and operating office equipment.
+ Frequent sitting.
+ Travel, as required.
Pinkerton is an equal opportunity employer to all applicants and positions without regard to race/ethnicity, color, national origin, ancestry, sex/gender, gender identity/expression, sexual orientation, marital/prenatal status, pregnancy/childbirth or related conditions, religion, creed, age, disability, genetic information, veteran status, or any protected status by local, state, federal or country-specific law.
Submit a Referral ( _US-AZ-Phoenix_
**ID** _ _
**Category** _Investigations_
**Position Type** _Full-Time_
**Job Type** _On-Site_
Pinkerton is an equal opportunity employer to all applicants and positions without regard to race/ethnicity, color, national origin, ancestry, sex/gender, gender identity/expression, sexual orientation, marital/prenatal status, pregnancy/childbirth or related conditions, religion, creed, age, disability, genetic information, veteran status, or any protected status by local, state, federal or country-specific law.
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Director of Investigations

Posted 2 days ago
Job Viewed
Job Description
Corporate Risk
Phoenix,
Arizona
Portland,
Oregon
Irvine,
California
Los Angeles,
California
Tigard,
Oregon
**Description**
**About Us:**
At Columbia, we create a great place to work by offering a unique brand of relationship banking and fostering a culture where associates thrive. We are dedicated to supporting our customers and communities, and we can only achieve this through the dedication of ourassociates.
We value Trust, Ownership, Growth, Empathy, Teamwork, Heart, Enjoyment, and Relationships, and we are eager to meet candidates who embody these core values. We are always on the lookout for results-focused individuals who can think independently, work collaboratively, and support our broader purpose.
Think of us as financial partners, because at Columbia, we believe the best way forward is together. Together for people. Together for business. Together for better.
**About the Role:**
Responsible for overseeing all day-to-day Financial Investigation Department (FID) Investigations activities. Looking for an innovative Director who is seasoned in implementing and maintaining a world class Fraud and Anti-Money laundering (AML) investigations and transaction monitoring program that provides the ability to deter the use of our products and services to deter terrorist financing and money laundering activities. Must be able to provide subject matter expertise and leadership in the field of AML and fraud investigations as well as understanding the risks associated and types of controls that must be in place.
+ Development, management and execution of fraud and AML investigations and transaction monitoring program.
+ Develop policies and procedures for all investigations, including life cycle, reviews of scenario validation, segmentation, and optimization tools.
+ Engagement in rules development and use of machine learning and AI in fraud and AML transaction and behavioral monitoring.
+ Review of policy and related documents to ensure that all investigative risk management processes are addressed.
+ Determine emerging risk impacting transaction monitoring and fraud/AML typologies.
+ Analyze data, prepare and present regional and global reports related to fraud and AML investigations including related issues and escalations.
+ Develop strategy, requirements and recommendations for investigative workflows relating to new products and services, including serving as driver or strong contributor for investigative projects and progress, and development of monitoring proposals.
+ Initiate, assess and determine data quality and recommend solutions to improve and deliver sustaining and effective monitoring, alert handling, and SAR filing processes.
+ Establish and conduct oversight of operations functions engaged in the handling/resolution of AML alerts and manual investigations related to internal employee, fraud, and highly sensitive investigations.
+ Provide oversight and support services for groups that impact FID related to fraud investigations and AML transaction monitoring, process and policies.
+ Working knowledge and experience in Actimize, LexisNexis, other systems as required.
+ Other duties as assigned.
+ Supervise up to 8 employees including managers
**About** **You:**
+ Bachelor's degree in business, finance, risk management, criminal justice, information technology or related field is preferred.
+ 6+ years in investigations including fraud and AML as well as transaction monitoring, including a strong understanding of fraud and AML regulations and
+ Understanding of the financial services environment, across various products and geographical locations, and how they interact with financial crimes investigations.
+ Ability to identify emerging financial crime risks that impact investigations and transaction monitoring.
+ Excellent project management and organizational skills and capability to handle multiple projects at one time
+ Experience with and previous exposure to internal control functions and regulators.
+ Excellent written, verbal communication, and analytical skills
+ Demonstrated attention to detail with understanding of strategic vision and context.
+ Ability to lead and influence people to successfully execute strategies across functions and at senior levels using sound judgment.
+ Experience managing managers of teams.
+ Promoting a culture of accountability and early escalation of issues
+ CAMS or equivalent certification or willingness to obtain.
