- Sanford Health (Fargo, ND)
- …Health Care Fraud Investigator (AHFI) certification or Certified Fraud Examiner (CFE) preferred Nursing or other clinical experience highly preferred ... health insurance investigation/audit. - Master's Degree preferred - Accredited Health Care Fraud Investigator (AHFI) certification or Certified Fraud … more
- Elevance Health (Atlanta, GA)
- ** Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 ... is determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** Clinical Fraud Investigator II** is responsible for identifying… more
- Humana (Oklahoma City, OK)
- …**Required Qualifications** + **Must be an Oklahoma resident** + 2+ years of healthcare fraud investigations and auditing experience + Knowledge of healthcare ... first** Humana's Special Investigations Unit is seeking a Senior Fraud & Waste Investigator to join the...+ Bachelor's degree or higher + Any applicable certifications ( Clinical Certifications, CPC, CCS, CFE, AHFI) + Understanding of… more
- Humana (Dayton, OH)
- …**Required Qualifications** + Must reside in Ohio + At least 2 years of healthcare fraud investigations and auditing experience + Knowledge of healthcare ... community and help us put health first** This Senior Fraud and Waste Investigator will serve as...degree + Graduate degree and/or certifications (MBA, JD, MSN, Clinical Certifications, CPC, CCS, CFE, AHFI) + Understanding of… more
- Humana (Tallahassee, FL)
- …in Fraud & Abuse Investigations required + At least 2 years of healthcare fraud investigations and auditing experience + Knowledge of healthcare payment ... of our caring community and help us put health first** The Senior Fraud and Waste Professional conducts investigations of allegations of fraudulent and abusive… more
- MVP Health Care (Rochester, NY)
- …innovative thinking and continuous improvement. To achieve this, we're looking for a ** Clinical Investigator ** to join #TeamMVP. This is the opportunity for you ... professional investigation experience involving economic or insurance related matters. + A clinical investigator must have in addition to the above requirements:… more
- Molina Healthcare (Ann Arbor, MI)
- …Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses ... records to document relevant findings of a post pay clinical review. This position manages documents and prioritizes case...of experience working in a FWA / SIU or Fraud investigations + Thorough knowledge of PC based software… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …of the SIU Management, this position is responsible for the accurate and thorough clinical investigation of potential fraud , waste and abuse (FWA) for all lines ... substantiating referrals, case planning and research, conducting onsite or desk audits, clinical reviews of medical records to ensure correct billing of services and… more
- CVS Health (Morgantown, WV)
- … you will conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high ... of business, or cases involving multiple perpetrators or intricate healthcare fraud schemes. + Investigates to prevent...lines of business + Researches and prepares cases for clinical and legal review + Documents all appropriate case… more
- AmeriHealth Caritas (Columbus, OH)
- …An associate's degree, with a minimum of four years of experience working in healthcare fraud , waste, and abuse investigations and audits. + Experience and ... + Bachelor's degree with a minimum of two years of experience in the healthcare field working in fraud , waste, and abuse investigations and audits OR… more
- Point32Health (Canton, MA)
- …health and well-being organization dedicated to delivering high-quality, affordable healthcare . Serving nearly 2 million members, Point32Health builds on the ... behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it's at the core of… more
- CVS Health (Topeka, KS)
- …in the United States. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit ... manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key...claimants, and customers. + Research and prepare cases for clinical and legal review. + Document all appropriate case… more
- CVS Health (Oklahoma City, OK)
- …- Conducts investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply ... - Conducts investigations of known or suspected acts of healthcare fraud and abuse. - Communicates with... and abuse. - Researches and prepares cases for clinical and legal review. - Documents all appropriate case… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …continuous performance feedback and encourage growth and development of staff. * Accredited Healthcare Fraud Investigator (AHFI) in good standing through the ... of Minnesota Position Title: Supervisor - Special Investigations Unit Clinical Location: Hybrid | Eagan, Minnesota Career Area: Legal...be considered. * Experience using data analysis tools (eg Healthcare Fraud Shield, etc.) * 1+ years… more
- GE HealthCare (Boston, MA)
- …business segment and technology teams on legal issues related to GE HealthCare sponsored and investigator -initiated research and collaboration proposals and ... outside counsel (as necessary) * Advise on legal and compliance matters including Good Clinical Practices (GCP), Fraud and Abuse, Foreign Corrupt Practices Act /… more