New Jersey Licensed Investigator

Job Summary

A company is looking for an Investigator II to conduct analytical and investigative activities related to fraud detection in claims and operations.

Key Responsibilities

• Detect fraudulent activities by various parties and decide on investigation methods
• Prepare and document fraud cases, assembling evidence for potential prosecution
• Represent the company in legal proceedings and settlement negotiations

Required Qualifications, Training, and Education

• Bachelor's Degree required
• Minimum 2 years of claims, customer service, or relevant law enforcement experience
• Preferred certifications include AHFI, CFE, or CPC
• In-depth knowledge of health insurance operations is required
• Preferred working knowledge of NJ Criminal and Civil Law related to health insurance fraud