- Humana (Oklahoma City, OK)
- …and help us put health first** Humana's Special Investigations Unit is seeking a Senior Fraud & Waste Investigator to join the Oklahoma Medicaid Team. This ... claims to Humana's Oklahoma Medicaid line of business. As the Senior Fraud and Waste Investigator , you will serve as Humana's Program Integrity Officer,… more
- Humana (Hartford, CT)
- …analysis of situations or data requires an in-depth evaluation of variable factors. The Fraud and Waste Investigator collaborates in investigations with law ... health first** Humana is looking for an experienced Healthcare Investigator to join its industry leading Special Investigations Unit....of all do you have a passion for combating Fraud , Waste , and Abuse in the Health… more
- City of New York (New York, NY)
- …surveillance; interviewing witnesses, suspects, customers and preparing investigative reports. ASSOCIATE FRAUD INVESTIGATOR ( - 31118 Qualifications 1. A ... combined law enforcement and regulatory agency with jurisdiction over the trade waste industry and the public wholesale markets. Under supervision, with some… more
- Magellan Health Services (Boise, ID)
- …- Required License and Certifications - Preferred AHFI - Accredited Healthcare Fraud Investigator - EnterpriseEnterprise, CFE - Certified Fraud ... ID. This position is responsible for comprehensive management and ownership of fraud , waste and abuse investigations including development and presentation of… more
- AmeriHealth Caritas (Columbia, SC)
- …Ensures compliance with all requirements related to Special Investigation Units and fraud , waste and abuse investigations. + Conducts investigations of ... administrative services. Discover more about us at www.amerihealthcaritas.com. The Investigator is responsible for conducting comprehensive investigations of reported,...potential; fraud , waste and/or abuse with a focus… more
- Highmark Health (Harrisburg, PA)
- …Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of provider ... for conducting investigations of organizational or functional activities related to alleged fraud , waste and abuse perpetrated by providers, members, facilities,… more
- Highmark Health (Pittsburgh, PA)
- …Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of provider ... for conducting investigations of organizational or functional activities related to alleged fraud , waste and abuse perpetrated by providers, members, facilities,… more
- Point32Health (Canton, MA)
- …prevent future loss. This role will be responsible for conducting high-volume Pre-Payment Fraud Waste & Abuse ("FWA") investigations under the direction of the ... Investigation Unit ("SIU") responsible for leading complex provider investigations related to fraud , waste , and abuse, and developing action plans to address… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …this position is responsible for the accurate and thorough clinical investigation of potential fraud , waste and abuse (FWA) for all lines of business. The scope ... + Prepares recommendations on preventive/corrective measures for the deterrent of future fraud . + Supports other SIU investigators and analysts with their cases by… more
- CVS Health (Columbus, OH)
- …the state of Ohio + 4+ years investigative experience in the area of healthcare fraud , waste and abuse matters. + Working knowledge of medical coding; CPT, ... each and every day. **Position Summary** As a Senior Investigator you will conduct high level, complex investigations of...with an additional four+ years working on health care fraud , waste , and abuse investigations and audits;… more
- UPMC (Pittsburgh, PA)
- …the Special Investigations Unit (SIU) Investigator is responsible for investigating assigned fraud , waste and abuse (FWA) cases, as well as researching and ... has an exciting opportunity for a Special Investigations Unit Investigator position. This is a temporary position working Monday...data in order to identify potential FWA. The SIU Investigator is also responsible for maintaining the FWA case… more
- City of New York (New York, NY)
- …of clean drinking water for New Yorkers. DOI is seeking a Confidential Investigator who will be responsible for investigating fraud , corruption, and ... will be responsible for the investigation of matters involving fraud , waste and abuse related to the...of Management & Budget approval for budgeted headcount. CONFIDENTIAL INVESTIGATOR - 31143 Qualifications 1. A four-year high school… more
- General Dynamics Information Technology (Fairfax, VA)
- …for SOP updates as needed.** **Prioritize, evaluate, and analyze information for potential fraud , waste , and abuse (FWA) using data related to consumer ... **Experience:** 3 + years of related experience **Job Description:** **Marketplace Investigator ** **The Affordable Care Act (ACA) requires every state to establish… more
- Navy Exchange Services (NEX) (Newport, RI)
- …detect and detain individuals suspected of shoplifting. Investigates other suspected incidents of fraud waste and abuse as directed. - Prepares case reports ... Title: A/P SAFETY INVESTIGATOR / PART TIME Location: United States-Rhode Island-Newport Job Number: 250002OT Job Summary: Responsible for the protection of Navy… more
- Molina Healthcare (Covington, KY)
- …delivery systems + Understanding of datamining and use of data analytics to detect fraud , waste , and abuse + Proven ability to research and interpret regulatory ... position must have the ability to determine correct coding, documentation, potential fraud , abuse, and over utilization by providers and recipients. The position… more
- Parsons Corporation (Springfield, VA)
- …**Responsibilities include, but are not limited to** **:** + Investigate complaints of fraud , waste and abuse, data spills, and network penetrations. + Respond ... of fraudulent recruitment practices. To learn more about recruitment fraud and how to report it, please refer to https://www.parsons.com/fraudulent-recruitment/… more
- Elevance Health (Indianapolis, IN)
- …evaluate and recommend focused investigative activities involving market trends indicating Fraud , Waste and Abuse within the healthcare industry. **How ... You Will Make an Impact:** + Assisting the team manager with the administration and operational activities occurring within the Special Investigations Unit for **pharmacy Investigations** ; coordinating and conducting case reviews for quality assurance,… more
- Zelis (Boston, MA)
- …certification as a Certified Fraud Examiner (CFE), Accredited Health Care Fraud Investigator (AHFI), Health Care Anti- Fraud Associate (HCAFA), Certified ... in prevention, detection, reporting, and monetary recovery related to financial fraud and healthcare fraud , waste , and abuse. What You'll Do + Perform… more
- MyFlorida (Tallahassee, FL)
- …with a program integrity related professional certification, such as: Certified Fraud Examiner; Accredited Healthcare Fraud Investigator ; Certified ... is to ensure fewer budgeted dollars are lost to fraud , abuse, and waste . The Bureau of...Financial Crimes Investigator ; Certified Insurance Fraud Investigator ; or Certified Compliance and Ethics… more
- Aramco Services Company (Houston, TX)
- …be completed. + Conducts objective, thorough, and timely investigations into allegations of fraud , waste or abuse committed by employees or contractors against ... assignments beyond the normal scope of the audit function. The Senior Lead Investigator handles hotline reports or calls and manages cases of moderate to high… more