- Providence (OR)
- …+ Current certification in health care fraud investigation, such as Accredited Healthcare Fraud Investigator (AHFI), Certification as an Internal Auditor ... behavior change + Provide education related to coding, medical record documentation requirements, healthcare compliance and fraud , waste and abuse to Health Plan… 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 (Miami, 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
- Independent Health (Buffalo, NY)
- …first-class perks, benefits and commitment to diversity and inclusion. **Overview** The Fraud Investigator develops, implements and administers the IH anti- ... fraud program, including a regular fraud risk assessment, and project managing the program, facilitating cross functional fraud control owners to ensure… more
- Molina Healthcare (Covington, KY)
- …ASSOCIATION** : + Health Care Anti- Fraud Associate (HCAFA). + Accredited Health Care Fraud Investigator (AHFI). + Certified Fraud Examiner (CFE). To all ... **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation,… more
- State of Massachusetts (Boston, MA)
- …direct application page.** * https://ago-ma.igreentree.com/CSS\_External/CSSPage\_Welcome.ASP*/ /* Criminal Investigator Criminal Bureau Insurance & Unemployment ... agencies. _Primary Duties_: Conduct complex investigations of all types of insurance fraud , including fraud involving healthcare , automobile claims, workers'… more
- MyFlorida (Miami, FL)
- …or education requirements of s. 943.135. Preference will be given to candidates with healthcare fraud investigative experience working in a Medicaid Fraud ... LAW ENFORCEMENT INVESTIGATOR II - 41000982 Date: Jun 17, 2024...experience, or five (5) years of work experience conducting healthcare fraud investigations. Note: All newly hired… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …Professional Coder (CPC), Certified Fraud Examiner (CFE), or Accredited Health Care Fraud Investigator (AHFI) preferred. + (2) years of active experience in ... 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… 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
- CVS Health (Hartford, CT)
- …investigations to effectively pursue the prevention, detection, investigation and prosecution of healthcare fraud , waste, and abuse. Also reports suspected ... - Conducts investigations of known or suspected acts of healthcare fraud , waste, and abuse - Communicates...in Employee Competencies - Exhibits behaviors outlined in SIU Investigator Competencies - May include travel to testify in… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- …approach to uncover abuse and neglect of residents and complex financial fraud committed by healthcare providers, including hospitals, nursing homes, pharmacies, ... INVESTIGATOR /SPECIAL AGENT (1-3) Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4500803) Apply ...cyber crimes, white collar crimes, and public corruption. Medicaid Fraud Control Unit: The Louisiana Medicaid Fraud … more
- CVS Health (Richmond, VA)
- …- Conducts investigations to effectively pursue the prevention, investigation, and prosecution of healthcare fraud and abuse, to recover lost funds, and to ... and practices. - Conducts investigations of known or suspected acts of healthcare fraud and abuse. - Communicates with federal, state, and local law enforcement… more
- Commonwealth Care Alliance (Boston, MA)
- …review, witness interviews and data analysis to identify, evaluate and measure potential healthcare fraud and abuse to determine valid cases for appropriate ... **Why This Role is Important to Us:** The Associate Investigator works with a growing team conducting and managing...with a growing team conducting and managing Health Care Fraud , Waste and Abuse investigation and prevention activities under… more
- Elevance Health (West Des Moines, IA)
- …for the identification, investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client funds ... ** Investigator II** **Schedule** : 1-2 days per week...claims. + Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company… more
- Elevance Health (St. Louis, MO)
- …for the identification, investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client funds ... ** Investigator II** **Location** : This position will work...claims. + Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company… more
- SGI Global, LLC (Baton Rouge, LA)
- SGI Global is seeking an Affirmative Civil Enforcement (ACE) Investigator to support the United States Attorney's Office, Middle District of Louisiana to assist in ... federal laws or to recover federal funds lost to fraud , waste, or abuse. *Position is contingent upon award*...hard-copy or electronic formats-such as bank records, financial records, healthcare claims data, and tax records + US Citizenship… more
- Elevance Health (Richmond, VA)
- …independent identification, investigation and development of complex cases against perpetrators of healthcare fraud in order to recover corporate and client ... ** Investigator Sr** **Schedule:** 1-2 days per week in...+ Responsible for independently identifying and developing enterprise-wide specific healthcare investigations and initiatives that may impact more than… more
- General Dynamics Information Technology (Fairfax, VA)
- …**Experience:** 3 + years of related experience **Job Description:** **Marketplace Investigator ** **The Affordable Care Act (ACA) requires every state to establish ... administrative actions to CMS; and recommend referrals to law enforcement if potential fraud and abuse is identified.** **HOW YOU WILL MAKE AN IMPACT:** **Conducts… more
- New York State Civil Service (Albany, NY)
- …a police officer within a major metropolitan area, experience in the area of fraud and white collar crime and at least three years of demonstrated internal ... capital district.. Must possess a valid driver's license. Current Certified Fraud Examiner, Certified Fraud Specialist, Certified Public Accountant, Certified… 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...experience Education/Certifications: . Bachelor's Degree . Accredited Health Care Fraud Investigator (AHCFI) certification preferred . Certified… more