- Sanford Health (Fargo, ND)
- …insurance investigation/audit. - Master's Degree preferred - Accredited Health Care Fraud Investigator (AHFI) certification or Certified Fraud Examiner (CFE) ... package for referral to third parties including contract holders, state insurance fraud bureaus and law enforcement agencies. Respond to subpoenas and requests for… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- … Healthcare Administration, Statistics, or a related field) preferred. + Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), ... 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
- New York State Civil Service (Albany, NY)
- …detectives, data analysts, and legal support analysts, to conduct complex, long-term healthcare fraud and patient abuse and neglect investigations. The Medicaid ... Agency Attorney General, Office of the Title Legal Nurse: Investigate Medicaid Fraud /Patient Abuse (6399) Occupational Category Legal Salary Grade NS Bargaining Unit… more
- Elevance Health (Norfolk, VA)
- …Coding Certificate or Registered Nurse strongly preferred + Law Enforcement dealing with Healthcare Fraud Please be advised that Elevance Health only accepts ... **Clinical Fraud Investigator II** **Location** : _Hybrid1:_ This role...and medical records prior to payment. + Researches new healthcare related questions as necessary to aid in investigations.… more
- New York State Civil Service (Syracuse, NY)
- …data analysts, and legal support analysts to conduct complex, long-term healthcare fraud investigations. The Medicaid program provides health coverage ... Agency Attorney General, Office of the Title Legal Nurse: Investigate Medicaid Fraud /Patient Abuse (6401) Occupational Category Legal Salary Grade NS Bargaining Unit… more
- Zelis (St. Petersburg, FL)
- …prevention, investigations, or risk management - preferably in payments, fintech, or healthcare . + Proven expertise in fraud detection tools, behavioral ... So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more… more
- CVS Health (Charleston, WV)
- …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
- CVS Health (Harrisburg, PA)
- …conducts investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to ... and local law enforcement agencies in the investigation and prosecution of healthcare fraud and abuse matters. - Demonstrates high level of knowledge and… more
- Highmark Health (Montgomery, AL)
- …3 years of relevant, progressive experience in the health insurance industry and/or healthcare fraud investigations **Preferred** + 1 year in Financial Analysis ... Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of provider… more
- New York State Civil Service (Mineola, NY)
- …the unit's forensic accountants/auditors, detectives, and analysts to identify and prosecute financial fraud in the healthcare industry and abuse and neglect of ... Attorney General, Office of the Title Attorney: Prosecute Medicaid Fraud /Nursing Home Abuse (3818) Occupational Category Legal Salary Grade...residents in healthcare facilities, present evidence to grand juries, and conduct… more
- New York State Civil Service (New York, NY)
- …the unit's forensic accountants/auditors, detectives, and analysts to identify and prosecute financial fraud in the healthcare industry and abuse and neglect of ... Attorney General, Office of the Title Attorney: Prosecute Medicaid Fraud /Nursing Home Abuse (3819) Occupational Category Legal Salary Grade...residents in healthcare facilities, present evidence to grand juries, and conduct… more
- CVS Health (Hartford, CT)
- …investigations to effectively pursue the prevention, detection, investigation and prosecution of healthcare fraud , waste, and abuse. Also reports suspected ... Components:** - Conducts investigations of known or suspected acts of healthcare fraud , waste, and abuse - Communicates with federal, state, and local… more
- Highmark Health (Pittsburgh, PA)
- …reports, graphs, and charts to timely identify trends and patterns of potential healthcare fraud , waste and abuse. Communicate findings to company management of ... **Required** + 7 years of in the Health Insurance industry and/or Healthcare Fraud investigations + 3 years in leading projects of varying size and… more
- CVS Health (Albany, NY)
- …and every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Dental/Pharmacy/Broker Investigative Team ... you will manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct high level,… more
- Centene Corporation (Sacramento, CA)
- …perspective on workplace flexibility. **Position Purpose:** Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, ... executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse. + Conduct investigations of potential waste,… 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 ... and eligibility of providers as requested. + Assists prosecutors in Healthcare Fraud investigations by reviewing provider and patient records. + Makes… more
- Travelers Insurance Company (Richardson, TX)
- …terminology. + Industry certifications (Certified Insurance Fraud Investigator, Certified Fraud Examiner, Accredited Healthcare Fraud Investigator). + ... Case Unit Investigative Analyst, you will proactively analyze data to determine fraud schemes, trends and conduct major case investigations. Your attention to detail… more
- MyFlorida (Tampa, FL)
- …in Tampa, Florida or Orlando Florida, and involves auditing complex multi-million-dollar healthcare fraud investigations that can result in criminal and/or civil ... as lead investigator on cases involving suspected Cost Report Fraud and Prospective Payment System Medicaid provider fraud... Fraud and Prospective Payment System Medicaid provider fraud involving: 1) Nursing Homes, 2) Hospitals, and 3)… more
- New York State Civil Service (New York, NY)
- …the unit's New York City office. The selected attorney will lead complex civil fraud investigations in the healthcare industry, as well as litigate such matters ... Agency Attorney General, Office of the Title Attorney: Lead Complex Civil Fraud Investigations (3820) Occupational Category Legal Salary Grade NS Bargaining Unit M/C… more
- Executive Office for US Attorneys and the Office of the US… (Sacramento, CA)
- …Affirmative Civil Enforcement: Responsibilities include enforcement investigations and litigation involving healthcare fraud , procurement fraud , grant ... fraud , financial fraud , pharmaceutical diversion, wildlife recovery actions, and civil rights enforcement, among other things. Asset Forfeiture: Responsibilities include using criminal and civil asset forfeiture proceedings to seize, restrain, encumber,… more