- Syntricate Technologies (San Antonio, TX)
- …of 4 types of investigations : Claims Investigation /Life Annuity Investigation , Financial Crime/ Fraud , Medicare Supplement Claims, Overall Life ... Fraud . Complete Regulatory Reporting Requirements. Develop, maintain, monitor Life company Fraud trends and strategies. Manage Fraud operational losses within… more
- Summa Health (Akron, OH)
- … under general supervision to effectively pursue the identification, prevention, and investigation of healthcare fraud , waste and abuse (FWA), to facilitate ... medical records, analysis, report development, database administration, claims coding, and Fraud , Waste and Abuse identification and investigation . b. Certified… more
- The Travelers Indemnity Company (Downers Grove, IL)
- …which a settlement should be considered. What Will You Do? Conduct investigations , including, but not limited to assessing policy coverage, contacting insureds, ... to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome.… more
- State of Colorado (Grand Junction, CO)
- …CBI name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure ... intellectual and developmental disabilities. This role focuses on the thorough investigation and prevention of Mistreatment, Abuse, Neglect, and Exploitation (MANE)… more
- State of Colorado (Arapahoe County, CO)
- …CBI name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure ... all subject areas. + Pass CBI and FBI background investigations + The Diana Screen(R), a sexual risk screening...Veterans Community Living Centers). + Included in the background investigation is a current/previous employer check. Your current and… more
- State of Colorado (Jefferson County, CO)
- …CBI name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure ... of fingerprinting, polygraph, drug screen, physical exam and an extensive background investigation ) will be conducted as part of the selection process. Felony… more
- Methodist Health System (Dallas, TX)
- …including, but not limited to, state specific health care laws and regulations, Medicare /Medicaid rules, fraud and abuse including Stark and anti-kickback laws ... and state laws relating to healthcare, including but not limited to Medicare /Medicaid reimbursement, HIPAA, AKS, self-referral prohibitions, and fraud and abuse.… more
- Corewell Health (Grand Rapids, MI)
- Job Summary Performs activities related to the detection and investigation of fraud and abuse within Priority Health. Utilizes knowledge/expertise of health care ... provider and agent agreements, products offered, State and Federal laws related to fraud , waste or abuse, Medicare and Medicaid regulations, etc. + Ability… more
- CVS Health (Hartford, CT)
- …and every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU). In ... investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct...federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud . +… more
- Humana (Oklahoma City, OK)
- …Qualifications** + **Must be an Oklahoma resident** + 2+ years of healthcare fraud investigations and auditing experience + Knowledge of healthcare payment ... community and help us put health first** Humana's Special Investigations Unit is seeking a Senior Fraud ...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- CACI International (Latham, NY)
- …to convey complex data clearly and persuasively _Desired:_ + Experience in **healthcare fraud investigations ** + Previous involvement in a **litigation or law ... in the Affirmative Civil Enforcement (ACE) Unit, focusing primarily on **healthcare fraud , waste, and abuse investigations ** . You'll have the opportunity… more
- Amentum (Baltimore, MD)
- …anomalies that might be indicative of improper billing or other types of fraud . + Initiate contacts with federal, state, and local officials, and other ... organizations, including Medicare and Medicaid contractors, related to the subject of...and Medicaid contractors, related to the subject of the investigation for the purpose of gathering facts, obtaining records,… more
- Corewell Health (Grand Rapids, MI)
- …of the Special Investigation Unit (SIU), ensuring timely and thorough investigation of potential fraud , waste, and abuse (FWA) cases. Provide coaching, ... Job Summary - Manager Special Investigation Unit The SIU Manager is responsible for...a focus on identifying, investigating, and resolving health insurance fraud , waste, and abuse (FWA). This role provides operational… more
- UnityPoint Health (Anamosa, IA)
- …hospital and department compliance requirements for federally funded healthcare programs (eg Medicare and Medicaid) regarding fraud , waste and abuse. Brings any ... emergency and routine requests for service. Documents relevant incidents, conducts investigations as appropriate, monitors security cameras and other equipment as… more
- UnityPoint Health (Sioux City, IA)
- …hospital and department compliance requirements for federally funded healthcare programs (eg Medicare and Medicaid) regarding fraud , waste and abuse. Brings any ... Quality Assurance (QA) and Resource Management + Assists and completes investigations involving unexpected or adverse outcomes and keeps documentation according to… more
- Molina Healthcare (St. Petersburg, FL)
- …opinions. + Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations . + Knowledge of Managed Care and the Medicaid and ... medical records and data analysis, and makes determinations as to whether the investigation and/or audit identified potential fraud , waste, or abuse. +… more
- State of Georgia (Fulton County, GA)
- …Medicaid Program. Participates as a member of an interdisciplinary team in Healthcare fraud investigations , and provides support to members of other disciplines ... of providers as requested. + Assists prosecutors in Healthcare Fraud investigations by reviewing provider and patient...claims and/or claims data; experience in the detection and investigation of healthcare fraud . Additional Information +… more
- Travelers Insurance Company (Irvine, CA)
- …a settlement should be considered. **What Will You Do?** + Conduct investigations , including, but not limited to assessing policy coverage, contacting insureds, ... to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome.… more
- State of Minnesota (St. Paul, MN)
- …to conduct a variety of program integrity activities and establish Special Investigations Units (SIUs) that conduct specific activities designed to prevent, detect ... and respond to fraud , waste, abuse and noncompliance with certain contractual or...Auditor, Department of Health, and Centers for Medicaid and Medicare Services. + Evaluate and report on MCO compliance… more
- Option Care Health (Milwaukee, WI)
- …the regulatory landscape, with a strong focus on preventing, detecting, and addressing fraud , waste and abuse (FWA). This leader promotes a culture of integrity and ... expert in health care compliance including, but not limited to FWA, Medicare & Medicaid billing requirements, and interactions with healthcare professionals. Lead or… more
