- State of Georgia (Fulton County, GA)
- Criminal Investigator - Medicaid Fraud Georgia - Fulton - Atlanta (https://ga.referrals.selectminds.com/jobs/73115/other-jobs-matching/location-only) Hot ... through this announcement will serve in the Investigations section of our Medicaid Fraud Division. Duties & Responsibilities: Investigators conduct health care… more
- Humana (Dayton, OH)
- …for the Ohio Department of Medicaid (ODM) and other agencies such as the Medicaid Fraud Control Unit (MFCU) and coordinate all aspects of FWA activities in ... community and help us put health first** This Senior Fraud and Waste Investigator will serve as...Ohio to increase Medicaid program transparency and accountability. _Essential Functions and Responsibilities_… more
- Humana (Oklahoma City, OK)
- …Humana's Special Investigations Unit is seeking a Senior Fraud & Waste Investigator to join the Oklahoma Medicaid Team. This team of Investigators conducts ... Medicaid line of business. As the Senior Fraud and Waste Investigator , you will serve...contact for OHCA and other agencies such as the Medicaid Fraud Control Unit (MFCU) and coordinate… more
- MyFlorida (Tampa, FL)
- …Investigator II position is in the Office of the Attorney General within the Medicaid Fraud Control Unit in Tampa, Florida. The Attorney General's Medicaid ... LAW ENFORCEMENT INVESTIGATOR II - 41001246 Date: Nov 21, 2025...investigations of alleged violations of applicable laws pertaining to Medicaid fraud in the administration of the… more
- Louisiana Department of State Civil Service (LA)
- …and provides investigative services in cybercrimes, white collar crimes, and public corruption. Medicaid Fraud Control Unit: The Louisiana Medicaid Fraud ... Investigator /Special Agent 1-4 Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/5143725) Apply Investigator /Special Agent 1-4 Salary… more
- Idaho Division of Human Resources (Boise, ID)
- …be determined upon hire. Salary: $44.60 - $49.06 hourly Primary Duties: The Medicaid Fraud Control Unit (MFCU) is currently accepting applications for aCriminal ... This position is responsible for conducting complex criminal investigations involving Medicaid provider fraud , patient abuse, neglect and financial exploitation.… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …this position is responsible for the accurate and thorough clinical investigation of potential fraud , waste and abuse (FWA) for all lines of business. The scope of ... + Prepares recommendations on preventive/corrective measures for the deterrent of future fraud . + Supports other SIU investigators and analysts with their cases by… more
- AmeriHealth Caritas (Columbia, SC)
- …services. Discover more about us at www.amerihealthcaritas.com. The Investigator is responsible for conducting comprehensive investigations of reported, ... alleged or suspected fraud involving the full range of products at the...lieu of formal educational requirements for the Lead SIU Investigator position may be considered. + Valid driver's license… more
- CVS Health (Richmond, VA)
- …every day. **Position Summary** **WEST VIRGINIA RESIDENCY** **REQUIRED** As a Senior Investigator you will conduct high level, complex investigations of known or ... suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive...to prevent payment of fraudulent claims submitted to the Medicaid lines of business + Researches and prepares cases… more
- State of Georgia (Fulton County, GA)
- Intake Coordinator- Medicaid Fraud Georgia - Fulton - Atlanta (https://ga.referrals.selectminds.com/jobs/72587/other-jobs-matching/location-only) Hot ... announcement will serve in the Investigations Section of our Medicaid Fraud & Patient Protection Division. Duties...experience but an interest in progressing to be an Investigator with the Division. MAJOR WORKER CHARACTERISTICS . Knowledge… more
- MVP Health Care (Tarrytown, 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
- Office of Inspector General (Boston, MA)
- …on matters related to oversight of programs connected to the Center for Medicare and Medicaid Services and Medicaid Fraud Control Units. Serves as a mentor ... with a one-year extension, up to 3 years total. Responsibilities Duties for Investigator GS-1810-14 include but not limited to: Technical expert and advisor to… more
- Molina Healthcare (Ann Arbor, MI)
- **JOB DESCRIPTION** **Job Summary** The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical ... settings) or 5+ years of experience working in a FWA / SIU or Fraud investigations + Thorough knowledge of PC based software including Microsoft Word (edit/save… more
- Molina Healthcare (Covington, KY)
- …according to the SIU's standards. Position must have thorough knowledge of Medicaid /Medicare/Marketplace health coverage audit policies and be able to apply them in ... position must have the ability to determine correct coding, documentation, potential fraud , abuse, and over utilization by providers and recipients. The position… more
- CVS Health (St. Paul, MN)
- …investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with state ... regulations mandating fraud plans and practices. - Conducts investigations of known...meetings. **Required Qualifications** - 1+ years' experience working with Medicaid . - 3+ years' in healthcare field working in… more
- Elevance Health (St. Louis, MO)
- …the identification, investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on fraudulent ... Medicaid claims. **How You Will Make an Impact:** +...Reside in Missouri + Healthcare experience strongly preferred + Fraud certification from CFE, AHFI, AAPC or coding certificates… more
- City of New York (New York, NY)
- Job Description APPLICANTS MUST BE PERMANENT IN THE ASSOCIATE FRAUD INVESTIGATOR CIVIL SERVICE TITLE. The DSS Accountability Office (DSS-AO) is responsible for ... also responsible for evaluating and assessing the resources of Medicaid Nursing Home residents through computer bank matches. Claims...allowable levels. C&C is recruiting for (1) one Associate Fraud Investigator II to function as a… more
- MyFlorida (Tallahassee, FL)
- …with a program integrity related professional certification, such as: Certified Fraud Examiner; Accredited Healthcare Fraud Investigator ; Certified ... and abuse prevention efforts within the Bureau of Medicaid Program Integrity (MPI). MPI is organized by the...Financial Crimes Investigator ; Certified Insurance Fraud Investigator ; Certified Compliance and Ethics Professional,… more
- MyFlorida (Tallahassee, FL)
- …with a program integrity related professional certification, such as: Certified Fraud Examiner; Accredited Healthcare Fraud Investigator ; Certified ... is to ensure fewer budgeted dollars are lost to fraud , abuse, and waste. The Bureau of Medicaid...Financial Crimes Investigator ; Certified Insurance Fraud Investigator ; or Certified Compliance and Ethics… more
- MyFlorida (Tallahassee, FL)
- …Program Integrity (MPI). MPI is the Agency's lead unit responsible for oversight of Medicaid fraud , waste, and abuse, and ensure compliance with applicable laws, ... with a program integrity related professional certification, such as: Certified Fraud Examiner; Accredited Healthcare Fraud Investigator ; Certified… more