- Humana (Dublin, OH)
- …a part of our caring community and help us put health first** This Senior Fraud and Waste Investigator will serve as Humana's Program Integrity Officer, ... who will oversee the monitoring and enforcement of the fraud , waste , and abuse (FWA) compliance program...areas + Adequately staff and manage the program integrity investigator (s) responsible for all FWA detection programs and activities… more
- Humana (Columbus, OH)
- …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
- Molina Healthcare (Columbus, OH)
- …ASSOCIATION** : + Health Care Anti- Fraud Associate (HCAFA). + Accredited Health Care Fraud Investigator (AHFI). + Certified Fraud Examiner (CFE). To all ... investigation, reporting, and when appropriate, recovery of money related to health care fraud , waste , and abuse. Duties include performing accurate and reliable… more
- AmeriHealth Caritas (Columbus, OH)
- …Ensures compliance with all requirements related to Special Investigation Units and fraud , waste and abuse investigations. + Conducts investigations of ... administrative services. Discover more about us at www.amerihealthcaritas.com. The Investigator is responsible for conducting comprehensive investigations of reported,...potential; fraud , waste and/or abuse with a focus… more
- CVS Health (Columbus, OH)
- …the United States. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU), ... manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct high level, complex… more
- CVS Health (Columbus, OH)
- …+ Bachelor's degree or equivalent experience (3-5 years of working health care fraud , waste and abuse investigations). **Anticipated Weekly Hours** 40 **Time ... every day. **Position Summary** **WEST VIRGINIA RESIDENCY** **REQUIRED** As a Senior Investigator you will conduct high level, complex investigations of known or… more
- Centene Corporation (Columbus, OH)
- …and measure potential healthcare fraud and abuse. + Conduct investigations of potential waste , abuse, and fraud + Document activity on each case and refer ... in claims + Develop new queries and reports to detect potential waste , abuse, and fraud + Provide case updates on progress of investigations and coordinate with… more
- Molina Healthcare (Columbus, OH)
- …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