- Independent Health (Buffalo, NY)
- …first-class perks, benefits and commitment to diversity and inclusion. **Overview** The Fraud Investigator develops, implements and administers the IH anti- ... fraud program, including a regular fraud risk assessment, and project managing the program, facilitating...cases + Review medical record documentation provided in each case and identify the appropriate course of action +… more
- Molina Healthcare (Covington, KY)
- …ASSOCIATION** : + Health Care Anti- Fraud Associate (HCAFA). + Accredited Health Care Fraud Investigator (AHFI). + Certified Fraud Examiner (CFE). To all ... **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation,… more
- State of Massachusetts (Boston, MA)
- …direct application page.** * https://ago-ma.igreentree.com/CSS\_External/CSSPage\_Welcome.ASP*/ /* Criminal Investigator Criminal Bureau Insurance & Unemployment ... Duties_: Conduct complex investigations of all types of insurance fraud , including fraud involving healthcare ,...and securing evidence; . Assisting Assistant Attorneys General in case and trial preparation; . Testifying in grand jury… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …Professional Coder (CPC), Certified Fraud Examiner (CFE), or Accredited Health Care Fraud Investigator (AHFI) preferred. + (2) years of active experience in ... Work and Improve People's Lives** Our purpose, to improve customers' lives by making healthcare work better, is far from ordinary. And so are our employees. Working… more
- CVS Health (Baton Rouge, LA)
- … you will conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high ... of business, or cases involving multiple perpetrators or intricate healthcare fraud schemes. - Investigates to prevent...cases for clinical and legal review- Documents all appropriate case activity in case tracking system- Facilitates… more
- State of Georgia (Fulton County, GA)
- …Georgia Medicaid Program. Participates as a member of an interdisciplinary team in Healthcare fraud investigations, and provides support to members of other ... of the Attorney General Georgia Department of Law Nurse Investigator - Medicaid Fraud Division *To move forward...eligibility of providers as requested. + Assists prosecutors in Healthcare Fraud investigations by reviewing provider and… more
- CVS Health (Hartford, CT)
- …investigations to effectively pursue the prevention, detection, investigation and prosecution of healthcare fraud , waste, and abuse. Also reports suspected ... - Conducts investigations of known or suspected acts of healthcare fraud , waste, and abuse - Communicates...for clinical and legal review - Documents all appropriate case activity in tracking system - Makes referrals, both… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- …approach to uncover abuse and neglect of residents and complex financial fraud committed by healthcare providers, including hospitals, nursing homes, pharmacies, ... INVESTIGATOR /SPECIAL AGENT (1-3) Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4500803) Apply ...cyber crimes, white collar crimes, and public corruption. Medicaid Fraud Control Unit: The Louisiana Medicaid Fraud … more
- SGI Global, LLC (Baton Rouge, LA)
- SGI Global is seeking an Affirmative Civil Enforcement (ACE) Investigator to support the United States Attorney's Office, Middle District of Louisiana to assist in ... civil actions to enforce federal laws or to recover federal funds lost to fraud , waste, or abuse. *Position is contingent upon award* Job Duties + Assist with… more
- CVS Health (Richmond, VA)
- …- Conducts investigations to effectively pursue the prevention, investigation, and prosecution of healthcare fraud and abuse, to recover lost funds, and to ... - Conducts investigations of known or suspected acts of healthcare fraud and abuse. - Communicates with...for clinical and legal review. - Documents all appropriate case activity in tracking system. - Makes referrals and… more
- CVS Health (Trenton, NJ)
- …Conducts investigations to effectively pursue the prevention, investigation, and prosecution of healthcare fraud and abuse, to recover lost funds, and to ... fraud plans and practices.- Conducts investigations of known or suspected acts of healthcare fraud and abuse.- Communicates with federal, state, and local law… more
- Commonwealth Care Alliance (Boston, MA)
- …review, witness interviews and data analysis to identify, evaluate and measure potential healthcare fraud and abuse to determine valid cases for appropriate ... **Why This Role is Important to Us:** The Associate Investigator works with a growing team conducting and managing...with a growing team conducting and managing Health Care Fraud , Waste and Abuse investigation and prevention activities under… more
- MyFlorida (Tallahassee, FL)
- …related professional certification, such as: Certified Fraud Examiner; Accredited Healthcare Fraud Investigator ; Certified Financial Crimes ... (MPI) does this specifically through audits and investigations of healthcare providers, including managed care plans, suspected of engaging...Investigator ; Certified Insurance Fraud Investigator ; or Certified Compliance and Ethics… more
- MyFlorida (Miami, FL)
- …related professional certification, such as: Certified Fraud Examiner; Accredited Healthcare Fraud Investigator ; Certified Financial Crimes ... (MPI) does this specifically through audits and investigations of healthcare providers, including managed care plans, suspected of engaging...Investigator ; Certified Insurance Fraud Investigator ; or Certified Compliance and Ethics… more