[Skip to main content](#main-content) [OpenNash Jobs](https://jobs.opennash.com/) [Hiring report](/reports/hiring/) · [All Molina Healthcare jobs](https://jobs.opennash.com/companies/molina-healthcare/) · [Search jobs](/search/) Molina Healthcare · New York, NY # Investigator, Special Investigative Unit Coding (Remote) New York, NY, United States Remote Healthcare & Clinical Listed on Molina Healthcare’s official careers site. Posted August 25, 2026. Check that it is still open and apply there. [Apply on Molina Healthcare’s careers site →](https://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2038901) [OpenNash Jobs](https://jobs.opennash.com/) / [Molina Healthcare](https://jobs.opennash.com/companies/molina-healthcare/) / Investigator, Special Investigative Unit Coding (Remote) ## Job description ### JOB DESCRIPTION Provides support for special investigation unit (SIU) activities specific to medical provider coding fraud, waste and abuse (FWA). Investigates and resolves instances of health care fraud and abuse investigations of medical providers using informational tips from member benefits and medical records following review of post-payment claims. ### Essential Job Duties - Independently re-evaluates medical claims and associated records by applying knowledge of advanced coding, applicable federal and state regulatory requirements, and Molina policies. - Reviews post-pay claims against corresponding medical records to determine accuracy of claims payments. - Manages documents and prioritizes caseloads to ensure timely turnaround. - Ensures adherence to applicable state/federal/internal policies, Current Procedural Terminology (CPT) guidelines and provider contract requirements. - Devises clinical summary post-review. - Communicates and participates in meetings related to cases. - Completes medical review to facilitate referral to law enforcement or payment recovery. - Supports investigation work as necessary and required by the regulatory agency. ### Job Requirements - At least 2 years of CPT coding experience in a surgical, hospital and/or clinic setting, or equivalent combination of relevant education and experience. - Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Professional Medical Auditor (CPMA), or American Academy of Professional Coders (AAPC) certified. - Critical-thinking, problem-solving and analytical skills. - Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations. - Knowledge of managed care and the Medicaid, Medicare, and Marketplace programs. - Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems. - Ability to research and interpret regulatory requirements. - Ability to prioritize and manage multiple tasks. - Ability to work in a team setting. - Strong verbal/written communication skills, and presentation skills. - Microsoft Office suite (including Excel), and applicable software program(s) proficiency. - In some states, 5 years of experience working in a fraud, waste and abuse (FWA)/special investigations unit (SIU)/fraud investigations role may be required (dependent on state/contractual requirements). ### Preferred Qualifications - Certified Professional Compliance Officer (CPCO).Certified Fraud Examiner (CFE) and/or Accredited Health Care Fraud Investigator (AHFI). - Experience working in group health insurance, particularly within claims processing or operations. - Working knowledge of local, state and federal laws and regulations pertaining to health insurance, investigations and legal processes (commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, etc.). - Experience with claims processing systems. - Ability to use Microsoft Excel platform and work with large quantities of data. - Ability to answer questions, identify trends and patterns, and present findings." To all current Molina employees. If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V ## At a glance - Posted by the employer: Aug 25, 2026 - First seen by OpenNash: Oct 11, 2026 - Last checked: Oct 18, 2026 - Listed for: 54 days - Location: New York, NY, United States - Work arrangement: Remote[Apply on Molina Healthcare’s careers site →](https://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2038901) ## More jobs at Molina Healthcare ### [Associate Representative, Health Plan Provider Relations-NY City](https://jobs.opennash.com/companies/molina-healthcare/jobs/f386172bfaacaf413d7e/) New York, NY, United States ### [Uniform System Assessor Nurse (RN) - must be licensed in the state of NY](https://jobs.opennash.com/companies/molina-healthcare/jobs/89dc05334288c944306a/) New York, NY, United States ### [Care Manager, LTSS (RN) - must have an active RN license in NY](https://jobs.opennash.com/companies/molina-healthcare/jobs/aa2861b99432f051ff52/) New York, NY, United States ### [Specialist, Benefit Sales (Facilitated Enroller) In Field - Manhattan, NY](https://jobs.opennash.com/companies/molina-healthcare/jobs/dd3a1758e8774c0a3cc1/) New York, NY, United States ### [Specialist, Market Growth & Retention (Remote in NY)](https://jobs.opennash.com/companies/molina-healthcare/jobs/17b497c2ca19f1be2d36/) New York, NY, United States ## Similar jobs at other companies ### [Compliance – Surveillance Lead (Surveillance Investigative Unit) – Vice President](https://jobs.opennash.com/companies/jpmorganchase/jobs/95de28370cb4407a0cb0/) JPMorganChase · Jersey City, NJ, United States ### [Special Investigations Unit Pre Pay Coding Consultant](https://jobs.opennash.com/companies/unitedhealth-group/jobs/c161e6887576df67144b/) UnitedHealth Group · Plymouth, Minnesota ### [Wealth Financial Intelligence Unit Investigator, Assistant Vice President](https://jobs.opennash.com/companies/state-street/jobs/3c52fe2516934f6df23d/) State Street · Boston, Massachusetts ### [Senior Investigator](https://jobs.opennash.com/companies/unitedhealth-group/jobs/93a505c9dd0776c34a36/) UnitedHealth Group · Arlington, Virginia ### [Sr Threat Intelligence Investigator](https://jobs.opennash.com/companies/oracle/jobs/16bf3507e7bc19380b2d/) Oracle · Nashville, TN, United States OpenNash lists jobs from employers’ own careers sites and does not handle applications. Dates come from the employer where stated; “first seen” and “last checked” are our own observations. OpenNash Jobs · Official listings with dates and links to the employer. [Weekly hiring report](/reports/hiring/) · [Methodology](/methodology/)