Credit Card Fraud Investigator, Sr. jobs in New Mexico

Credit Card Fraud Investigator, Sr. investigates suspected fraudulent use of credit cards issued by the organization. Interviews individuals involved and coordinates investigations with law enforcement personnel. Being a Credit Card Fraud Investigator, Sr. analyzes loss trends and makes recommendations to prevent further loss. Requires a bachelor's degree. Additionally, Credit Card Fraud Investigator, Sr. typically reports to a supervisor or manager. The Credit Card Fraud Investigator, Sr. contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. To be a Credit Card Fraud Investigator, Sr. typically requires 4 to 7 years of related experience. (Copyright 2024 Salary.com)

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Sr Investigator
  • UnitedHealthcare
  • Continental Divide, NM FULL_TIME
  • At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us and start doing your life's best work.SM

    The SeniorInvestigator reports directly to the Manager of Investigations. The SeniorInvestigator is responsible for identification, investigation and prevention of healthcare fraud, waste, and abuse. The SeniorInvestigator will utilize claims data, applicable guidelines, and other sources of information to identify aberrant billing practices and patterns. The SeniorInvestigator is responsible to conduct investigations which may include field work to perform interviews and obtain records and/or other relevant documentation.

    If you reside in New Mexico, you will enjoy the flexibility to telecommute* as you take on some tough challenges.

    Primary Responsibilities:

    • Investigate medium to highly complex cases of fraud, waste and abuse
    • Detect fraudulent activity by members, providers, employees and other parties against the Company
    • Develop and deploy the most effective and efficient investigative strategy for each investigation
    • Maintain accurate, current and thorough case information in the Special Investigations Unit's (SIU's) case tracking system
    • Collect and secure documentation or evidence and prepare summaries of the findings
    • Participate in settlement negotiations and/or produce investigative materials in support of the later
    • Communicate effectively, to include written and verbal forms of communication
    • Develop goals and objectives, track progress and adapt to changing priorities
    • Collect, collate, analyze, and interpret data relating to fraud, waste and abuse referrals
    • Ensure compliance of applicable federal/state regulations or contractual obligations
    • Report suspected fraud, waste and abuse to appropriate federal or state government regulators
    • Comply with goals, policies, procedures and strategic plans as delegated by SIU leadership
    • Collaborate with state/federal partners, at the discretion of SIU leadership, to include attendance at workgroups or regulatory meetings

    You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

    Required Qualifications:

    • Associate's Degree (or higher)
    • Active affiliations:
      • National Health Care Anti-Fraud Association (NHCAA)
    • Accredited Health Care Fraud Investigator (AHFI)
    • Certified Fraud Examiner (CFE)
    • Certified Professional Coder (CPC)
    • Medical Laboratory Technician (MLT)
    • 2 years of equivalent work experience with healthcare related employment
    • 2-5 years of experience OR demonstrated intermediate level of knowledge in health care fraud, waste, and abuse (FWA)
    • 2-5 years of experience OR demonstrated intermediate level of knowledge in state or federal regulatory FWA requirements
    • 2-5 years of experience OR demonstrated intermediate level of knowledge analyzing data to identify fraud, waste and abuse trends
    • 2-5 years of experience OR demonstrated intermediate level of proficiency in Microsoft Excel and Word
    • Ability to participate in legal proceedings, arbitration, and depositions at the direction of management
    • Ability to travel up to 25% of the time within the Southwest region

    Preferred Qualifications:

    • Intermediate knowledge and experience in any of the following:
      • Statistical Analysis Software (SAS)
      • R
      • Python
      • Tableau
      • Toad
      • Structured Query Language (SQL)
      • Visual Basic for Applications (VBA)
      • Alteryx
    • Intermediate knowledge and experience in any of the following:
      • Statistical Analysis
      • Regression Analysis
      • Linear Analysis
      • Market-basket Analysis
    • Licensed and/or Certified Pharmacy Technician (CPhT)
    • Intermediate knowledge in pharmacy claims processing
    • Operational experience with a pharmacy and/or pharmacy benefits manager (PBM)

    *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

    At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

    Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

    UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

    #RPO #Yellow

  • 1 Day Ago

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Sr Investigator
  • UnitedHealthcare
  • Zuni, NM FULL_TIME
  • At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people f...
  • 2 Days Ago

