- CVS Health (Charleston, 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 ... involving multi-lines of business, or cases involving multiple perpetrators or intricate healthcare fraud schemes. + Investigates to prevent payment of… more
- Highmark Health (Dover, DE)
- …+ Certified Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge ... 3 years of relevant, progressive experience in the health insurance industry and/or healthcare fraud investigations **Preferred** + 1 year in Financial Analysis… more
- CVS Health (Trenton, NJ)
- …from home anywhere in the United States. We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna ... you will manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct high level,… more
- Fallon Health (Worcester, MA)
- …this work is a plus, such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or other coding certifications or similar ... will oversees the day-to-day operations over investigations and allegations into healthcare fraudulent, wasteful, and/or abusive billing and practices to mitigate… more
- MyFlorida (Tallahassee, FL)
- …related professional certification, such as: Certified Fraud Examiner; Accredited Healthcare Fraud Investigator ; Certified Financial Crimes ... (MPI) does this specifically through audits and investigations of healthcare providers, including managed care plans, suspected of engaging...Investigator ; Certified Insurance Fraud Investigator ; or Certified Compliance and Ethics… more
- MyFlorida (Tallahassee, FL)
- …related professional certification, such as: Certified Fraud Examiner; Accredited Healthcare Fraud Investigator ; Certified Financial Crimes ... (MPI) does this specifically through audits and investigations of healthcare providers suspected of engaging in fraudulent or abusive...Investigator ; Certified Insurance Fraud Investigator ; or Certified Compliance and Ethics… more
- BlueCross BlueShield of North Carolina (NC)
- …+ Preferred: Relevant certifications (eg, Certified Fraud Examiner (CFE), accredited healthcare fraud investigator (AHFI) **Salary Range** At Blue Cross ... Stay informed about changes in laws, regulations, and industry practices related to healthcare fraud . + Assist in preparing documentation for audits, compliance… more
- NBT Bank (Lakeville, CT)
- Pay Range: $27.48 - $36.65 The Senior Fraud /AML Investigator will work fraud and money laundering cases as assigned by the BSA Officer and Security Officer ... patterns of customer activity + Must be a skilled investigator with understanding of types of fraud ...health and well-being. + Flexible Spending Accounts : For healthcare and dependent care expenses. + Employer-Paid Disability Coverage… more
- Elevance Health (Atlanta, GA)
- **Nurse and CPC - Clinical Fraud Investigator II - SIU Fraud & Abuse** **Location:** This position will work a hybrid model (remote and office). The ideal ... Strategy:** 1-2 days in office per week The **Clinical Fraud Investigator II** is responsible for identifying...claims and medical records prior to payment. Researches new healthcare -related questions as necessary to aid in investigations. +… more
- US Bank (Cincinnati, OH)
- …skills and discover what you excel at-all from Day One. **Job Description** External Fraud Investigators may concentrate on one specific or many different fraud ... fraud , elder and vulnerable adult financial exploitation, technology related fraud , organized fraud rings and anti-money laundering depending on business… more
- US Bank (Cincinnati, OH)
- …(FinCEN) as well as writing and preparing cases that result in No SARs. An Investigator should have a basic understanding of Fraud laws and regulations, the ... US Bank products and services for illegal purposes. As an Investigator , you will conduct enterprise-wide investigations identifying unusual activity and preparing… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, ... reporting, and when appropriate, recovery of money related to health care fraud , waste, and abuse. Duties include performing accurate and reliable medical review… more
- Molina Healthcare (AZ)
- **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, ... reporting, and when appropriate, recovery of money related to health care fraud , waste, and abuse. Duties include performing accurate and reliable medical review… more
- CareFirst (Baltimore, MD)
- …+ Independently or as lead in part of an assigned team develop and conduct healthcare fraud , waste, and abuse investigations of all levels (low to complex). ... of which must be health care specific and includes independently conducting healthcare fraud , waste, and abuse investigations of all levels.… more
- Molina Healthcare (Columbus, OH)
- …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
- State of Georgia (Fulton County, GA)
- …Sign Up for Job Alerts Office of the Attorney General Department of Law Medicaid Fraud - Criminal Investigator Salary: High 40's Min starting The mission of the ... Investigator - Criminal Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/64242/other-jobs-matching/location-only) Hot… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …Work and Improve People's Lives** Our purpose, to improve customers' lives by making healthcare work better, is far from ordinary. And so are our employees. Working ... at Premera means you have the opportunity to drive real change by transforming healthcare . To better serve our customers, we are fostering a culture that emphasizes… more
- CVS Health (Columbus, OH)
- …conducts complex investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to ... and local law enforcement agencies in the investigation and prosecution of healthcare fraud and abuse matters. - Demonstrates high level of knowledge and… 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 ... of the Attorney General Georgia Department of Law Nurse Investigator - Medicaid Fraud Division *To move forward...eligibility of providers as requested. + Assists prosecutors in Healthcare Fraud investigations by reviewing provider and… more
- US Bank (Columbus, OH)
- …**Additional Skills** Investigators may concentrate on one specific or many different fraud typologies such as external fraud , elder and vulnerable adult ... financial exploitation, technology related fraud , organized fraud rings and anti-money laundering...fraudulent activity, and filing Suspicious Activity Reports (SARs). An investigator may review consumer and commercial DDAs, loans, lines… more