- 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
- 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… more
- AmeriHealth Caritas (Columbia, SC)
- …(ACFC). **Major Accountabilities:** + Ensures compliance with all requirements related to Special Investigation Units and fraud , waste and abuse investigations. ... administrative services. Discover more about us at www.amerihealthcaritas.com. The Investigator is responsible for conducting comprehensive investigations of reported,… 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
- 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
- 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
- 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 ... extension, up to 3 years total. Responsibilities Duties for Investigator GS-1810-14 include but not limited to: Technical expert...but not limited to: Technical expert and advisor to Special Agents and Assistant Special Agents in… 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
- 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 (Tampa, FL)
- …30% Serve as lead investigator on cases involving suspected Cost Report Fraud and Prospective Payment System Medicaid provider fraud involving: 1) ... in the Office of the Attorney General within the Medicaid Fraud Control Unit in Tampa, Florida...DRUG FREE WORKPLACE: All OAG positions are "sensitive or special trust" and require favorable results on a background… more