- BlueCross BlueShield of North Carolina (NC)
- **Job Description** The Sr Pharmacy Fraud Investigations Analyst is responsible to conduct timely and thorough health care fraud investigations on ... claims processing and investigative process development + Government or corporate healthcare fraud investigative experience. **Salary Range** $62,100.00 -… more
- CVS Health (Springfield, IL)
- …will conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high ... multi-lines of business, or cases involving multipleperpetrators or intricate healthcare fraud schemes * Investigates to prevent...or an additional 5 years of working health care fraud , waste and abuse investigations . Pay Range… more
- CVS Health (Tallahassee, FL)
- …- Conducts high level, complex investigations of known or suspected acts of healthcare fraud and abuse. - Routinely handles cases that are sensitive or high ... provider groups, or cases involving multiple perpetrators or intricate healthcare fraud schemes. - Investigates to prevent...in identifying resources and best course of action on investigations . - Serves as back up to the Team… more
- Prime Therapeutics (Columbus, OH)
- …conclusions and recommendations. MISCELLANEOUS DUTIES: + Provide backup support to team members ( SIU Coordinator and Senior SIU Specialist) in the ... to find suspicious patterns and outliers using knowledge of healthcare coding conventions, fraud schemes, and general...in behavioral health, radiology or pharmacy. + 3+ years' fraud investigations /claims experience. + Ability to manage… more
- Providence (CA)
- …Pre-Payment External Auditor, Finance who will:** + Support the compliance related activities of the Special Investigations Unit ( SIU ) at the Health Plan ... tracking of prepay audit operations (ie. live claims queue, SIU claims workflow, claims review history) and audit documentation...and effective manner + Current certification as an Accredited Healthcare Fraud Investigator (ie, AHFI, CFI) +… more