- Sanford Health (Fargo, ND)
- …health insurance investigation/audit. - Master's Degree preferred - Accredited Health Care Fraud Investigator (AHFI) certification or Certified Fraud ... in health insurance investigation/audit. Master's Degree preferred Accredited Health Care Fraud Investigator (AHFI) certification or Certified Fraud … more
- Blue KC (Kansas City, MO)
- …AAPC, AHIMA + FWA Certification: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI) + Medical License: Registered Nurse ... part of Blue KC's Special Investigations Unit (SIU), the Fraud Investigator conducts reviews to identify potential...of plan assets. + Monitor hotlines, internal referrals, external fraud alerts (eg, CMS, BCBSA), external healthcare … more
- Highmark Health (Pittsburgh, PA)
- …+ Certified Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge ... 3 years of relevant, progressive experience in the health insurance industry and/or healthcare fraud investigations **Preferred** + 1 year in Financial Analysis… more
- Providence (Oakland, CA)
- …data mining software/tools. **Preferred Qualifications:** + Current certification as an Accredited Healthcare Fraud Investigator (AHFI) upon hire. + ... **Description** ** Investigator External Audit Special Investigations Unit \*Remote The...providing education related to coding, medical record documentation requirements, healthcare compliance and fraud , waste and abuse… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …or a related field) preferred. + Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified Professional Coder (CPC), or ... investigation targets, proposes new methods of data analytics and healthcare informatics to discover Fraud , Waste and...data analytics and healthcare informatics to discover Fraud , Waste and Abuse activities as well as provide… more
- MyFlorida (Tallahassee, FL)
- …related professional certification, such as: Certified Fraud Examiner; Accredited Healthcare Fraud Investigator ; Certified Financial Crimes ... (MPI) does this specifically through audits and investigations of healthcare providers, including managed care plans. This OPS Government...Investigator ; Certified Insurance Fraud Investigator ; or Certified Compliance and Ethics… more
- General Dynamics Information Technology (Fairfax, VA)
- …QUALIFICATIONS AND EXPERIENCE:** + Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) designation strongly desired. + ... trends in the data and create leads and referrals for the Healthcare Fraud Prevention Partnership (HFPP) members (Partner) and the Trusted Third Party (TTP).… more
- MyFlorida (Tallahassee, FL)
- …related professional certification, such as: Certified Fraud Examiner; Accredited Healthcare Fraud Investigator ; Certified Financial Crimes ... Investigator ; Certified Insurance Fraud Investigator ; Certified Compliance and Ethics Professional, or other relevant certification, such as: Project… more
- Humana (Oklahoma City, OK)
- …**Required Qualifications** + **Must be an Oklahoma resident** + 2+ years of healthcare fraud investigations and auditing experience + Knowledge of healthcare ... and help us put health first** Humana's Special Investigations Unit is seeking a Senior Fraud & Waste Investigator to join the Oklahoma Medicaid Team. This team… more
- NBT Bank (Norwich, NY)
- …Range: $24.98 - $33.31 Responsible for the entire process related to moderately complex external fraud cases in the area of check fraud , identity theft, online ... fraud , elder fraud and cyber fraud . With a solid understanding of various regulations, products...health and well-being. + Flexible Spending Accounts : For healthcare and dependent care expenses. + Employer-Paid Disability Coverage… more
- Molina Healthcare (Louisville, KY)
- …ASSOCIATION** : + Health Care Anti- Fraud Associate (HCAFA). + Accredited Health Care Fraud Investigator (AHFI). + Certified Fraud Examiner (CFE). To all ... **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation,… more
- Molina Healthcare (Milwaukee, WI)
- …Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses ... of experience working in a FWA / SIU or Fraud investigations + Thorough knowledge of PC based software...position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina… more
- Idaho Division of Human Resources (Boise, ID)
- …at least 5 years of investigative experience, preferably in law enforcement, healthcare fraud or financial crimes. Strong analytical; interviewing, and ... minimum of 5 years of investigative experience, preferably in Medicaid or healthcare fraud , financial crimes or white-collar investigations. + Experience… more
- AmeriHealth Caritas (Columbus, OH)
- …An associate's degree, with a minimum of four years of experience working in healthcare fraud , waste, and abuse investigations and audits. + Experience and ... + Bachelor's degree with a minimum of two years of experience in the healthcare field working in fraud , waste, and abuse investigations and audits OR… more
- Point32Health (Canton, MA)
- …health and well-being organization dedicated to delivering high-quality, affordable healthcare . Serving nearly 2 million members, Point32Health builds on the ... behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it's at the core of… more
- CVS Health (Nashville, TN)
- … you will conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high ... involving multi-lines of business, or cases involving multiple perpetrators or intricate healthcare fraud schemes. + Investigates to prevent payment of… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …this position is responsible for the accurate and thorough clinical investigation of potential fraud , waste and abuse (FWA) for all lines of business. The scope of ... + Prepares recommendations on preventive/corrective measures for the deterrent of future fraud . + Supports other SIU investigators and analysts with their cases by… more
- State of Georgia (Fulton County, GA)
- …Georgia Medicaid Program. Participates as a member of an interdisciplinary team in Healthcare fraud investigations, and provides support to members of other ... of the Attorney General Georgia Department of Law Nurse Investigator - Medicaid Fraud Division *To move forward...eligibility of providers as requested. + Assists prosecutors in Healthcare Fraud investigations by reviewing provider and… more
- Louisiana Department of State Civil Service (LA)
- …approach to uncover abuse and neglect of residents and complex financial fraud committed by healthcare providers, including hospitals, nursing homes, pharmacies, ... Investigator /Special Agent 1-4 Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4951050) Apply ...in cybercrimes, white collar crimes, and public corruption. Medicaid Fraud Control Unit: The Louisiana Medicaid Fraud … more
- Lane County (OR)
- Investigator Print (https://www.governmentjobs.com/careers/lanecountyor/jobs/newprint/5128761) Apply Investigator Salary $85,176.00 - $116,584.00 Annually ... an integral member of our public safety team, this Investigator role will primarily support the Family Law (Child...thorough investigations in areas such as public corruption, major fraud , missing persons, or estate and child support enforcement.… more
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