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Sr Investigator
  • UnitedHealth Group
  • Albuquerque, NM FULL_TIME
  • At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people f...
  • 16 Days Ago

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Sr Credit Analyst
  • Century Bank
  • Albuquerque, NM FULL_TIME
  • REPORTS TO:SVP, Commercial Credit Underwriting DirectorMAJOR DUTIES AND RESPONSIBILITIES:1. Develops credit information for use by lending officers or committees in making lending decisions on new, re...
  • 4 Days Ago

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Investigator
  • Ethos Risk Services
  • Albuquerque, NM PART_TIME
  • Ethos Risk is Looking for an Experienced Field Investigator in the Albuquerque, NM area. Position Overview: We are looking for qualified candidates to join our growing team of professionals. We are lo...
  • 16 Days Ago

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CREDIT BUYER
  • SANDIA AREA FEDERAL CREDIT UNION
  • Albuquerque, NM OTHER
  • Job Details Job Location: Rutledge Operations Center - Albuquerque, NM Position Type: Full Time Salary Range: Undisclosed Job Shift: Day DescriptionOVERALL JOB PURPOSE Responsible for reviewing, analy...
  • 1 Month Ago

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Credit Checkers
  • Trade College
  • The states with the most job growth for Credit Checker are **Utah, Florida, and Washington**. Watch out if you plan on w...
  • 3/28/2024 12:00:00 AM

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Credit Checkers
  • Business Degree Central
  • Charleston, WV
  • The states with the most job growth for Credit Checker are **Utah, Florida, and Washington**. Watch out if you plan on w...
  • 3/28/2024 12:00:00 AM

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Credit Investigator Eastern RegionAlpharetta, GA
  • AVA Consulting
  • Alpharetta, GA
  • Company Background: Our client, a major employer in the area, is looking for a Credit Investigator Eastern Region to be ...
  • 3/28/2024 12:00:00 AM

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Commercial Credit Review Officer (Remote)
  • Northwest
  • Warren, PA
  • Job Summary The Loan Review Officer is responsible for performing a variety of loan review activities which aid in the e...
  • 3/27/2024 12:00:00 AM

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VP Project Finance Portfolio Management- Renewables + Power
  • Taurus Search
  • New York, NY
  • My client is an international bank and is looking to hire a Project Finance Portfolio Management VP to join their global...
  • 3/27/2024 12:00:00 AM

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Credit Checkers
  • Course Advisor Inc
  • The states with the most job growth for Credit Checker are **Utah, Florida, and Washington**. Watch out if you plan on w...
  • 3/26/2024 12:00:00 AM

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Credit Review Supervisor Risk Consulting
  • RSM Global
  • New York, NY
  • We are the leading provider of professional services to the middle market globally, our purpose is to instill confidence...
  • 3/26/2024 12:00:00 AM

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Customer Financial Analyst
  • Carlisle Construction Materials
  • Carlisle, PA
  • This position’s primary function is to evaluate new and existing customer credit-worthiness during the onboarding proces...
  • 3/25/2024 12:00:00 AM

New Mexico (Spanish: Nuevo México Spanish pronunciation: [ˈnweβo ˈmexiko] (listen), Navajo: Yootó Hahoodzo pronounced [jòːtxó xɑ̀xʷòːtsò]) is a state in the Southwestern region of the United States of America; its capital and cultural center is Santa Fe, which was founded in 1610 as capital of Nuevo México (itself established as a province of New Spain in 1598), while its largest city is Albuquerque with its accompanying metropolitan area. It is one of the Mountain States and shares the Four Corners region with Utah, Colorado, and Arizona; its other neighboring states are Oklahoma to the north...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Credit Card Fraud Investigator, Sr. jobs
$45,170 to $61,684

Credit Card Fraud Investigator, Sr. in Great Falls, MT
Although credit card security is the responsibility of each vendor via their chosen banking relationship, UCF Police, Business Services, and the Information Security Office have been working with vendors on campus during the past couple of weeks.
January 18, 2020
Credit Card Fraud Investigator, Sr. in Salt Lake City, UT
On average, a Bachelor's Degree is the highest level of education for a Credit Card Fraud Investigator.
December 12, 2019
Credit Card Fraud Investigator, Sr. in Pascagoula, MS
The indictments allege that the defendants were stealing customer credit and debit card information from local businesses and manufacturing counterfeit cards used to obtain hundreds or thousands of dollars from businesses.
December 16, 2019