- Fallon Health (Worcester, MA)
- …the Senior Director of Internal Audit in their leadership of the Fraud , Waste and Abuse ( FWA ) program. The FWA Manager will be responsiblefor general ... Assist in the development, implementation and manage strategic fraud , waste and abuse ( FWA ) activities by maintaining state and federal requirements and… more
- Sharp HealthCare (San Diego, CA)
- …a critical role responsible for overseeing the entire lifecycle of fraud , waste , and abuse ( FWA ) investigations. This position involves triaging ... employer business practices. **What You Will Do** The Senior Fraud , Waste and Abuse Specialist...compliance with regulatory, accreditation and contract standards. The Senior FWA Specialist will manage day-to-day anti- fraud activities,… more
- Humana (Indianapolis, IN)
- …Integrity Officer, who will oversee the monitoring and enforcement of the fraud , waste , and abuse ( FWA ) compliance program to prevent and detect ... community and help us put health first** This Senior Fraud and Waste Investigator will serve as...plans + Assess records and independently refer suspected member fraud , provider fraud , and member abuse… more
- CVS Health (Tallahassee, FL)
- …manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse ( FWA ). **Key Responsibilities** + Conduct high level, ... complex investigations of known or suspected acts of healthcare fraud , waste and abuse . + Conduct Investigations to prevent payment of suspect or fraudulent… more
- Centene Corporation (Austin, TX)
- …good faith concerns regarding Medicare non-compliance and potential instances of fraud , waste and abuse ( FWA ) + Responding to reports of potential ... + Maintaining documentation for each report of potential non-compliance or potential FWA received from any source, through any reporting channel or mechanism +… more
- General Dynamics Information Technology (Fairfax, VA)
- …updates as needed.** **Prioritize, evaluate, and analyze information for potential fraud , waste , and abuse ( FWA ) using data related to consumer ... CMS; and recommend referrals to law enforcement if potential fraud and abuse is identified.** **HOW YOU...with the support of investigative staff into the potential FWA behavior using various investigative techniques.** **As needed, initiate… more
- UPMC (Pittsburgh, PA)
- …Special Investigations Unit (SIU) Investigator is responsible for investigating assigned fraud , waste and abuse ( FWA ) cases, as well as researching and ... analyzing claims data in order to identify potential FWA . The SIU Investigator is also responsible for maintaining...The SIU Investigator is also responsible for maintaining the FWA case system with accurate and detailed investigative activities… more
- Air National Guard Units (Scott AFB, IL)
- …Commanders' Inspection Programs (CCIP), as well as the Complaints Resolution, and Fraud , Waste , and Abuse ( FWA ) Programs. Work products impact a wide ... CCIP, Unit Self-Assessment Program (USAP), Complaints Resolution Program (CRP) and FWA Program. Oversee multifaceted IG programs designed to independently assess… more
- Air Force Elements, US Special Operations Command (Macdill AFB, FL)
- …strategies for handling varied complex issues such as Congressional inquiries, Fraud , Waste , and Abuse ( FWA ) complaints, DoD Hotline cases, and ... techniques, principles, and procedures to direct or conduct investigations of allegations of fraud , waste , and abuse or other complaints of wrong doing or… more
- SSM Health (Jefferson City, MO)
- …MME, source and DAW to avoid audit charge backs and ensure compliance with Fraud Waste and Abuse ( FWA ) Laws. + Contributes to zero medication errors with ... procedures for quality control and disposal of unusable medications and hazardous waste . Issue controlled substances and maintains records as required by law,… more
- Air National Guard Units (Robins AFB, GA)
- …technical expert to wing personnel on the Air Force Complaints Resolution and Fraud , Waste and Abuse ( FWA ) programs and the Air Force Inspection System ... (AFIS). Plans, directs and manages the activities of the Inspector General office, directing the Commander's Inspection Program (CCIP) and overseeing the wing's self-assessment, exercise and inspection programs. Ensures programs comply with legal and… more
- Commonwealth Care Alliance (Boston, MA)
- CCA- Fraud , Waste & Abuse Essential Duties & Responsibilities: * Conduct prospective medical record review of claims as part of a prepayment review process or ... actions and/or resolutions. * Maintain and update cases in FWA case management database within prescribed timeframes. * Participate...of federal and state laws and regulations pertaining to fraud , waste and abuse . *… more
- Highmark Health (Harrisburg, PA)
- …while learning and understanding how to triage and work a reported allegation of suspected fraud waste or abuse . **Job Functions** + Attend bi-weekly huddles ... baccalaureate program. **PREFERRED QUALIFICATIONS** + Seeking a degree closely related to FWA . This can include security, homeland security or comparable. + Open to… more