- Sharp HealthCare (San Diego, CA)
- …for the position, and employer business practices. **What You Will Do** The Senior Fraud , Waste and Abuse Specialist at Sharp Health Plan is a critical ... role responsible for overseeing the entire lifecycle of fraud , waste , and abuse (FWA)...ensuring compliance with regulatory, accreditation and contract standards. The Senior FWA Specialist will manage day-to-day anti- fraud … more
- Fallon Health (Worcester, MA)
- …position supports the Senior Director of Internal Audit in their leadership of the Fraud , Waste and Abuse (FWA) program. The FWA Manager will be ... summary of purpose:** Under the general direction of the Senior Internal Audit Manager, theAnalyze and interpret patient medical...+ Assist in the development, implementation and manage strategic fraud , waste and abuse (FWA)… more
- Humana (Indianapolis, IN)
- **Become a part of our caring community and help us put health first** This Senior Fraud and Waste Investigator will serve as Humana's Program Integrity ... Officer, who will oversee the monitoring and enforcement of the fraud , waste , and abuse (FWA) compliance program to prevent and detect potential FWA… more
- CVS Health (Hartford, CT)
- …+ Bachelor's degree or equivalent experience (3-5 years of working health care fraud , waste and abuse investigations). **Pay Range** The typical ... will conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse . Routinely handles cases that are sensitive or high… more
- CVS Health (Tallahassee, FL)
- …role, you will manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct ... and affordable. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our...complex investigations of known or suspected acts of healthcare fraud , waste and abuse . +… more
- Amazon (Arlington, VA)
- …and uses signals in transactional data such as invoices and payments as indicators of theft, fraud , waste , or abuse . We are looking for a technical minded ... on best practices, identify training gaps and opportunities for fraud investigators, and manage upwards with senior ...for fraud investigators, and manage upwards with senior leaders. You will have a strong background in… more
- CVS Health (Columbus, OH)
- …oversee a team of investigators in our efforts to identify, prevent, and mitigate healthcare fraud , waste and abuse . This role involves not only directing ... and investigation activities but also developing strategies to minimize fraud risks, ensuring compliance with regulatory standards, and achieving operational… more
- CareFirst (Columbia, MD)
- …through the detection, investigation, and resolution of all levels (low to complex), of fraud , waste , and abuse schemes, resulting in the savings and ... 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 and… more
- CVS Health (Columbus, OH)
- …**Education:** - Bachelor's degree or an additional 5 years of working health care fraud , waste and abuse investigations. **Pay Range** The typical pay ... will conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse . Routinely handles cases that are sensitive or high… more
- State of Massachusetts (Boston, MA)
- …public money and property. The OIG is an independent agency charged with preventing and detecting fraud , waste and abuse in the use of public funds and ... functions. Together the bureau work to prevent and detect waste , fraud and abuse of...of Construction Management At-Risk projects and public land dispositions. * Senior Policy Analyst: Position Overview* As part of the… more
- City of New York (New York, NY)
- … Senior Investigators, who will: - Conduct complex investigations into allegations of fraud , waste , and/or abuse of social services benefits administered ... Job Description APPLICANTS MUST BE PERMANENT IN THE FRAUD INVESTIGATOR CIVIL SERVICE TITLE OR IN A...all statutory, regulatory, and contractual standards. The Bureau of Fraud Investigations (BFI) is mandated to conduct investigations of… more
- Election Assistance Commission (Washington, DC)
- …knowledge of Generally Accepted Government Auditing Standards ("Yellow Book"). Ability to assess fraud , waste , abuse , and mismanagement in the operation of ... Summary The Senior Program Analyst reports to the Assistant Inspector...Auditor (CIA), Certified Information Systems Auditor (CISA), and/or Certified Fraud Examiner (CFE). Please Note: The full-performance level is… more
- City of New York (New York, NY)
- …identify risks and opportunities to improve services through a coordinated structure that prevents fraud , waste , and abuse and fosters compliance with legal ... agencies in assessing their operational, financial and compliance risks, addressing waste and mismanagement, and improving the effectiveness of City operations.… more
- Prime Therapeutics (Columbus, OH)
- …risk management and increase efficiencies; and reduces the potential for non-compliance, fraud , waste , and abuse . **Responsibilities** + Participate in ... every decision we make. **Job Posting Title** Internal Auditor Senior - Remote **Job Description** The Senior ...Lead brainstorming sessions for each audit conducted to identify fraud and other potential risks + Oversee the technical… more
- Humana (Columbus, OH)
- …regulatory and operational issues. + Provide guidance related to the application of fraud , waste , and abuse laws, including the Anti-Kickback Statute, ... caring community and help us put health first** The Senior Counsel provides a full range of legal advice...a full range of legal advice and services. The Senior Counsel works on problems of diverse scope and… more
- City of New York (New York, NY)
- …identify risks and opportunities to improve services through a coordinated structure that prevents fraud , waste , and abuse and fosters compliance with legal ... of the Director and Deputy Director(s) of MORMC, the Senior Policy Analyst will work directly with City agencies...(1) City Research Scientist, II to function as a Senior Policy Analyst, who will: - Leading and coordinating… more
- The Cigna Group (Bloomfield, CT)
- …claim coding, enrollment, coordination of benefits, overpayment identification, claims auditing, pharmacy, Fraud , Waste and Abuse , and third party liability ... The Claims Strategy and Payment Integrity Senior Manager will play an important role in...a small team and report directly to the IFP Senior Director of Operations. The role is designed for… more
- New York Power Authority (White Plains, NY)
- …controls. May also include execution of special investigations/audits involving cases of fraud , waste , and abuse and/or ethical/regulatory complaints. ... Senior Auditor - Technology Location: White Plains, US...improvements, and partner with leadership to communicate observations to senior management and auditees. + Lead, coach, and mentor… more
- MetLife (Bloomfield, CT)
- …and reconciles inconsistencies when gathering information during claim evaluations and collaborates with Fraud Waste and Abuse resources as needed and ... the lives of our customers and our communities. The Senior Long Term Disability (LTD) Claims Specialist evaluates long...within prescribed time service standards. In this role, the Senior LTD Claims Specialist is required to exercise independent… more
- Commander, Navy Installations (Keyport, WA)
- …Assists in the maintenance of internal control program requirements to protect against fraud , waste , and abuse . Prepares draft memoranda or letters ... responding to correspondence of a non-routine nature explaining various aspects of accounting and providing detailed and technical explanations of accounting discrepancies or procedural or reporting requirements. 1. Prepares reports and correspondence relating… more