Medicare Claims Fraud Investigator (Hiring Immediately)

Company: USAA
Location: Phoenix
Posted on: May 28, 2025

Job Description:

Why USAA?
At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.

Embrace a fulfilling career at USAA, where our core values - honesty, integrity, loyalty and service - define how we treat each other and our members. Be part of what truly makes us special and impactful.

The Opportunity
USAA Life Company's SIU Life & Health is seeking a talented Life Special Investigations Unit Investigator I (Mid-Level) to review, analyze, and investigate life, health, and annuity claims to ensure claim validity and to protect the association from potentially fraudulent activity. This role will provide investigative support and recommendations on claim settlements and assists with fraud detection and deterrence, as well as, investigate fraud investigations that may have significant financial impact to Life Company and/or the association. Consult and involve Legal Counsel, Underwriting, law enforcement, and other agencies as appropriate.

As a Mid-Level Life SIU Investigator for Medicare Supplement Fraud, Waste, and Abuse you will support the Life Special Investigations team that is responsible for increasing fraud awareness throughout USAA and its membership, developing innovative fraud detection and prevention programs, and investigating cases of suspected fraud for Life Company.

We offer a flexible work environment that requires an individual to be in the office 4 days per week. This position can be based in one of the following locations: San Antonio, TX, Phoenix, AZ, Colorado Springs, CO, Tampa, FL, or Plano, TX. Relocation assistance is not available for this position.

What you'll do:
Conducts moderately complex investigations for life, health, and annuity products for potential claims fraud.

Gathers evidence through interviews, searches of investigative databases, internal resources, internet resources, medical records, law enforcement records, and/or public records to support conclusions while adjusting investigative strategies as necessary.

Prepares detailed and comprehensive investigative reports to summarize and substantiate the results/outcome of the investigation.

Applies proficient knowledge of state/federal laws and regulations and legal concepts, including contract and case law, to ensure investigations are conducted within regulatory requirements.

Applies proficient product and system knowledge to ensure appropriate investigation and/or claim settlement.

Proactively manages the life of an investigation and acts as the liaison between the member, legal counsel, law enforcement, and other related agencies, as appropriate.

Submits Department of Insurance fraud reports in compliance with established regulatory guidelines and time frames.

Uses evidence of investigation and supporting documentation to make claim settlement determinations and recommendation for claim payments.

Represents USAA at mediations and/or trial as required.

Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.

What you have:
High School Diploma or General Equivalency Diploma required.

2 years of life insurance claims and/or investigation experience.

Proficient knowledge of life insurance products, claims, and underwriting.

Proficient knowledge and understanding of fraud investigations as well as application of state/federal laws and regulations.

Ability to gather a broad range of evidence and draw conclusions based on the objective details.

Strong oral and written communication skills.

Demonstrated experience analyzing and interpreting data to identify trends and patterns

What sets you apart:
US military experience through military service or a military spouse/domestic partner

5 or more years healthcare/insurance claim investigations experience or law enforcement investigations experience.

2 or more years Medicare or Medicare Supplement claims experience.

FE, AHFI, CHC, or other relevant industry designations.

Associate degree or higher in criminal justice or a related field.

Knowledge of claim billing codes, medical terminology, anatomy, and health care delivery systems

Compensation range: The salary range for this position is: $63,590 - $121,530 .

USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.).

Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.

Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.

The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.

Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.

For more details on our outstanding benefits, visit our benefits page on USAAjobs.com.

Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting.

USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Keywords: USAA, Prescott , Medicare Claims Fraud Investigator (Hiring Immediately), Other , Phoenix, Arizona