- 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
- Highmark Health (Montgomery, AL)
- …+ 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
- 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
- Travelers Insurance Company (Richardson, TX)
- …Insurance Fraud Investigator , Certified Fraud Examiner, Accredited Healthcare Fraud Investigator ). + Advanced data analytics and utilization ... Case Unit Investigative Analyst, you will proactively analyze data to determine fraud schemes, trends and conduct major case investigations. Your attention to detail… more
- Highmark Health (Pittsburgh, PA)
- …+ Certified Professional Coder- Hospital(CPC-H) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have ... graphs, and charts to timely identify trends and patterns of potential healthcare fraud , waste and abuse. Communicate findings to company management of various… more
- CVS Health (Albany, NY)
- …each and every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Dental/Pharmacy/Broker Investigative ... you will manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct high level,… more
- State of Georgia (Fulton County, GA)
- Investigator - Medicaid Fraud Georgia - Fulton - Atlanta (https://ga.referrals.selectminds.com/jobs/67636/other-jobs-matching/location-only) Hot ... Sign Up for Job Alerts The Office of the Attorney General Department of Law Medicaid Fraud Division - Investigator The mission of the Department of Law is to… more
- Elevance Health (Norfolk, VA)
- **Clinical Fraud Investigator II** **Location** : _Hybrid1:_ This role requires associates be in the office 1-2 days per week, fostering collaboration and ... accommodation is granted as required by law. The **Clinical Fraud Investigator II** is responsible for identifying...Registered Nurse strongly preferred + Law Enforcement dealing with Healthcare Fraud Please be advised that Elevance… more
- Elevance Health (Richmond, VA)
- **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 ... to recover, eliminate and prevent unnecessary medical-expense spending. The **Clinical Fraud Investigator II** is responsible for identifying issues and/or… more
- Molina Healthcare (Lexington, 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
- NTT DATA North America (Boston, MA)
- … Examiner (CFE), Certified Professional Coder (CPC), or Accredited Health Care Fraud Investigator (AHFI) preferred Familiarity with Partial Hospitalization and ... overall sourcing strategy. NTT DATA's Client is seeking a Investigator for Health Plan Special Investigations Unit ( "SIU...assigned to conduct pre-payment reviews of medical records for healthcare claims in one or more of the following… 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
- 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
- Lane County (OR)
- Investigator Print (https://www.governmentjobs.com/careers/lanecountyor/jobs/newprint/5068942) Apply Investigator Salary $85,176.00 - $116,584.00 Annually ... the Position As an integral member of our public safety team, the Investigator will support Deputy District Attorneys across Criminal, Family Law (Child Support… 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
- New York State Civil Service (New York, NY)
- …approximately eight to ten investigators assigned to investigate insurance, financial and healthcare fraud across upstate and downstate regions.The duties of ... schemes and other emerging criminal activity affecting insurance, financial and healthcare companies;* Monitors investigator performance to ensure that matters… more
- MVP Health Care (Rochester, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Clinical Investigator ** to join #TeamMVP. This is the opportunity for you if you have ... investigation experience involving economic or insurance related matters. + A clinical investigator must have in addition to the above requirements: A duly licensed… more
- Elevance Health (Middletown, NY)
- …independent identification, investigation and development of complex cases against perpetrators of healthcare fraud in order to recover corporate and client ... ** Investigator Senior** **Supports the Payment Integrity line of...+ Responsible for independently identifying and developing enterprise-wide specific healthcare investigations and initiatives that may impact more than… more
- Experian (Costa Mesa, CA)
- …around the world. We help to redefine lending practices, uncover and prevent fraud , simplify healthcare , create marketing solutions, and gain deeper insights ... across a range of markets, from financial services to healthcare , automotive, agribusiness, insurance, and many more industry segments....Overview We are looking for a Senior Cyber Forensic Investigator to join our Cyber Fusion Centre. Our Cyber… 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