Director of SIU Analytics & Fraud Detection
Centene Corporation
Centene Corporation is seeking a senior leader to direct SIU analytics, driving detection and investigation of fraud, waste, and abuse. You will leverage data assets, predictive monitoring, and vendor partnerships to strengthen program integrity and deliver measurable value. The role requires strategic planning, team leadership, and collaboration with enterprise stakeholders to modernize analytics capabilities and reporting. #J-18808-Ljbffr Centene Corporation
$87.7k - $157.8k
...direction, development, and optimization of SIU capabilities that support the detection, prevention, and investigation of fraud, waste, and abuse (FWA). Drives the effective... ...internal and external data assets, advanced analytic tools, predictive monitoring methodologies,...FraudFull timePart timeWork at officeRemote workFlexible hours- ...and Blue Shield of North Carolina is seeking a Healthcare Analytics Analyst to serve as a strategic partner to SIU and Payment Integrity, delivering insights, dashboards, and audit support that drive fraud detection and cost savings. The role translates complex healthcare...Fraud
- ...Missouri. The ideal candidate will have flexible hours to provide expert investigative services for various insurance claims, including fraud and liability. Key responsibilities include conducting surveillance, completing investigations, and submitting timely reports....FraudFlexible hours
- Blue KC’s Special Investigations Unit seeks a Fraud Investigator to conduct reviews identifying fraud, waste and abuse, with cases of... ...limited oversight. You will perform risk assessments, use data analytics, monitor hotlines, coordinate subpoenas, prepare case reports,...Fraud
$89.17k - $142.68k
...Description Serves as a strategic analytics partner to the Special Investigations Unit (SIU) and Payment Integrity teams by... ...engagement to identify fraud, waste, abuse, payment accuracy... ...that support fraud, waste, abuse detection, payment accuracy, and operational...Fraud- ...JCPenney is seeking an Asset Protection/Shrink Investigator to detect theft and fraud, collect evidence, and document all stages of investigations across stores. You will follow AP directives, conduct external interviews when needed, and report to AP leadership. The role...Fraud
$70.1k - $126.2k
...workplace flexibility. Position Purpose Independently leads complex fraud, waste, and abuse (FWA) investigations involving providers,... ...utilizing referrals, claims data, medical records, interviews, analytics, and other investigative resources. Analyzes and interprets...FraudFull timePart timeWork at officeRemote workFlexible hours- ...Protection role focused on shrink reduction and safety. You will detect theft, conduct investigations, and collect evidence while... ...This position involves external interviews and reporting suspected fraud to leadership to maintain store integrity. Responsibilities include...Fraud
- ...Review, analyze, and decision fraud detection system alerts in accordance with the Fraud Department’s policies, processes, and procedures... .... Associate's degree or equivalent work experience. Strong analytical, problem‑solving, multi‑tasking, and conflict resolution skills...FraudWork experience placementWork at office
- ...types of insurance claims including workers' compensation, suspected fraud, liability and aimed at mitigating expenses for our clients and... ..., including Surveillance and Special Investigations Unit (SIU) assignments, within an assigned geographical area. Surveillance...FraudFlexible hours
$116.2k - $229.1k
...Recruiting for this role ends on 08/22/2026. Work you’ll do The Quality Analytics and Enablement Manager plays a pivotal role in supporting the... ...comprehensive analysis of multi-source risk data to detect underlying trends, anomaly drivers, and emerging risk patterns...Local area$72k - $141k
...salvage opportunities or potential fraud occurrences by evaluating the... ...Claim, Recovery or SIU resources for further investigation... ...Reporting RelationshipTypically Director or aboveSkills, Knowledge & AbilitiesThorough... ...clearly.Demonstrated analytical and investigative mindset with...FraudFull timeWork experience placementWork at officeLocal areaShift work$97.5k - $127.5k
...Monitoring industry trends relative to money laundering or fraud schemes including detection and reporting of suspicious activity.Performing any... ...higher and high risk customers. Detail-oriented, highly analytical and comfortable digging into dataStrong communication skills...FraudRemote workFlexible hours- ...discrepancies, duplicate submissions, or potential fraud and elevate as needed Ensure timely... ...policies Strong attention to detail and analytical skills Ability to interpret and apply... ...Analytical mindset with the ability to detect irregularities or trends Customer service...FraudTemporary workWork at office
$116k - $165k
...salvage opportunities or potential fraud occurrences by evaluating the... ...Claim, Recovery or SIU resources for further investigation... ...Reporting RelationshipTypically Director or aboveSkills, Knowledge & AbilitiesThorough... ...clearly.Demonstrated analytical and investigative mindset with...FraudFull timeWork experience placementWork at officeLocal areaFlexible hoursShift work- ...experience. This is a senior‑level position that requires strong analytical abilities, deep system knowledge, and the capability to manage... ...Review Declined Transactions Report daily to identify issues, fraud indicators, or unprocessed items. Review Purchasing Detail Report...Fraud
- ...environment.Strong verbal, written, and interpersonal skills.Strong analytical and problem-solving skills.Ability to formulate and... ...underwritingExperience with Moody's CreditLensExperience in fraud detection best practices associated with on-line lending.Experience with...FraudTemporary workFlexible hours
$60k - $75k
...of company cards by enforcing card policy, preventing misuse or fraud, and training employees on correct procedures and systems. They... ...accounts remain current Perform audits of card transactions to detect fraud, policy violations, and irregular spending Maintain accurate...FraudWork at office- ...league based in Kansas City is seeking a Research and Development Director to lead innovative research initiatives and enhance operations... ...candidate will have a background in sports science or data analytics, with strong analytical, problem-solving, and project...
