Senior Investigator - Medical Canvass

Senior Investigator - Medical Canvass

Department: Claims Administration & Adjusting

Employment Type: Permanent - Full Time

Location: Home United States

Compensation: $25.00 - $35.00 / hour

Description

Our StoryImagine being part of a team that’s not just shaping the future but actively driving it. At Davies North America, we’re at the forefront of innovation and excellence, blending cutting-edge technology with top-tier professional services. As a vital part of the global Davies Group, we help businesses navigate risk, optimize operations, and spearhead transformation in the insurance and regulated sectors.

What’s in Store We're on the lookout for a Medical Canvass Investigator to join our growing team! As a Senior Investigator – Medical Canvass, you will conduct comprehensive medical canvasses to uncover undisclosed treatment histories for insurance claims investigations. This role requires exceptional investigative skills, analytical thinking, and strong communication abilities.

Key Responsibilities

• Conduct thorough medical canvasses to identify undisclosed medical treatments, facilities, and providers
• Contact hospitals, clinics, urgent care facilities, pharmacies, and other medical providers while adhering to all legal and ethical standards
• Verify and document medical records, treatments, and provider information for claims investigations
• Maintain accurate, detailed, and organized records of investigative activities and findings
• Analyze and report findings to clients in a clear, concise, and timely manner
• Collaborate with claims adjusters, SIU teams, and legal professionals to support fraud detection efforts
• Stay informed of legal and regulatory guidelines governing medical canvassing and investigative practices
• Perform other duties as assigned

Skills, knowledge & expertise

• Minimum of 5 years of experience in medical canvassing (required)
• Strong knowledge of insurance fraud, medical records, and claims processes
• Excellent communication skills, including the ability to conduct investigative interviews with medical providers professionally
• Detail-oriented with strong analytical and problem-solving skills
• Ability to maintain confidentiality and adhere to ethical standards
• Proficiency in case management systems and Microsoft Office Suite
• Strong organizational and time-management skills to manage multiple investigations simultaneously
• Experience working with SIU departments or legal counsel on complex claims investigations preferred
• Familiarity with HIPAA regulations and compliance requirements preferred

Benefits

At Davies North America, we are dedicated to supporting the well-being and future of our qualifying employees. Our comprehensive benefits package includes:

• Medical, dental, and vision plans to ensure your health and that of your family
• A 401k plan with employer matching to help you build a secure financial future
• Our time-off policies, including Discretionary Time Off for exempt employees and Paid Time Off (PTO) package for non-exempt employees, reflect our commitment to promoting a healthy work environment
• Paid holidays
• Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones

 Diversity and InclusionDavies is dedicated to fostering a diverse and inclusive workplace that embraces a wide range of perspectives and experiences. We believe that diversity of thought is essential for innovation and creativity, and we actively promote an environment where all voices are valued and heard. Apply