**Travel:**
Occasional
**Job Location(s):** Ability to work fully onsite at posted location(s).
Portland, OR
Los Angeles, CA
Irvine, CA
Phoenix, AZ
**Our** **Benefits:**
We offer a competitive total rewards package including basewagesand comprehensive benefits. Thepayrange for this role is $103,000.00 - $140,000.00, and the pay rate for theselected candidate isdependent upon a variety of non-discriminatory factors including, but not limited to, job-related knowledge, skills, and experience, education, and geographic location. The rolemay beeligible for performance-based incentive compensation and those details will be provided during the recruitment process.
We offer eligible associates comprehensive healthcare coverage (medical, dental, and vision plans), a 401(k)-retirement savings plan with employer match for qualifying associate contributions, an employee assistance program, life insurance, disability insurance, tuition assistance, mental health resources, identity theft protection, legal support, auto and home insurance, pet insurance, access to an online discount marketplace, and paid vacation, sick days, volunteer days, and holidays. Benefit eligibility begins the first day of the month following the date of hire for associates who are regularly scheduled to work at least thirty hours weekly.
**Our Commitment to** **Diversity** **:**
Columbia Bank isan equal opportunityand affirmative actionemployercommitted to employing, engaging, and developinga diverse workforce.Allqualifiedapplicants will receive considerationfor employmentwithout regard to race, color,national origin,religion, sex, age, sexual orientation, gender identity, gender expression, protected veteran status, disability, or any other applicable protected status or characteristics.If you require an accommodation to complete the application or interview(s),please let us know by email: (email protected) .
**To Staffing and Recruiting Agencies:**
Our posted job opportunities are onlyintendedfor individuals seekingemploymentat Columbia Bank.Columbia Bank does not accept unsolicited resumes or applications from agencies and Columbia Bank will not be responsible for any fees related to unsolicited resume submissions.Staffing and recruiting agencies are not authorized to submit profiles, applications,or resumestothis site or toany Columbia Bank employeeand any such submissionswill be consideredunsolicitedunlessrequesteddirectlyby a member of the Talent Acquisition team.
Director of Investigations

Posted 2 days ago
Job Viewed
Job Description
Corporate Risk
Phoenix,
Arizona
Portland,
Oregon
Irvine,
California
Los Angeles,
California
Tigard,
Oregon
**Description**
**About Us:**
At Columbia, we create a great place to work by offering a unique brand of relationship banking and fostering a culture where associates thrive. We are dedicated to supporting our customers and communities, and we can only achieve this through the dedication of ourassociates.
We value Trust, Ownership, Growth, Empathy, Teamwork, Heart, Enjoyment, and Relationships, and we are eager to meet candidates who embody these core values. We are always on the lookout for results-focused individuals who can think independently, work collaboratively, and support our broader purpose.
Think of us as financial partners, because at Columbia, we believe the best way forward is together. Together for people. Together for business. Together for better.
**About the Role:**
Responsible for overseeing all day-to-day Financial Investigation Department (FID) Investigations activities. Looking for an innovative Director who is seasoned in implementing and maintaining a world class Fraud and Anti-Money laundering (AML) investigations and transaction monitoring program that provides the ability to deter the use of our products and services to deter terrorist financing and money laundering activities. Must be able to provide subject matter expertise and leadership in the field of AML and fraud investigations as well as understanding the risks associated and types of controls that must be in place.
+ Development, management and execution of fraud and AML investigations and transaction monitoring program.
+ Develop policies and procedures for all investigations, including life cycle, reviews of scenario validation, segmentation, and optimization tools.
+ Engagement in rules development and use of machine learning and AI in fraud and AML transaction and behavioral monitoring.
+ Review of policy and related documents to ensure that all investigative risk management processes are addressed.
+ Determine emerging risk impacting transaction monitoring and fraud/AML typologies.
+ Analyze data, prepare and present regional and global reports related to fraud and AML investigations including related issues and escalations.
+ Develop strategy, requirements and recommendations for investigative workflows relating to new products and services, including serving as driver or strong contributor for investigative projects and progress, and development of monitoring proposals.
+ Initiate, assess and determine data quality and recommend solutions to improve and deliver sustaining and effective monitoring, alert handling, and SAR filing processes.
+ Establish and conduct oversight of operations functions engaged in the handling/resolution of AML alerts and manual investigations related to internal employee, fraud, and highly sensitive investigations.
