- State of Michigan (MI)
- Departmental Analyst 9-P11 - Healthcare Fraud Investigator - MDHHS OIG Integrity Division Print ... (https://www.governmentjobs.com/careers/michigan/jobs/newprint/4795098) Apply Departmental Analyst 9-P11 - Healthcare Fraud Investigator - MDHHS OIG Integrity… more
- Fallon Health (Worcester, MA)
- …+ Additional certification applicable to this work is a plus, such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or ... will oversees the day-to-day operations over investigations and allegations into healthcare fraudulent, wasteful, and/or abusive billing and practices to mitigate… more
- New York State Civil Service (Albany, NY)
- …data analysts, nurses, and legal support analysts to conduct complex, long-term healthcare fraud investigations.The Medicaid program provides health coverage to ... General, Office of the Title Forensic Auditor: Entry-Level, Investigate Medicaid Fraud (6354) Occupational Category Financial, Accounting, Auditing Salary Grade NS… more
- Humana (Indianapolis, IN)
- …days/week. **Required Qualifications** + Bachelor's degree + At least 2 years of healthcare fraud investigations and auditing experience + Knowledge of ... 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… more
- New York State Civil Service (Syracuse, NY)
- …attorneys, auditors, detectives, data analysts, and nurses to conduct complex, long-term healthcare fraud investigations. The position is suitable for both ... Office of the Title New Legal Support Analyst Opportunity w/the Medicaid Fraud Control Unit in Syracuse (Ref #: MFCU_SYR_LSA_6359) Occupational Category Legal Salary… more
- Molina Healthcare (Columbus, OH)
- …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
- BlueCross BlueShield of North Carolina (NC)
- …Stay informed about changes in laws, regulations, and industry practices related to healthcare fraud . + Assist in preparing documentation for audits, compliance ... You'll Bring (Hiring Requirements)** + Minimum 7+ years of experience in healthcare fraud detection, investigation, or auditing + Bachelor's degree preferred in … more
- CVS Health (Annapolis, MD)
- …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
- 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 ... enforcement experience, or five (5) years of work experience conducting healthcare fraud investigations. Note: All newly hired employees must obtain CJSTC Sworn… 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
- Highmark Health (Dover, DE)
- …3 years of relevant, progressive experience in the health insurance industry and/or healthcare fraud investigations **Preferred** + 1 year in Financial Analysis ... Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of provider… more
- New York State Civil Service (New York, NY)
- …the unit's forensic accountants/auditors, detectives, and analysts to identify and prosecute financial fraud in the healthcare industry and abuse and neglect of ... General, Office of the Title Attorney: Investigate, Prosecute Medicaid Fraud (3755) Occupational Category Legal Salary Grade NS Bargaining...residents in healthcare facilities, present evidence to grand juries, and conduct… more
- CVS Health (Baton Rouge, LA)
- …investigations to effectively pursue the prevention, detection, investigation and prosecution of healthcare fraud , waste, and abuse. Also reports suspected ... and local law enforcement agencies in the investigation and prosecution of healthcare fraud and abuse matters. + Demonstrates high level of knowledge and… more
- CVS Health (Raleigh, NC)
- …investigations to effectively pursue the prevention, detection, investigation and prosecution of healthcare fraud , waste, and abuse. Also reports suspected ... Components:** - Conducts investigations of known or suspected acts of healthcare fraud , waste, and abuse - Communicates with federal, state, and local… more
- CVS Health (Hartford, CT)
- …You will lead a team responsible for ensuring the quality and integrity of healthcare fraud and abuse investigations. This role involves overseeing the training ... lead a team responsible for ensuring the quality and integrity of healthcare fraud and abuse investigations. This role involves overseeing the training and… more
- MyFlorida (Tallahassee, FL)
- …with a program integrity related professional certification, such as: Certified Fraud Examiner; Accredited Healthcare Fraud Investigator; Certified ... is to ensure fewer budgeted dollars are lost to fraud , abuse, and waste. The Bureau of Medicaid Program...(MPI) does this specifically through audits and investigations of healthcare providers, including managed care plans. This Medical Health… 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 SIU). ... you will manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct high level,… more
- CVS Health (Frankfort, KY)
- …convenient and affordable. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator (Pharmacy) to join our Special Investigations ... you will manage complex investigations into suspected and known acts of Healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conducts high level,… 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
- CVS Health (Columbus, OH)
- …regulatory inquiries. **Required Qualifications:** Minimum 5+ years of experience in healthcare fraud detection, investigation, or auditing In-depth knowledge of ... healthcare systems, claims processing, and regulatory requirements related to healthcare fraud . Proficient in researching information and identifying… more
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