- Humana (Oklahoma City, OK)
- …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 ... claims to Humana's Oklahoma Medicaid line of business. As the Senior Fraud and Waste Investigator , you will serve as Humana's Program Integrity Officer,… more
- Humana (Dayton, 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 (Tallahassee, FL)
- …part of our caring community and help us put health first** The Senior Fraud and Waste Professional conducts investigations of allegations of fraudulent and ... abusive practices. The Senior Fraud and Waste Professional work assignments involve moderately complex to complex issues where the analysis of situations or data… more
- State of Michigan (Oakland, MI)
- Regulation Agent 9-P11 ( Fraud Investigator ) - MDHHS OIG (Oakland County) Print (https://www.governmentjobs.com/careers/michigan/jobs/newprint/5145616) Apply ... Regulation Agent 9-P11 ( Fraud Investigator ) - MDHHS OIG (Oakland County) Salary $2,056.00 - $3,155.20 Biweekly Location Oakland, MI Job Type Permanent Full Time… more
- Molina Healthcare (Louisville, KY)
- …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
- MyFlorida (Miami, FL)
- …of Financial Services. This advertisement is for theBureau of Public Assistance Fraud . This advertisement is for aFinancial Crime Investigator Iposition which ... FINANCIAL CRIME INVESTIGATOR I (PENDING RECLASS) - 43061944 Date: Nov... Fraud is to aggressively identify and eliminate fraud , waste , and abuse to safeguard the… 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
- MyFlorida (Fort Lauderdale, FL)
- …of Financial Services. This advertisement is for the Bureau of Public Assistance Fraud . This advertisement is for aFinancial Crime Investigator Iposition which ... FINANCIAL CRIME INVESTIGATOR I - 43061893 Date: Nov 22, 2025... Fraud is to aggressively identify and eliminate fraud , waste , and abuse to safeguard the… more
- Highmark Health (Pittsburgh, PA)
- …Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of provider ... for conducting investigations of organizational or functional activities related to alleged fraud , waste and abuse perpetrated by providers, members, facilities,… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …use of Microsoft Word, Excel, PowerPoint and Visio. * Accredited Health Insurance Fraud Investigator (AHFI) in good standing through the National Health Care ... prospective and retrospective investigations of suspected claims and the development of fraud , waste , abuse and over-payment recovery cases. This includes… more
- Point32Health (Canton, MA)
- …prevent future loss. This role will be responsible for conducting high-volume Pre-Payment Fraud Waste & Abuse ("FWA") investigations under the direction of the ... Investigation Unit ("SIU") responsible for leading complex provider investigations related to fraud , waste , and abuse, and developing action plans to address… 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
- CVS Health (Topeka, KS)
- …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 (Morgantown, WV)
- …+ 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
- City of New York (New York, NY)
- …of clean drinking water for New Yorkers. DOI is seeking a Confidential Investigator who will be responsible for investigating fraud , corruption, and ... will be responsible for the investigation of matters involving fraud , waste and abuse related to the...of Management & Budget approval for budgeted headcount. CONFIDENTIAL INVESTIGATOR - 31143 Qualifications 1. A four-year high school… more
- CVS Health (Oklahoma City, OK)
- …- Must be located in Oklahoma. - 1+ years experience working in healthcare fraud , waste and abuse investigations and audits. - Experience reviewing and analyzing ... equivalent experience with two additional years working in health care fraud , waste , and abuse investigations and audits. **Anticipated Weekly Hours** 40 **Time… more
- Navy Exchange Services (NEX) (Pensacola, FL)
- …and detain individuals suspected of shoplifting. Investigates other suspected incidents of fraud waste and abuse as directed. Prepares case reports investigative ... Title: ASSET PROTECTION/SAFETY INVESTIGATOR (Full Time w/Benefits) Location: United States-Florida-Pensacola Job Number: 250003DS Job Summary : Responsible for the… more
- Navy Exchange Services (NEX) (Newport, RI)
- …detect and detain individuals suspected of shoplifting. Investigates other suspected incidents of fraud waste and abuse as directed. - Prepares case reports ... Title: A/P SAFETY INVESTIGATOR / PART TIME Location: United States-Rhode Island-Newport Job Number: 250002OT Job Summary: Responsible for the protection of Navy… 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 (Cincinnati, 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