- Kelsey-Seybold Clinic (Pearland, TX)
- **Responsibilities** The Sr. Fraud Investigator SIU (Special Investigations Unit) assists in the implementation and daily operation of the organization's ... will be responsible for identification, investigation and prevention of healthcare fraud , waste and abuse. The primary...and obtain medical records/ and other relevant documentation. The Senior Investigator will also act as subject… more
- Elevance Health (Indianapolis, IN)
- ** Senior Investigator ( Investigator Sr)** _Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 ... to recover, eliminate, and prevent unnecessary medical-expense spending. The ** Senior Investigator ** is responsible for the independent identification,… more
- Providence (CA)
- …+ Current certification in health care fraud investigation, such as Accredited Healthcare Fraud Investigator (AHFI), Certification as an Internal Auditor ... manage a workload with multiple cases and audits simultaneously + May assist Senior Investigator or SIU Director in developing, implementing and performing… more
- CareFirst (Baltimore, MD)
- …+ Provide support to investigative teams as they perform all levels of healthcare fraud , waste, and abuse investigations. Oral, written, and other communication ... FUNCTIONS:** + Review of medical records and claims. + Investigate potential fraud and over-utilization by performing complex medical reviews of claims and medical… more
- Veterans Affairs, Veterans Health Administration (Battle Creek, MI)
- …or working at a VA property. Responsibilities The single focus of the Senior Criminal Investigator is the investigation of suspected major offenses against ... crimes such as homicide, involve an extensive supply chain fraud network, large scale drug diversion, prostitution rings requiring...and assets and the potential prosecution of criminals. The Senior Criminal Investigator reports to the Chief… more
- Elevance Health (Atlanta, GA)
- …for the identification, investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client funds ... ** Investigator II - Carelon Payment Integrity** **Location:** This...claims. + Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company… more
- Elevance Health (FL)
- …for the identification, investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client funds ... Job Description ** Investigator II** **Supporting the Payment Integrity line of...claims. + Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company… more
- Zelis (FL)
- …Treasury . Qualifications: + Bachelor's degree required + 3+ w orking experience as a Fraud Analyst or Fraud Investigator + Industry experience in financial ... institution , fintech, or payments company required ; Healthcare payments industry, preferred + Knowledge of fraud schemes, fraud prevention methods, and … more
- Premera Blue Cross (Mountlake Terrace, WA)
- …Finance, Management, Nursing, Criminal Justice, or similar field of study preferred. + Accredited Healthcare Fraud Investigator (AHFI) or Certified Fraud ... + (8) years of experience with anti- fraud with specific experience involving healthcare fraud , including a minimum of (3) years of related SIU/criminal… more
- Olympus Corporation of the Americas (Center Valley, PA)
- …not legitimate. **Job Description** The primary responsibilities of the Senior Manager, Governance, Risk, and Compliance "GRC" Investigations include directing, ... for alleged violations of applicable codes, policies, and procedures. The Senior Manager, GRC Investigations also co-administers and maintains the global Integrity… more
- Bausch + Lomb (Seattle, WA)
- …as providing scientific insights back to the Medical Affairs internal team. The MSL/ Senior MSL title will be determined based on a candidate's experience level. ... the practice of their colleagues. + Identify unsolicited requests for investigator -initiated research. + Where appropriate, provide overall medical / scientific… more
- City of New York (New York, NY)
- …Serve as the Bureau's lead on all matters regarding response to provider noncompliance, fraud and poor performance; Serve as a senior member of Bureau ... LIST), ADMINISTRATIVE DIRECTOR OF SOCIAL SERVICES, ADMINISTRATIVE ACCOUNTANT, ADMINISTRATIVE INVESTIGATOR Established in 1805, the New York City Department of… more
- Robert Half-Robert Half Corporate (San Ramon, CA)
- …These investigations can involve various areas including compliance, ethics violations, fraud , harassment and other workplace misconduct. + This role will ensure ... planning, receiving/documenting the complaint, determining the best qualified impartial investigator , preparation for the investigation including reviewing relevant policies… more
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