- CVS Health (Cary, NC)
- …Unit is seeking a Sr. Manager to lead our new ASO investigations team. The Healthcare Fraud Senior Manager is responsible for overseeing and managing ... ensuring compliance with regulatory requirements. The Senior Manager develops strategies to mitigate fraud risks,...Management:** + Direct and oversee complex investigations into suspected healthcare fraud , waste, and abuse. + Ensure… more
- Prime Therapeutics (Raleigh, NC)
- …passion and drives every decision we make. **Job Posting Title** Internal Auditor Senior - Remote **Job Description** The Senior Internal Auditor conducts audit ... and increase efficiencies; and reduces the potential for non-compliance, fraud , waste, and abuse. **Responsibilities** + Participate in enterprise-level risk… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …and concurrent reviews. The Senior Care Coordinator reports to the Senior Nurse Manager , Utilization Management. Primary Responsibilities + Partner with ... our people are committed to the improvement of how healthcare is accessed and delivered. When you join our...level. *We are an Equal Opportunity Employer JOB ALERT FRAUD : We have become aware of scams from individuals,… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The ideal candidate is an experienced program manager in healthcare payer domain with Third party Administration of self-funded clients in the ... the Multi-employer Trust or Health Plan Administration of self-funded clients in healthcare payer + Documents scope, objectives and ensures they align with expected… more
- Elevance Health (Durham, NC)
- …for the identification, investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client funds ... pharmacy claims. + Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company health plan,… more