- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Senior Fraud and Waste Professional (Program Integrity Lead) is responsible for overseeing the ... monitoring and enforcement of the Fraud , Waste , and Abuse (FWA) program. This role aims to prevent and detect potential FWA activities in accordance with state… more
- Humana (Boston, MA)
- …part of our caring community and help us put health first** The Manager, Fraud and Waste Investigator : Nurse Audit/Review performs clinical audit/validation ... and determines approach, resources, schedules and goals. The Manager, Fraud and Waste Investigator : Nurse Audit/Review validates and interprets medical… more
- Highmark Health (Boston, MA)
- …Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of provider ... for conducting investigations of organizational or functional activities related to alleged fraud , waste and abuse perpetrated by providers, members, facilities,… more
- Point32Health (Canton, MA)
- …prevent future loss. This role will be responsible for conducting high-volume Pre-Payment Fraud Waste & Abuse ("FWA") investigations under the direction of the ... Investigation Unit ("SIU") responsible for leading complex provider investigations related to fraud , waste , and abuse, and developing action plans to address… more
- Zelis (Boston, MA)
- …certification as a Certified Fraud Examiner (CFE), Accredited Health Care Fraud Investigator (AHFI), Health Care Anti- Fraud Associate (HCAFA), Certified ... in prevention, detection, reporting, and monetary recovery related to financial fraud and healthcare fraud , waste , and abuse. What You'll Do + Perform… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …related field) preferred. + Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified Professional Coder (CPC), or similar ... proposes new methods of data analytics and healthcare informatics to discover Fraud , Waste and Abuse activities as well as provide program-wide trend analysis.… more