- MyFlorida (Tallahassee, FL)
- …Analyst I and will assist with performing activities related to data analytics to identify fraud , waste , or abuse in claims data. The Program Integrity Unit was ... established to detect and prevent fraud , waste and abuse related to the...Health Insurance Fraud Analyst III, Health Insurance Fraud Analyst II, Audit Manager , and the… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …Investigations or prepayment team. This position reports directly to the Data Science Fraud Manager and assists in the development of investigation targets, ... proposes new methods of data analytics and healthcare informatics to discover Fraud , Waste and Abuse activities as well as provide program-wide trend analysis.… more
- Blue KC (Kansas City, MO)
- …**Employee discount program** **Job Description Summary:** As part of Blue KC's Special Investigations Unit (SIU), the Fraud Investigator conducts reviews to ... identify potential fraud , waste , and abuse (FWA) and claim overpayments. Assigned cases...peers and clinical standards, etc. In conjunction with the Manager and/or Senior Investigator, evaluate FWA risks and prioritize… more
- CVS Health (Cheyenne, WY)
- …federal and state audits. **Required Qualifications** + 2 to 5 years of managing healthcare fraud , waste and abuse investigations and audits. + 3 to 5 years of ... activities related to the prevention, investigation, and prosecution of health care fraud to recover lost funds. Responsible for compliance with state and federal… more
- Molina Healthcare (Louisville, KY)
- …and actions. + Works with leadership to maintain and revise policies and procedures, fraud , waste , and abuse plans, annual audit work plans, including department ... License, Certification, Association + Active and unrestricted Accredited Health Care Fraud Investigator (AHFI) designation or Certified Fraud Examiner (CFE)… more
- Providence (Oakland, CA)
- …education related to coding, medical record documentation requirements, healthcare compliance and fraud , waste and abuse to Health Plan staff, vendors and ... **Description** **Investigator External Audit Special Investigations Unit \*Remote The SIU Audit Investigator supports the compliance related activities of the … more
- CVS Health (Hartford, CT)
- …within the Special Investigations Unit (SIU) plays a key role in supporting fraud , waste , and abuse investigations by managing and responding to Requests for ... best practices. The analyst will also provide **leadership support** to the Manager by assisting with team coordination, reporting, and strategic planning efforts.… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …on the specific position **Required Training:** + HIPAA Privacy & Security Course + Fraud , Waste and Abuse Course **Job Skill Requirements:** + Business to ... As the primary point of contact for ProAct clients, the Account Manager is responsible for building relationships with new clients and coordinating internal… more
- Air Combat Command (Tyndall AFB, FL)
- …performance. Administers internal control system to preclude or minimize the potential for fraud , waste , and abuse. Arranges for equipment repairs and other ... at a level that meets current business trends and minimizes waste . Establishes financial goals, prepares budgets, analyzes financial results, maintains solid… more
- Customs and Border Protection (Washington, DC)
- …are covered by internal controls and that appropriate precautions are taken to prevent fraud , waste , and misuse of resources in accordance with the Federal ... 1) to $131,826.00 (GS-12, Step 10). In this Program Manager position you will become a key member of...Office Providing administrative program direction to various directors and special staff for a variety of diverse programs and/or… more
- SCI Shared Resources, LLC (Whittier, CA)
- …and provide detailed information for analysis as necessary. Establish safeguards against fraud , waste , and inefficiency. + **_Policies & procedures_** - Ensure ... to each area. **Leadership** + Provide leadership to all departments in the Manager of At-Need Operation areas of responsibility by setting the example, providing… more
- Bausch + Lomb (Greenville, SC)
- …water supply; storm and wastewater discharges; liquid, solid and hazardous waste management; site recycling, petroleum and chemical storage tank management; ... processes, conducting training, and ensuring compliance with applicable regulations. ** Special Skills:** Strong written and verbal communication. This position may… more
- Aramco Services Company (Houston, TX)
- …conflict of interest, insider trading & anti-trust violations, procurement schemes and fraud . Involves in special inquiry investigations, that require a high ... be completed. + Conducts objective, thorough, and timely investigations into allegations of fraud , waste or abuse committed by employees or contractors against… more
- CVS Health (Phoenix, AZ)
- …with heart, each and every day. The Advisor-Investigations/Compliance provides expert healthcare fraud , waste , and abuse investigative expertise in support of ... Ops provides investigative expertise in support of QPS, a fraud , waste and abuse program for PBM...with the Microsoft office suite. Preferred Qualifications o Healthcare fraud investigations experience. o Pharmacy Benefit Manager … more
- MyFlorida (Jacksonville, FL)
- …the Bureau of Public Assistance Fraud is to aggressively identify and eliminate fraud , waste , and abuse to safeguard the integrity of taxpayer funded public ... EMPLOYMENT OPPORTUNITY DIVISION: CRIMINAL INVESTIGATIONS DIVISION BUREAU: PUBLIC ASSISTANCE FRAUD CITY: JACKSONVILLE COUNTY: DUVAL The Criminal Investigations Division… more
- Elevance Health (Tampa, FL)
- …of 3 years medical coding/auditing experience, including minimum of 1 year in fraud , waste abuse experience; or any combination of education and experience, ... and/or entities that may pose potential risk associated with fraud and abuse. **How you will make an impact:**...trends and changes in laws/regulations. + Collaborates with the Special Investigation Unit and other internal areas on matters… more
- Elevance Health (MD)
- …of 4 years medical coding/auditing experience, including minimum of 1 year in fraud , waste abuse experience; or any combination of education and experience, ... and/or entities that may pose potential risk associated with fraud and abuse. **How you will make an impact:**...trends and changes in laws/regulations. + Collaborates with the Special Investigation Unit and other internal areas on matters… 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 ... + Prepares recommendations on preventive/corrective measures for the deterrent of future fraud . + Supports other SIU investigators and analysts with their cases by… more
- UnityPoint Health (Sioux City, IA)
- …requirements for federally funded healthcare programs (eg Medicare and Medicaid) regarding fraud , waste and abuse. Brings any questions or concerns regarding ... products, etc. to provide the menu selections for patient, cafeteria, special function and satellite accounts while meeting productivity levels. Is knowledgeable… more
- TE Connectivity (PA)
- …world.** **Job Overview** The Indirect Procurement Facilities Commodity Manager is responsible for strategically sourcing, negotiating, and managing indirect ... initiatives. **Knowledge of sustainability practices in procurement, including Zero Waste to Landfill (ZWTL) initiatives, is desirable.** **Job Summary:** **1.… more