Job Description Summary:
CES is looking for an Undercover Field Investigator to collect data/information for audits/investigations concerning fraud, waste, and abuse allegations, utilizing a combination of analytical skills and attention to detail, reviewing documentation, interviewing involved parties, and communicating with various stakeholders to gather relevant information for successful resolution and closure. Identify opportunities to proactively target fraud, waste, and abuse. Adheres to industry regulations and policies, assesses information for potential managerial follow-up. Analyzes data in order to effectively assess the validity of allegations. Provides accurate recommendations to management for resolution and closure. Documents and inputs all findings, while preparing comprehensive reports that may be used for legal or audit/investigative purposes.
Duties/Responsibilities:
Conducts routine and impartial audits/investigations from start to closure into fraud, waste, and abuse allegations, ensuring accurate and fair assessment.
Provides customer service by addressing inquiries and concerns, and escalates audit/investigation, as needed.
Compiles detailed and organized records of audit/investigation findings, ensuring accuracy and compliance with legal and regulatory requirements.
Applies functional knowledge to create and implement strategies to identify and prevent fraudulent activities.
Conducts interviews with relevant witnesses, claimants, and other stakeholders to gather additional information and perspectives.
Communicates with appropriate internal teams to ensure the proper processing of audits/investigations, while adhering to legal and regulatory standards.
Communicates audit/investigation findings clearly and professionally to customers, claimants, and other stakeholders, managing expectations and providing updates.
Assists in providing training and support to other auditors/investigators, contributing to the continuous improvement of investigative processes.
Required qualifications/skills:
Must have a Bachelor's degree.
Must have a Private Investigator license.
A minimum of 2-4 years experience in related field.
Must have knowledge and experience needed to use Microsoft Office Suite including but not limited to Excel, Word, PowerPoint, Teams, and Outlook.
Other:
Field work: Up to 75% of work will be performed in the field conducing site visits/investigations. Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.
The worker could be substantially exposed to adverse environmental conditions as field investigations and site visits will take place in areas with known criminal elements and in high crime areas.
Equal Opportunity Employer/Veterans/Disabled.
For more information about CES, please visit www.cesnb.com.
