- CVS Health (Hartford, CT)
- …heart, each and every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit ... you will manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct high level,… more
- Highmark Health (Dover, DE)
- …+ 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 ... Investigator ; Certified Insurance Fraud Investigator ; Certified Compliance and Ethics Professional, or other relevant certification, such as: Project… more
- City National Bank (Newark, DE)
- * 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
- 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 Senior** **Location:** _Hybrid1:_ This role requires associates be in the office 1-2 days per week, fostering collaboration and ... dynamic and adaptable workplace. Alternate locations may be considered. The **Clinical Fraud Investigator Senior** is responsible for identifying issues and/or… more
- Elevance Health (Gilbert, MN)
- **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
- US Bank (Knoxville, TN)
- …include the following (some may vary based on role, location or hours): + Healthcare (medical, dental, vision) + Basic term and optional term life insurance + ... Short-term and long-term disability + Pregnancy disability and parental leave + 401(k) and employer-funded retirement plan + Paid vacation (from two to five weeks depending on salary grade and tenure) + Up to 11 paid holiday opportunities + Adoption assistance… more
- Molina Healthcare (St. Petersburg, FL)
- …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
- CareFirst (Baltimore, MD)
- …+ Independently or as lead in part of an assigned team develop and conduct healthcare fraud , waste, and abuse investigations of all levels (low to complex). ... **Education Level:** Bachelor's Degree **Licenses/Certifications Preferred:** + Certified Insurance Fraud Investigator (CIFI) + Certified Expert Coder-AHIMA or… more
- CVS Health (Carson City, NV)
- …conducts complex investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to ... and local law enforcement agencies in the investigation and prosecution of healthcare fraud and abuse matters. - Demonstrates high level of knowledge and… 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
- 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
- SGI Global, LLC (Mobile, AL)
- …(or equivalent experience). + Background in law enforcement, forensic accounting, healthcare fraud , civil litigation, or legal investigations. + Experience ... Full Time SGI Global is seeking a Senior Civil Investigator to support the Affirmative Civil Enforcement (ACE) program...plays a vital role in investigating and developing civil fraud cases and other enforcement actions that protect taxpayer… more
- Elevance Health (Atlanta, GA)
- …for the identification, investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client funds ... ** Investigator II - Payment Integrity SIU** **Location:** This...claims + Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company… more
- CVS Health (Annapolis, MD)
- …- Conducts investigations to effectively pursue the prevention, investigation, and prosecution of healthcare fraud and abuse, to recover lost funds, and to ... and practices. - Conducts investigations of known or suspected acts of healthcare fraud and abuse. - Communicates with federal, state, and local law enforcement… more
- Elevance Health (Metairie, LA)
- …independent identification, investigation and development of complex cases against perpetrators of healthcare fraud in order to recover corporate and client ... ** Investigator Senior - Carelon Payment Integrity SIU** **Location:**...+ Responsible for independently identifying and developing enterprise-wide specific healthcare investigations and initiatives that may impact more than… more
- Experian (Allen, TX)
- …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
- Sanofi Group (Cambridge, MA)
- …prior experience with investigations or audits focused on issues such as healthcare compliance, bribery, corruption, fraud and/or white-collar investigations. + ... **Job Title:** Investigator , Ethics and Business Integrity, North America **Location:**...assisting with compliance-related matters. We are an innovative global healthcare company with one purpose: to chase the miracles… more
- Molina Healthcare (Owensboro, KY)
- …Required License, Certification, Association + Active and unrestricted Accredited Health Care Fraud Investigator (AHFI) designation or Certified Fraud ... + Works with leadership to maintain and revise policies and procedures, fraud , waste, and abuse plans, annual audit work plans, including department guidance… more
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