- State of Colorado (Denver, CO)
- …+ CBI name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure ... with CDHS. + Must pass a Colorado Bureau of Investigations and a Federal Bureau of Investigations background check as a condition of employment. Included in… 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 Investigator will serve as Humana's Program Integrity Officer, who will… more
- State of Colorado (Adams County, CO)
- …CBI name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure ... applicant from future State employment with CDHS. Included in the background investigation is a current/previous employer check. Your current and previous employers… more
- Fallon Health (Worcester, MA)
- …the healthcare industry. **Experience:** + Advanced knowledge of FWA operations, fraud investigation and/or detection and analysis, and laws/regulations related ... clinical background. + Strong attention to detail with the ability to identify fraud , assess the impact, resolve investigations , mitigate risk, and capture… more
- Centene Corporation (Austin, TX)
- …Overseeing the development and implementation of Corrective Action Plans + Coordinating potential fraud investigations and referrals from and with the SIU, where ... and employees to report, without fear of retaliation, good faith concerns regarding Medicare non-compliance and potential instances of fraud , waste and abuse… more
- State of Georgia (Fulton County, GA)
- …plan the financial and audit strategy for criminal and civil fraud investigations . + Participates in meetings throughout an investigation to discuss various ... Investigative Auditor - Medicaid Fraud Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/52416/other-jobs-matching/location-only) Hot… more
- CVS Health (Columbus, OH)
- …innovation within the team. **Required Qualifications** + 7-10 years of experience in fraud Investigations within the healthcare sector. + Strong analytical and ... waste and abuse. This role involves not only directing fraud detection and investigation activities but also...and productive work environment. + Direct and oversee all fraud detection activities and investigations , ensuring alignment… more
- CVS Health (Hartford, CT)
- …high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high profile, those ... federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud and...or equivalent experience (3-5 years of working health care fraud , waste and abuse investigations ). **Pay Range**… 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). ... investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct...federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud . +… more
- CVS Health (Columbus, OH)
- …high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high profile, those ... federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud and...or an additional 5 years of working health care fraud , waste and abuse investigations . **Pay Range**… more
- VNS Health (Manhattan, NY)
- …with Compliance and Special Investigation Unit on issues related to Fraud , Waste, and Abuse of Medicare /Medicaid services.* Collaborates with pharmacy ... implementation of new government program policies and the monitoring for fraud , waste, abuse of drugs. Educates pharmacists on adherence, inappropriate prescribing… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …protocols specific to hospital revenue cycle risk areas highlighted by the OIG, Medicare , State Medicaid, State Insurance Fraud ; Managed Care or Governmental ... revenue cycle risk areas + Assists in auditing and investigations requested by the System Director, Compliance. + Assists...payments discovered as a result of claims audit or investigation . + Maintains awareness of fraud , waste… more
- Lilly (IN)
- …litigating class actions, matters involving state and federal healthcare programs (eg, Medicare , Medicaid, 340B), and fraud and abuse laws (eg, Anti-Kickback ... to the Associate Vice President and Assistant General Counsel for Litigation, Government Investigations , Legal Policy & Strategy, this role plays a critical part in… more
- State of Georgia (Fulton County, GA)
- …Medicaid Program. Participates as a member of an interdisciplinary team in Healthcare fraud investigations , and provides support to members of other disciplines ... of providers as requested. + Assists prosecutors in Healthcare Fraud investigations by reviewing provider and patient...claims and/or claims data; experience in the detection and investigation of healthcare fraud . Additional Information +… more
- CVS Health (Hartford, CT)
- …will lead a team responsible for ensuring the quality and integrity of healthcare fraud and abuse investigations . This role involves overseeing the training and ... responsible for ensuring the quality and integrity of healthcare fraud and abuse investigations . This role involves...team of Quality Reviewers to effectively assess the prevention, investigation , and prosecution of healthcare fraud and… more
- Point32Health (Canton, MA)
- …of corrective action plans. + ** Fraud Prevention:** Work with the Fraud Special Investigations Unit to ensure compliance with CMS requirements. + ... laws and regulations related to the Government Programs Compliance Programs for Medicare and Duals products. This role involves guiding teams and processes while… more
- General Dynamics Information Technology (Fairfax, VA)
- …small businesses. Through the Center of Program Integrity (CPI), the Centers for Medicare & Medicaid Services (CMS) has strong oversight and internal controls to ... (MPIC) is designed to support this oversight. Through research, investigation , and data analysis, the desired outcomes of the...CMS; and recommend referrals to law enforcement if potential fraud and abuse is identified.** **HOW YOU WILL MAKE… more
- Molina Healthcare (KY)
- …clinic settings) or 5+ years of experience working in a FWA / SIU or Fraud investigations role for New Jersey/New York location + Thorough knowledge of PC ... of Local, State & Federal laws and regulations pertaining to health insurance, investigations & legal processes (Commercial insurance, Medicare , Medicare … more
- SGI Global, LLC (Grand Rapids, MI)
- …and prosecution of cases under the USAO's Affirmative Civil Enforcement program. Most investigations involve: (1) monetary fraud against a multitude of federal ... emphasis on fraud matters involving federal health care programs including Medicare and Medicaid. Job Duties: + Develop an understanding of applicable federal,… more
- McLaren Health Care (Indianapolis, IN)
- …compliance with all requirements related to Special Investigation Units and fraud , waste and abuse investigations . **This position is fully remote.** **Equal ... Inc. at https://www.mdwise.org/ **Position Summary:** Responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving… more