- Guidehouse (New York, NY)
- …Will Do** **:** Guidehouse has an aggressive growth strategy for its Healthcare Fraud , Financial Crime, Compliance, and Investigative Services (FFI-Health) team. ... FFI-Health is currently seeking candidates with relevant healthcare fraud , waste, and abuse (FWA), regulatory compliance, and/or investigations experience (eg,… more
- New York State Civil Service (Syracuse, NY)
- …Agency Attorney General, Office of the Title Forensic Auditor: Support Healthcare Fraud Investigations (6342) Occupational Category Financial, Accounting, ... data analysts, nurses, and legal support analysts to conduct complex, long-term healthcare fraud investigations.The Medicaid program provides health coverage to… more
- AmeriHealth Caritas (Dublin, OH)
- **Special Investigator ( Healthcare Fraud , Waste & Abuse)- Ohio resident** Location: Dublin, OH Primary Job Function: Compliance ID**: 34748 **Job Brief** This ... be required to make Ohio provider visits as needed. Healthcare SIU / FWA experience required. Your career starts...for conducting comprehensive investigations of reported, alleged or suspected fraud involving the full range of products at the… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …The SIU Investigator will be responsible for identification, investigation and prevention of healthcare fraud , waste and abuse. The primary responsibility of the ... of knowledge with local, state and federal laws and regulations pertaining to healthcare fraud . Experience analyzing and interpreting data to identify trends,… more
- Idaho Division of Human Resources (Boise, ID)
- …investigator and experience with white collar investigations with an emphasis on healthcare or Medicaid fraud . Applications: E-mail resumes to [email protected] ... Medicaid Fraud Control Unit Investigator, OAG, Criminal Law Division...applicant will be assigned to the Attorney General's Medicaid Fraud Control Unit (MFCU). This investigator will be responsible… more
- Molina Healthcare (Owensboro, KY)
- …The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses ... of experience working in a FWA / SIU or Fraud investigations role for New Jersey/New York location +...position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …+ (8) years of experience with anti- fraud with specific experience involving healthcare fraud , including a minimum of (3) years of related SIU/criminal ... Criminal Justice, or similar field of study preferred. + Accredited Healthcare Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE) preferred.… more
- Providence (CA)
- …certification in health care fraud investigation, such as Accredited Healthcare Fraud Investigator (AHFI), Certification as an Internal Auditor (CIA), ... behavior change + Provide education related to coding, medical record documentation requirements, healthcare compliance and fraud , waste and abuse to Health Plan… more
- Centene Corporation (Frankfort, KY)
- …perspective on workplace flexibility. **Position Purpose:** Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, ... executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse. + Conduct investigations of potential waste,… more
- State of Georgia (Fulton County, GA)
- …Georgia Medicaid Program. Participates as a member of an interdisciplinary team in Healthcare fraud investigations, and provides support to members of other ... and eligibility of providers as requested. + Assists prosecutors in Healthcare Fraud investigations by reviewing provider and patient records. + Makes… more
- DCCA (Columbia, MD)
- …leadership experience . Payment Integrity knowledge and skills . Experience with healthcare fraud analytics . Demonstrates strong communication skills Desired ... Skills : . Healthcare Fraud Programs . Special Investigations Unit (SIU) experience Education/Certifications: . Bachelor's Degree . Accredited Health Care … more
- Zelis (FL)
- …Industry experience in financial institution , fintech, or payments company required ; Healthcare payments industry, preferred + Knowledge of fraud schemes, ... Overview: The Fraud Analyst will report to the Manager of...in accordance with Company policies. Zelis is modernizing the healthcare financial experience by providing a connected platform that… more
- New York State Civil Service (New York, NY)
- …the Unit's New York City office. The selected attorneys will lead complex civil fraud investigations in the healthcare industry, as well as litigate such matters ... Attorney General, Office of the Title Lateral Attorney: Lead Complex Civil Fraud Investigations(3723) Occupational Category Legal Salary Grade NS Bargaining Unit M/C… more
- CVS Health (Tallahassee, FL)
- …and Directors as appropriate in matters pertaining to the investigation of suspected healthcare fraud cases. + Provides clinical expertise and consultation in ... creation of data analytic monitors to identify potential patterns of suspected fraud , waste, or abuse. + Providers subject matter expert support to enterprise-wide… more
- CareFirst (Baltimore, MD)
- …+ Provide support to investigative teams as they perform all levels of healthcare fraud , waste, and abuse investigations. Oral, written, and other communication ... FUNCTIONS:** + Review of medical records and claims. + Investigate potential fraud and over-utilization by performing complex medical reviews of claims and medical… more
- McLaren Health Care (Indianapolis, IN)
- …risk arrangements._ + _Certification as a Certified Fraud Examiner (CFE), Certified Professional Medical Auditor or Accredited Healthcare Fraud Investigator_ ... (4) years of related experience. + Three (3) years' experience in fraud , waste, and abuse audits and/or investigations; internal audits and/or investigations; and/or… more
- Executive Office for US Attorneys and the Office of the US… (Midland, TX)
- …crimes; human trafficking; organized crime; terrorism; white collar crime, including wire and mail fraud , healthcare fraud , and mortgage fraud ; criminal ... immigration matters; and general crimes. The qualified applicant would be expected to (a) assist federal law enforcement agents in structuring and implementing criminal investigative plans and strategies; (b) actively participate in grand jury proceedings,… more
- Elevance Health (Atlanta, GA)
- …for the identification, investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client funds ... pharmacy claims. + Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company health plan,… more
- Elevance Health (FL)
- …for the identification, investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client funds ... pharmacy claims. + Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company health plan,… more
- Executive Office for US Attorneys and the Office of the US… (Dallas, TX)
- …work on a wide variety of practice areas, including narcotics, public corruption, healthcare fraud , cybercrimes, terrorism, and other federal crimes. Within the ... torts, constitutional torts, immigration, prisoner litigation, commercial, financial, and civil fraud . There is a required background check because of the sensitive… more