- Humana (Oklahoma City, OK)
- …and help us put health first** Humana's Special Investigations Unit is seeking a Senior Fraud & Waste Investigator to join the Oklahoma Medicaid Team. This ... claims to Humana's Oklahoma Medicaid line of business. As the Senior Fraud and Waste Investigator , you will serve as Humana's Program Integrity Officer,… more
- Humana (Concord, NH)
- …a part of our caring community and help us put health first** The Fraud and Waste Professional 2 is responsible for conducting comprehensive investigations of ... reported, alleged or suspected fraud involving Florida's Medicaid Program. The Fraud and Waste Professional 2 coordinates investigation with law enforcement… more
- CareFirst (Baltimore, MD)
- …Preferred:** + Certified Fraud Examiner (CFE) + Certified Insurance Fraud Investigator (CIFI) + Certified Coder (CCS or CPC)-AHIMA or ... detection, investigation, and resolution of low to medium levels fraud , waste , and abuse schemes, resulting in...as Certified Fraud Examiner (CFE), Accredited Health Fraud Investigator (AHFI), RN/LPN, or Certified Professional… more
- Magellan Health Services (Boise, ID)
- …- Required License and Certifications - Preferred AHFI - Accredited Healthcare Fraud Investigator - EnterpriseEnterprise, CFE - Certified Fraud ... ID. This position is responsible for comprehensive management and ownership of fraud , waste and abuse investigations including development and presentation of… more
- AmeriHealth Caritas (Columbus, OH)
- …Ensures compliance with all requirements related to Special Investigation Units and fraud , waste and abuse investigations. + Conducts investigations of potential ... administrative services. Discover more about us at www.amerihealthcaritas.com. The Investigator is responsible for conducting comprehensive investigations of reported,... fraud , waste and/or abuse with a focus… more
- Highmark Health (Harrisburg, PA)
- …Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of provider ... for conducting investigations of organizational or functional activities related to alleged fraud , waste and abuse perpetrated by providers, members, facilities,… more
- Highmark Health (Pittsburgh, PA)
- …Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of provider ... for conducting investigations of organizational or functional activities related to alleged fraud , waste and abuse perpetrated by providers, members, facilities,… more
- Point32Health (Canton, MA)
- …prevent future loss. This role will be responsible for conducting high-volume Pre-Payment Fraud Waste & Abuse ("FWA") investigations under the direction of the ... Investigation Unit ("SIU") responsible for leading complex provider investigations related to fraud , waste , and abuse, and developing action plans to address… more
- UPMC (Pittsburgh, PA)
- …Investigations Unit (SIU) Investigator is responsible for investigating assigned dental fraud , waste and abuse (FWA) cases, as well as researching and ... Health Plan has an exciting opportunity for a SIU Investigator ! This is a remote, full-time role working daylight...data analysis to identify, evaluate and measure potential healthcare fraud , waste and abuse to determine valid… more
- Centene Corporation (Frankfort, KY)
- …A license in one of the following is required: Other Accredited Health Care Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE). Other Pharmacy ... subject matter expert for the Contractor's Program Integrity unit to reduce Fraud , Waste and Abuse of Medicaid services within Kentucky. Provides direction and… more
- CVS Health (Columbus, OH)
- …the state of Ohio + 4+ years investigative experience in the area of healthcare fraud , waste and abuse matters. + Working knowledge of medical coding; CPT, ... each and every day. **Position Summary** As a Senior Investigator you will conduct high level, complex investigations of...with an additional four+ years working on health care fraud , waste , and abuse investigations and audits;… more
- City of New York (New York, NY)
- …of clean drinking water for New Yorkers. DOI is seeking a Confidential Investigator who will be responsible for investigating fraud , corruption, and ... will be responsible for the investigation of matters involving fraud , waste and abuse related to the...of Management & Budget approval for budgeted headcount. CONFIDENTIAL INVESTIGATOR - 31143 Qualifications 1. A four-year high school… more
- State of Georgia (Fulton County, GA)
- …yourself. Conducts independent and objective investigations to obtain evidence of reported fraud , abuse, mismanagement, waste , or other violations of rules, ... Compliance Investigator Georgia - Fulton - Atlanta (https://ga.referrals.selectminds.com/jobs/75300/other-jobs-matching/location-only) New… more
- Centene Corporation (Harrisburg, PA)
- …IS REMOTE CANDIDATE MUST HAVE EXPERIENCE INVESTIGATING OR IDENTIFYING BEHAVIORAL HEALTH FRAUD , WASTE AND ABUSE TRENDS **Position Purpose:** Conduct comprehensive ... and prepayment reviews of medical records to identify potential fraud , waste , and abuse and inappropriate billing practices. + Investigate, analyze,… more
- Molina Healthcare (Covington, KY)
- …delivery systems + Understanding of datamining and use of data analytics to detect fraud , waste , and abuse + Proven ability to research and interpret regulatory ... position must have the ability to determine correct coding, documentation, potential fraud , abuse, and over utilization by providers and recipients. The position… more
- Parsons Corporation (Springfield, VA)
- …**Responsibilities include, but are not limited to** **:** + Investigate complaints of fraud , waste and abuse, data spills, and network penetrations. + Respond ... of fraudulent recruitment practices. To learn more about recruitment fraud and how to report it, please refer to https://www.parsons.com/fraudulent-recruitment/… more
- Elevance Health (Costa Mesa, CA)
- …evaluate and recommend focused investigative activities involving market trends indicating Fraud , Waste and Abuse within the healthcare industry. **How ... You Will Make an Impact:** + Assisting the team manager with the administration and operational activities occurring within the Special Investigations Unit for **pharmacy Investigations** ; coordinating and conducting case reviews for quality assurance,… more
- BlueCross BlueShield of North Carolina (NC)
- …+ Relevant certifications (eg, Certified Fraud Examiner (CFE), accredited healthcare fraud investigator (AHFI) **What You'll Get** : + The opportunity to ... AVP Special Investigations Unit (SIU) is responsible for overseeing and managing fraud , waste , and abuse (FWA) detection, investigation, and prevention efforts… more
- Aveanna Healthcare (Homestead, FL)
- …to individual approved protocols. Complete clinical trial visits on-site with investigator teams, or in an off-site capacity, working remotely visiting patients' ... (RNPM), Research nurse manager, site staff and the Principal Investigator , to ensure a smooth and efficient flow of...that may be required Report any suspected misconduct or fraud to Aveanna & Illingworth and associated companies Where… more
- City of New York (New York, NY)
- …Construction (DDC), and Department of Parks and Recreation (DPR), seeks an experienced investigator to serve as an Assistant Inspector General. Squad 10 oversees a ... Inspector General (AIG) who will lead and conduct criminal investigations into fraud and corruption relating to City agencies, employees and contractors. This… more