- Humana (Oklahoma City, OK)
- …on business needs. **Required Qualifications** + **Must reside in Oklahoma** + Healthcare fraud , waste , and abuse investigations experience + Knowledge of ... put health first** Humana Healthy Horizons in Oklahoma is seeking a Fraud and Waste Professional 2 who conducts investigations of allegations of fraudulent and… more
- Amazon (Arlington, VA)
- …and uses signals in transactional data such as invoices and payments as indicators of theft, fraud , waste or abuse . We are looking for a technical minded ... Amazon is seeking a data-driven, highly motivated and organized Investigator and Risk Manager of Corporate Fraud ...in Finance Operations with the ultimate goal of preventing fraud , waste , and abuse across… more
- Point32Health (Canton, MA)
- …Special Investigation Unit (SIU) responsible for leading complex provider investigations related to fraud , waste , and abuse , and developing action plans to ... address the investigative findings and prevent future loss. The Investigator works closely with other members of the SIU...monitor provider activity post-investigation + Identify root causes of fraud , waste and abuse and… more
- State of Michigan (MI)
- …Oakland, and Wayne Counties This Regulation Agent position will conduct investigations of fraud , waste or abuse by recipients, non-Medicaid providers and ... Regulation Agent 9-P11 ( Fraud Investigator ) - OIG - Macomb,...No 13 Do you have any substantiated cases of abuse or neglect reported on the Department of Health… more
- State of Massachusetts (Boston, MA)
- …public money and property. The OIG is an independent agency charged with preventing and detecting fraud , waste and abuse in the use of public funds and ... functions. Together the bureaus work to prevent and detect waste , fraud and abuse of...when no crime or civil action is involved. *Senior Investigator : Position Overview* The Senior Investigator reports… more
- Highmark Health (Columbus, OH)
- …for conducting investigations of organizational or functional activities related to alleged fraud , waste and abuse perpetrated by providers, members, ... to complete a review of a special project, potential fraud , waste and abuse case,...(CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have… more
- AmeriHealth Caritas (Washington, DC)
- …+ Ensures compliance with all requirements related to Special Investigation Units and fraud , waste and abuse investigations. + Conducts investigations of ... **Special Investigator Managed Care - DMV Counties only** Location:...potential fraud , waste and / or abuse with a... fraud , waste and / or abuse with a focus on thoroughness and attention to… more
- CVS Health (Springfield, IL)
- …information EDUCATION: *Bachelor's degree or an additional 5 years of working health care fraud , waste and abuse investigations. Pay Range The typical pay ... will conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse . Routinely handles cases that are sensitive or high… more
- MyFlorida (Tallahassee, FL)
- … Fraud Analysts and will perform data mining and investigative activities to identify fraud , waste , or abuse in claims data within our program. ... Health Insurance Fraud Analysts will identify outliers and trends based on relevant fraud , waste , and abuse topics; design and implement algorithms to… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …(SIU), the ** Investigator III** will be responsible for investigating allegations of external fraud , waste , and abuse (FWA). The reports prepared by this ... Coder (CPC), Certified Fraud Examiner (CFE), or Accredited Health Care Fraud Investigator (AHFI) preferred. + (2) years of active experience in auditing and… more
- State of Minnesota (St. Paul, MN)
- …investigate, and take administrative or legal action in response to suspected fraud , over-utilization and/or abuse of the Minnesota Health Care Programs ... are not limited to: + Investigation of activities related fraud , abuse or over utilization by Minnesota...law enforcement and/or criminal justice system experience to combat waste , mismanagement, misuse, fraud , and criminal corruption… more
- MyFlorida (Tallahassee, FL)
- …the Division of Public Assistance Fraud is to aggressively identify and eliminate fraud , waste , and abuse to safeguard the integrity of taxpayer funded ... FINANCIAL CRIME INVESTIGATOR I (PENDING RECLASSIFICATION)- 43061929 Date: Apr 15, 2024 Location: TALLAHASSEE, FL, US, 32399 The State Personnel System is an E-Verify… more
- CVS Health (Richmond, VA)
- …Department of Medical Assistance Services- 3 years in healthcare field working in fraud , waste and abuse investigations and audits.- Strong analytical ... and/or an Associate's degree with three additional years working in health care fraud , waste , and abuse investigationsand audits. Pay Range The typical pay… more
- Commonwealth Care Alliance (Boston, MA)
- … Investigator works with a growing team conducting and managing Health Care Fraud , Waste and Abuse investigation and prevention activities under the ... management reports. + Knowledge of federal and state laws and regulations pertaining to fraud , waste and abuse . + Desire to work in a collaborative and… more
- Point32Health (Canton, MA)
- …team member of the SIU, responsible for leading complex provider investigations related to fraud , waste and abuse , and developing action plans to address ... the investigative findings and prevent future loss. The Investigator works closely with other members of the SIU...monitor provider activity post-investigation + Identifying root causes of fraud , waste and abuse and… more
- CVS Health (Columbus, OH)
- …Competencies Required Qualifications + Minimum three years in healthcare field working in fraud , waste and abuse investigations and audits utilizing ... to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse , to recover lost funds, and to comply with state regulations… more
- CVS Health (Tallahassee, FL)
- …Must reside in Florida - 3-5 years Investigative experience in the area of healthcare fraud , waste and abuse . - Bilingual in English/Spanish - Experience ... to effectively pursue the prevention, investigation and prosecution of health care fraud and abuse , to recover lost funds, and to comply with state regulations… more
- Battelle Energy Alliance dba Idaho National Laboratory (Idaho Falls, ID)
- …concerns allegations related to environmental safety and health (ESH); quality; mismanagement; waste , fraud , and abuse (WFA); technical standards; regulatory ... Idaho National Laboratory is hiring a Workplace Concerns Investigator to work in our Workplace Concerns and Investigations department. Our team works a 9x80 schedule… more
- Office of the Director of National Intelligence (Reston, VA)
- …into possible violations of laws, rules and regulations, mismanagement, fraud , gross waste of funds, and abuse of authority within the Office of the ... and detect violations of laws, rules and regulations and fraud and abuse . Manage and guide the...knowledge of unauthorized disclosure investigations. Experience serving as an investigator within an OIG. Superior knowledge of and experience… more
- Elevance Health (Columbus, OH)
- …effectively evaluate and recommend focused investigative activities involving market trends indicating Fraud , Waste and Abuse within the healthcare industry. ... a check, or ask you for payment as part of consideration for employment. **Lead Investigator ** + Job Family: FRD > Investigation + Type: Full time + Date Posted:Apr… more