+ Provide oversight and support services for groups that impact FID related to fraud investigations and AML transaction monitoring, process and policies.
+ Working knowledge and experience in Actimize, LexisNexis, other systems as required.
+ Other duties as assigned.
+ Supervise up to 8 employees including managers
**About** **You:**
+ Bachelor's degree in business, finance, risk management, criminal justice, information technology or related field is preferred.
+ 6+ years in investigations including fraud and AML as well as transaction monitoring, including a strong understanding of fraud and AML regulations and
+ Understanding of the financial services environment, across various products and geographical locations, and how they interact with financial crimes investigations.
+ Ability to identify emerging financial crime risks that impact investigations and transaction monitoring.
+ Excellent project management and organizational skills and capability to handle multiple projects at one time
+ Experience with and previous exposure to internal control functions and regulators.
+ Excellent written, verbal communication, and analytical skills
+ Demonstrated attention to detail with understanding of strategic vision and context.
+ Ability to lead and influence people to successfully execute strategies across functions and at senior levels using sound judgment.
+ Experience managing managers of teams.
+ Promoting a culture of accountability and early escalation of issues
+ CAMS or equivalent certification or willingness to obtain.
**Travel:**
Occasional
**Job Location(s):** Ability to work fully onsite at posted location(s).
Portland, OR
Los Angeles, CA
Irvine, CA
Phoenix, AZ
**Our** **Benefits:**
We offer a competitive total rewards package including basewagesand comprehensive benefits. Thepayrange for this role is $103,000.00 - $140,000.00, and the pay rate for theselected candidate isdependent upon a variety of non-discriminatory factors including, but not limited to, job-related knowledge, skills, and experience, education, and geographic location. The rolemay beeligible for performance-based incentive compensation and those details will be provided during the recruitment process.
We offer eligible associates comprehensive healthcare coverage (medical, dental, and vision plans), a 401(k)-retirement savings plan with employer match for qualifying associate contributions, an employee assistance program, life insurance, disability insurance, tuition assistance, mental health resources, identity theft protection, legal support, auto and home insurance, pet insurance, access to an online discount marketplace, and paid vacation, sick days, volunteer days, and holidays. Benefit eligibility begins the first day of the month following the date of hire for associates who are regularly scheduled to work at least thirty hours weekly.
**Our Commitment to** **Diversity** **:**
Columbia Bank isan equal opportunityand affirmative actionemployercommitted to employing, engaging, and developinga diverse workforce.Allqualifiedapplicants will receive considerationfor employmentwithout regard to race, color,national origin,religion, sex, age, sexual orientation, gender identity, gender expression, protected veteran status, disability, or any other applicable protected status or characteristics.If you require an accommodation to complete the application or interview(s),please let us know by email: (email protected) .
**To Staffing and Recruiting Agencies:**
Our posted job opportunities are onlyintendedfor individuals seekingemploymentat Columbia Bank.Columbia Bank does not accept unsolicited resumes or applications from agencies and Columbia Bank will not be responsible for any fees related to unsolicited resume submissions.Staffing and recruiting agencies are not authorized to submit profiles, applications,or resumestothis site or toany Columbia Bank employeeand any such submissionswill be consideredunsolicitedunlessrequesteddirectlyby a member of the Talent Acquisition team.
Director of Investigations

Posted 2 days ago
Job Viewed
Job Description
Corporate Risk
Phoenix,
Arizona
Portland,
Oregon
Irvine,
California
Los Angeles,
California
Tigard,
Oregon
**Description**
**About Us:**
At Columbia, we create a great place to work by offering a unique brand of relationship banking and fostering a culture where associates thrive. We are dedicated to supporting our customers and communities, and we can only achieve this through the dedication of ourassociates.
We value Trust, Ownership, Growth, Empathy, Teamwork, Heart, Enjoyment, and Relationships, and we are eager to meet candidates who embody these core values. We are always on the lookout for results-focused individuals who can think independently, work collaboratively, and support our broader purpose.
Think of us as financial partners, because at Columbia, we believe the best way forward is together. Together for people. Together for business. Together for better.
**About the Role:**
Responsible for overseeing all day-to-day Financial Investigation Department (FID) Investigations activities. Looking for an innovative Director who is seasoned in implementing and maintaining a world class Fraud and Anti-Money laundering (AML) investigations and transaction monitoring program that provides the ability to deter the use of our products and services to deter terrorist financing and money laundering activities. Must be able to provide subject matter expertise and leadership in the field of AML and fraud investigations as well as understanding the risks associated and types of controls that must be in place.
