- Highmark Health (Pittsburgh, PA)
- …+ Certified Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge ... :** **JOB SUMMARY** The job is responsible for developing and maintaining an anti- fraud program which includes development and delivery of training and filing of … more
- Highmark Health (Harrisburg, PA)
- …+ 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
- MyFlorida (Tallahassee, FL)
- …related professional certification, such as: Certified Fraud Examiner; Accredited Healthcare Fraud Investigator ; Certified Financial Crimes ... (MPI) does this specifically through audits and investigations of healthcare providers, including managed care plans. This OPS Government...Investigator ; Certified Insurance Fraud Investigator ; or Certified Compliance and Ethics… more
- Humana (Oklahoma City, OK)
- …**Required Qualifications** + **Must be an Oklahoma resident** + 2+ years of healthcare fraud investigations and auditing experience + Knowledge of healthcare ... 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 team… more
- City National Bank (Los Angeles, CA)
- * FRAUD INVESTIGATOR SPECIALIST* WHAT IS THE OPPORTUNITY? Responsible for performing and documenting through root cause analysis on clients' transactions ... activities that impact CNB's clients, and corporate losses. Additionally, the Fraud Investigator will quarterback internal events and investigation activities… more
- Humana (Santa Fe, NM)
- …and help us put health first** Humana is looking for an experienced Healthcare Investigator to join its industry leading Special Investigations Unit. Do ... EST/CST time zones **Required Qualifications** * Bachelor's degree * 2 years of healthcare fraud investigations and auditing experience * Knowledge of … more
- Elevance Health (Seattle, WA)
- **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role enables associates to work virtually ... to recover, eliminate and prevent unnecessary medical-expense spending. The **Clinical Fraud Investigator II** is responsible for identifying issues and/or… more
- Point32Health (Canton, MA)
- …health and well-being organization dedicated to delivering high-quality, affordable healthcare . Serving nearly 2 million members, Point32Health builds on the ... behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it's at the core of… more
- Humana (Lincoln, NE)
- …clinical experience to include multiple practice areas + At least 2 years of healthcare fraud investigations and auditing experience + Knowledge of healthcare ... part of our caring community and help us put health first** The Fraud and Waste Professional 2 is responsible for conducting comprehensive investigations of… more
- MyFlorida (Pensacola, FL)
- …or education requirements of s. 943.135. Preference will be given to candidates with healthcare fraud investigative experience working in a Medicaid Fraud ... LAW ENFORCEMENT INVESTIGATOR II - 41001250 1 Date: Dec 10,...experience, or five (5) years of work experience conducting healthcare fraud investigations. Note: All newly hired… more
- Molina Healthcare (Covington, KY)
- …insurance company + Minimum of two (2) years' experience working on healthcare fraud related investigations/reviews + Proven investigatory skill; ability to ... Certification, Association + Valid driver's license required. **Preferred Experience** + Healthcare Anti- Fraud Associate (HCAFA), Accredited Health Care Fraud… 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
- 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/5143725) Apply ...in cybercrimes, white collar crimes, and public corruption. Medicaid Fraud Control Unit: The Louisiana Medicaid Fraud … more
- AmeriHealth Caritas (Columbia, SC)
- …An associate's degree, with a minimum of four years of experience working in healthcare fraud , waste, and abuse investigations and audits. + Experience and ... + Bachelor's degree with a minimum of two years of experience in the healthcare field working in fraud , waste, and abuse investigations and audits OR… more
- Point32Health (Canton, MA)
- …health and well-being organization dedicated to delivering high-quality, affordable healthcare . Serving nearly 2 million members, Point32Health builds on the ... behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it's at the core of… more
- CVS Health (Columbus, OH)
- … 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 ... national in scope, complex cases, or cases involving multiple perpetrators or intricate healthcare fraud schemes. + Investigates to prevent payment of fraudulent… more
- Centene Corporation (Frankfort, KY)
- …for the Bachelors Degree . 5+ years of management experience Investigations and healthcare fraud -related investigations with audit and risk analysis. 1+ year of ... license in one of the following is required: Other Accredited Health Care Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE). Other Pharmacy … 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
- Micron Technology, Inc. (Manassas, VA)
- …a globally minded professional to fill the Staff Employee Relations Advisor and Investigator role. The Staff Employee Relations Advisor and Investigator are ... enabling team members to select the plans that best meet their family healthcare needs and budget. Micron also provides benefit programs that help protect your… more
- General Dynamics Information Technology (Fairfax, VA)
- …**Experience:** 3 + years of related experience **Job Description:** **Marketplace Investigator ** **The Affordable Care Act (ACA) requires every state to establish ... administrative actions to CMS; and recommend referrals to law enforcement if potential fraud and abuse is identified.** **HOW YOU WILL MAKE AN IMPACT:** **Conducts… more