- CareFirst (Baltimore, MD)
- …or as lead in part of an assigned team develop and conduct healthcare fraud , waste , and abuse investigations of all levels (low to complex). Develop ... health care specific and includes independently conducting healthcare fraud , waste , and abuse investigations of all levels. **Licenses/Certifications**… more
- Elevance Health (Hanover, MD)
- …errors. Works with health plan leaders, oversees the monitoring and enforcement of the fraud , waste , and abuse compliance program to prevent and detect ... potential fraud , waste , and abuse activities pursuant to state...Requires a BA/BS in business, engineering, nursing, finance, or healthcare administration and minimum of 5 years related work… more
- CVS Health (Annapolis, MD)
- …with a focus on developing performance measures, managing relationships, and addressing fraud , waste , and abuse within the pharmacy network. ... for pharmacy network contracts. + Identify and flag potential fraud , waste , and abuse within...with cross-functional teams. **Preferred Qualifications:** + Experience in the healthcare or pharmacy industry. + Experience in identifying and… more
- Elevance Health (Hanover, MD)
- …and minimum of 4 years medical coding/auditing experience, including minimum of 1 year in fraud , waste abuse experience; or any combination of education and ... and/or entities that may pose potential risk associated with fraud and abuse . **How you will make...next step in the claims lifecycle. + Researches new healthcare related questions as necessary to aid in investigations… more
- CVS Health (Annapolis, MD)
- …between Aetna, Caremark, and pharmacy partners. + Analyze risk, flags, and trends to mitigate fraud , waste , and abuse within the pharmacy network. + Manage ... are advantageous. + Experience with Medicare. + Experience in identifying and preventing fraud , waste , and abuse in pharmacy services. **Education:** +… more