+ Development, management and execution of fraud and AML investigations and transaction monitoring program.
+ Develop policies and procedures for all investigations, including life cycle, reviews of scenario validation, segmentation, and optimization tools.
+ Engagement in rules development and use of machine learning and AI in fraud and AML transaction and behavioral monitoring.
+ Review of policy and related documents to ensure that all investigative risk management processes are addressed.
+ Determine emerging risk impacting transaction monitoring and fraud/AML typologies.
+ Analyze data, prepare and present regional and global reports related to fraud and AML investigations including related issues and escalations.
+ Develop strategy, requirements and recommendations for investigative workflows relating to new products and services, including serving as driver or strong contributor for investigative projects and progress, and development of monitoring proposals.
+ Initiate, assess and determine data quality and recommend solutions to improve and deliver sustaining and effective monitoring, alert handling, and SAR filing processes.
+ Establish and conduct oversight of operations functions engaged in the handling/resolution of AML alerts and manual investigations related to internal employee, fraud, and highly sensitive investigations.
+ Provide oversight and support services for groups that impact FID related to fraud investigations and AML transaction monitoring, process and policies.
+ Working knowledge and experience in Actimize, LexisNexis, other systems as required.
+ Other duties as assigned.
+ Supervise up to 8 employees including managers
**About** **You:**
+ Bachelor's degree in business, finance, risk management, criminal justice, information technology or related field is preferred.
+ 6+ years in investigations including fraud and AML as well as transaction monitoring, including a strong understanding of fraud and AML regulations and
+ Understanding of the financial services environment, across various products and geographical locations, and how they interact with financial crimes investigations.
+ Ability to identify emerging financial crime risks that impact investigations and transaction monitoring.
+ Excellent project management and organizational skills and capability to handle multiple projects at one time
+ Experience with and previous exposure to internal control functions and regulators.
+ Excellent written, verbal communication, and analytical skills
+ Demonstrated attention to detail with understanding of strategic vision and context.
+ Ability to lead and influence people to successfully execute strategies across functions and at senior levels using sound judgment.
+ Experience managing managers of teams.
+ Promoting a culture of accountability and early escalation of issues
+ CAMS or equivalent certification or willingness to obtain.
**Travel:**
Occasional
**Job Location(s):** Ability to work fully onsite at posted location(s).
Portland, OR
Los Angeles, CA
Irvine, CA
Phoenix, AZ
**Our** **Benefits:**
We offer a competitive total rewards package including basewagesand comprehensive benefits. Thepayrange for this role is $103,000.00 - $140,000.00, and the pay rate for theselected candidate isdependent upon a variety of non-discriminatory factors including, but not limited to, job-related knowledge, skills, and experience, education, and geographic location. The rolemay beeligible for performance-based incentive compensation and those details will be provided during the recruitment process.
We offer eligible associates comprehensive healthcare coverage (medical, dental, and vision plans), a 401(k)-retirement savings plan with employer match for qualifying associate contributions, an employee assistance program, life insurance, disability insurance, tuition assistance, mental health resources, identity theft protection, legal support, auto and home insurance, pet insurance, access to an online discount marketplace, and paid vacation, sick days, volunteer days, and holidays. Benefit eligibility begins the first day of the month following the date of hire for associates who are regularly scheduled to work at least thirty hours weekly.
**Our Commitment to** **Diversity** **:**
Columbia Bank isan equal opportunityand affirmative actionemployercommitted to employing, engaging, and developinga diverse workforce.Allqualifiedapplicants will receive considerationfor employmentwithout regard to race, color,national origin,religion, sex, age, sexual orientation, gender identity, gender expression, protected veteran status, disability, or any other applicable protected status or characteristics.If you require an accommodation to complete the application or interview(s),please let us know by email: (email protected) .
**To Staffing and Recruiting Agencies:**
Our posted job opportunities are onlyintendedfor individuals seekingemploymentat Columbia Bank.Columbia Bank does not accept unsolicited resumes or applications from agencies and Columbia Bank will not be responsible for any fees related to unsolicited resume submissions.Staffing and recruiting agencies are not authorized to submit profiles, applications,or resumestothis site or toany Columbia Bank employeeand any such submissionswill be consideredunsolicitedunlessrequesteddirectlyby a member of the Talent Acquisition team.