- ...responsible for enforcing the Commodity Exchange Act (Act) and Commission Regulations (Regulations). As such, DOE investigates and litigates suspected violations of the Act and Regulations, including fraud, manipulation, and other abuses concerning derivatives and commodities....Fraud
- ...Union) IT experience Symitar experience FTP experience. Strong analytical skills. Good teammate If you got this far, we hope you're... ...strategy focuses on delivering secure data access, mitigating fraud, and enabling seamless integration. Empowering our teams to build...FraudRemote jobSummer workWork at officeLocal areaWork from home
$70.1k - $126.2k
...internal and external reporting. Supports the Director, Ethics & Investigations in the day-to-... ..., including Legal, People Relations, SIU, Privacy, Finance, and Business Operations... .... Licenses and Certifications: Certified Fraud Examiner (CFE) preferred. Certified Compliance...FraudFull timePart timeWork at officeRemote workFlexible hours- ...Auditor. Key Role Responsibilities - Core INTERNAL AUDITOR FAMILY - CORE Collects and analyzes data to detect deficient controls, duplicated effort, extravagance, fraud, or non-compliance with laws, regulations, and management policies. Prepares detailed reports on...Fraud
- ...ensuring the accuracy of claims payment through the prevention, detection, and correction of billing, payment, and membership errors.... ...plan leaders, the manager oversees monitoring and enforcement of fraud, waste, and abuse compliance programs to prevent and detect potential...FraudWork experience placementWork at officeLocal areaDay shift2 days per week1 day per week
$30 - $40 per hour
...Ethos Risk Services is a leading insurance claims investigation and medical management company, specializing in surveillance and fraud detection. At the forefront, we provide accurate data and actionable insights that translate into better decision-making for our clients....FraudHourly payLocal areaNight shiftWeekend work$46.99k - $122.4k
...referral to state regulators for any suspected fraud, waste or abuse (FWA). The Auditor must... ...and retrospective FWA avoidance, detection, and referral. Assist with the creation... ...Previous experience with QuickBase. Strong analytical and critical thinking skills. Strong...FraudHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hours$17.5 - $21.88 per hour
Shrink Observes activities to detect theft, fraud, or suspicious activity; collects investigative evidence utilizing CCTV and observations from the sales floor. Follows AP Directives and Company policy when making apprehensions. Executes required Company investigation...FraudHourly payFor contractorsWork experience placementLocal areaDay shift- ...zero-trust architecture, containerization, and advanced threat detection. The engineer collaborates with cross-functional teams to assess... ...(e.g., Diameter, SIP, and mitigate risks such as signaling fraud,DoS attacks, and SS7 vulnerabilities.Also responsible for other...FraudFull timeTemporary workPart timeWork experience placementLocal areaFlexible hours
$59.09k - $86.92k
...Fraud Prevention AnalystAs the Fraud Prevention Analyst, you will support UMB Fraud Operations... ...How you will spend your time:Analyze and detect check, card, ACH, wire and OLB fraud... ...using all tools available and engage in analytical and fraud detection skills.Review the queued...FraudWork at officeLocal areaRemote workFlexible hours$46.99k - $122.4k
...Program Integrity Auditor to review medical records and ensure compliance with coding standards. This role involves identifying potential fraud, assisting with provider education, and conducting audits across various healthcare lines. Candidates should have 3-5 years of...FraudFull time
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