- MyFlorida (Fort Lauderdale, FL)
- …investigations , financial examinations, health care fraud and/or insurance fraud investigations , analysis or other related investigative ... Control Unit and/or 5 years of work experience conducting Health Care Fraud Investigations . The...and one Personal Holiday each year. + State Group Insurance coverage options, including health , life, dental,… more
- Highmark Health (Dover, DE)
- …**Required** + 3 years of relevant, progressive experience in the health insurance industry and/or healthcare fraud investigations **Preferred** + 1 year ... fraud , waste and abuse case, conducting the initial investigations and coordinating the recovery/savings of money related to...in Financial Analysis in an acute care hospital or health insurance setting + 1 year in… more
- CVS Health (Wellesley, MA)
- Bring your heart to CVS Health . Every one of us at CVS ...seeking a Sr. Manager to lead our new ASO investigations team. The Healthcare Fraud Senior Manager ... purpose: Bringing our heart to every moment of your health . This purpose guides our commitment to deliver enhanced...fraud risks, analyzes complex data to identify potential fraud schemes, and directs investigations to resolve… more
- Humana (Indianapolis, IN)
- …**Required Qualifications** + Bachelor's degree + At least 2 years of healthcare fraud investigations and auditing experience + Knowledge of healthcare payment ... part of our caring community and help us put health first** This Senior Fraud and Waste...encourage sensible and culturally-competent business standards + Oversee internal investigations of FWA compliance issues + Work with the… more
- Guidehouse (Richardson, TX)
- …such as OFAC Sanctions, Anti-Money Laundering, KYC, CDD, EDD and/or Financial Fraud Investigations . + Understanding of the legal, corporate governance, and ... None **What You Will Do** **:** Guidehouse is seeking experienced Farud Investigations Analysts to conduct, identify and monitor financial crime risk and report… more
- Fallon Health (Worcester, MA)
- …inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid, and PACE (Program of ... equivalent relevant experience. + Experience with Medicare and Medicaid and/or health insurance , a plus. **License/Certifications:** + Certified Professional… more
- Sharp HealthCare (San Diego, CA)
- …field. + 5 Years in healthcare fraud investigation, preferably in a health plan, health insurance or managed care setting. **Preferred Qualifications** ... employer business practices. **What You Will Do** The Senior Fraud , Waste and Abuse Specialist at Sharp Health...critical role responsible for overseeing the entire lifecycle of fraud , waste, and abuse (FWA) investigations . This… more
- Guidehouse (New York, NY)
- …companies, public health agencies, and/or regulatory/government. + Provide support for fraud and/or bribery and corruption investigations . + Assist in the ... related to healthcare fraud , regulatory compliance, or investigations and/or relevant health care operations management...workplace. Benefits include: + Medical, Rx, Dental & Vision Insurance + Personal and Family Sick Time & Company… more
- Guidehouse (New York, NY)
- …and/or life science companies. + Experience with internal investigations of fraud and/or bribery and corruption for public health agencies, payer/providers, ... You Will Do** **:** Guidehouse has an aggressive growth strategy for its Health Financial Crime, Fraud , and Investigative Services practice. Guidehouse is… more
- Elevance Health (Los Angeles, CA)
- **Nurse and CPC - Clinical Fraud Investigator II - SIU Fraud & Abuse** **Location:** This position will work a hybrid model (remote and office). The ideal ... live within 50 miles of one of our Elevance Health PulsePoint locations. **Hybrid Workplace Strategy:** 1-2 days in...Strategy:** 1-2 days in office per week The **Clinical Fraud Investigator II** is responsible for identifying issues and/or… more
- MyFlorida (West Palm Beach, FL)
- …provides analytical support for attorneys and investigators in Florida-specific and multistate health care fraud investigations and litigation matters. An ... of damages models for use in Florida-specific and multistate health care fraud investigations and...and one Personal Holiday each year. + State Group Insurance coverage options, including health , life, dental,… more
- Walmart (Bentonville, AR)
- …E2E Delivery Platform, you will be responsible for overseeing all aspects of Fraud Prevention, Policy, Investigations , and related Data Analytics within our ... on-trip or delivery fraud , platform abuse, compliance fraud , PII compliance, and investigations . You will...great benefits for a happier mind, body, and wallet. Health benefits include medical, vision and dental coverage. Financial… more
- Highmark Health (Columbus, OH)
- …all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the ... impact assessments. + Leads engagement initiation and planning activities for fraud -related audits and monitoring activities within Highmark Health Enterprise;… more
- International Rescue Committee (New York, NY)
- …our values, and the law. The ECU is responsible for the IRC's Anti- Fraud /Corruption Program, The IRC Way, and internal investigations of safeguarding violations ... investigation outcomes and external benchmarks are incorporated into IRC's anti- fraud /corruption program * Analyze investigations outcomes, audit findings,… more
- Manulife (Boston, MA)
- …+ Ability to apply a working knowledge of state laws and regulations related to insurance fraud and SIU requirements **What motivates you?** + You obsess about ... build their JH careers. We are looking for a candidate with experience in insurance , Medicare, Long-Term Care or Disability fraud with expertise assessing and… more
- REI (Seattle, WA)
- …and builds cases that may be used in the resolution of internal and external fraud and integrity cases. Investigations may span both the digital and in store ... incurred due to fraudulent transactions and policy abuse (resellers, fraudulent insurance claims/returns, etc). The position monitors eCommerce and POS transactions… more
- CVS Health (Columbus, OH)
- …- Bachelor's degree or an additional 5 years of working health care fraud , waste and abuse investigations . **Pay Range** The typical pay range for this ... investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive... Examiners (CFE), or an accreditation from the National Health Care Anti- Fraud Association (AHFI) - Knowledge… more
- US Bank (Minneapolis, MN)
- …what you excel at-all from Day One. **Job Description** The Head of Fraud Strategy is responsible for leading fraud identification and mitigation strategies ... Banking Sales and Support divisions. This position focuses on fraud analytics strategic planning and is responsible for continually...designed to help you and your family boost your health , protect your financial security and give you peace… more
- US Bank (Irving, TX)
- …and discover what you excel at-all from Day One. **Job Description** The Fraud Risk Manager position works as a manager of individual contributors supporting the ... Fraud Strategy team. This role will lead a team...designed to help you and your family boost your health , protect your financial security and give you peace… more
- State of Colorado (Denver, CO)
- …will review referrals, assist with investigation of allegations of both securities and insurance fraud , and ultimately make charging decisions. We would be ... prosecution background. This attorney will work on a multi-disciplinary team to prosecute insurance and securities fraud throughout the state. In this position,… more
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