- Elevance Health (Washington, DC)
- **Nurse and CPC - Clinical Fraud Investigator II - SIU Fraud & Abuse** **Location:** This position will work a hybrid model (remote and office). The ... locations. **Hybrid Workplace Strategy:** 1-2 days in office per week The ** Clinical Fraud Investigator II** is responsible for identifying issues and/or… more
- Humana (Indianapolis, IN)
- …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 to prevent...areas + Adequately staff and manage the program integrity investigator (s) responsible for all FWA detection programs and activities… more
- CVS Health (Tallahassee, FL)
- …and affordable. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU). ... will manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct high level, complex… more
- Humana (Madison, WI)
- …a part of our caring community and help us put health first** The Fraud and Waste Professional 2 conducts investigations of allegations of fraudulent and abusive ... practices. The Fraud and Waste Professional 2 work assignments are varied...Monday-Friday, 8 hours/day, 5 days/week **Required Qualifications** + Strong clinical experience to include multiple practice areas + At… more
- State of Georgia (Fulton County, GA)
- …Job Alerts The Office of the Attorney General Georgia Department of Law Nurse Investigator - Medicaid Fraud Division *To move forward in the recruiting process ... Nurse Investigator Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/51086/other-jobs-matching/location-only) Hot...will serve within the Audits section of the Medicaid Fraud Division. Job Summary Under the direction of the… more
- Molina Healthcare (Meridian, ID)
- **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 (KY)
- **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
- AmeriHealth Caritas (Columbia, SC)
- …services. Discover more about us at www.amerihealthcaritas.com. The Investigator is responsible for conducting comprehensive investigations of reported, ... alleged or suspected fraud involving the full range of products at the...Management knowledge required. + Law enforcement experience preferred.; + Clinical Experience preferred + SIU and/or State Medicaid regulatory… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** **Job Summary** The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical ... 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 role for New Jersey/New York location +… more
- Fallon Health (Worcester, MA)
- …is a plus, such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or other coding certifications or similar in the ... nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences,...Director of Internal Audit in their leadership of the Fraud , Waste and Abuse (FWA) program. The FWA Manager… more
- Bausch + Lomb (Rochester, NY)
- …of the Director, Clinical Research and the direction of the Principal Investigator (PI). While the PI is primarily responsible for the overall design, conduct, ... advancement of eye health in the future. **Position Objectives** A Senior Clinical Research Coordinator (Sr. CRC) is a specialized medical research professional… more
- Lilly (Indianapolis, IN)
- …advocacy). These legal matters may include FDA and global regulatory clinical development, medical affairs, product manufacture and distribution, reimbursement, the ... of business objectives + Serve as point of contact for escalated clinical trial issues (recruitment tactics, subject injury, distribution concerns, investigator … more
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