- Unknown (Washington, DC)
- …Certified Internal Auditor, Certified in Compliance and Ethics Professional, Certified in Healthcare Privacy Compliance, or Certified Fraud Examiner. The ideal ... Care Type Privately Held Founded 1862 Employees 1001-5000 Categories Health Care Specialties healthcare About the Role The Company is in need of a Deputy Chief… more
- Unknown (Madison, WI)
- Chief Compliance and Privacy Officer (CCO) About the Company Highly regarded integrated healthcare system Industry Hospital & Health Care Type Non Profit About the ... as a Chief Compliance Officer in a complex, multi-location healthcare system. The role requires a leader with a...in areas such as Medicare and Medicaid billing, anti-kickback, fraud and abuse, and managed care compliance. The ideal… more
- Humana (Oklahoma City, OK)
- …**Required Qualifications** + **Must be an Oklahoma resident** + 2+ years of healthcare fraud investigations and auditing experience + Knowledge of healthcare ... help us put health first** Humana's Special Investigations Unit is seeking a Senior Fraud & Waste Investigator to join the Oklahoma Medicaid Team. This team of… more
- Manulife (Boston, MA)
- … healthcare provider credentialing and licensing requirements + Understanding healthcare fraud typologies and detection methodologies **Analytical Skills:** + ... Data Scientist to join our Long Term Care Insurance fraud analytics and AI team! This role combines deep... analytics and AI team! This role combines deep healthcare domain expertise with advanced analytics to protect our… more
- New York State Civil Service (New York, NY)
- …data analysts, and legal support analysts to conduct complex, long-term healthcare fraud investigations. The Medicaid program provides health coverage ... Agency Attorney General, Office of the Title Medical Analyst: Legal Nurse, Fraud /Patient Abuse (6418) Occupational Category Legal Salary Grade NS Bargaining Unit M/C… more
- State of Georgia (Fulton County, GA)
- …or more items below: + Attorneys with civil litigation experience, with an emphasis on healthcare or fraud matters. + Demonstrated ability to work in a team is ... Assistant Attorney General 1 - Medicaid Fraud -Civil Georgia - Fulton - Atlanta (https://ga.referrals.selectminds.com/jobs/72524/other-jobs-matching/location-only)… more
- Humana (Concord, NH)
- …clinical experience to include multiple practice areas + At least 2 years of healthcare fraud investigations and auditing experience + Knowledge of healthcare ... part of our caring community and help us put health first** The Fraud and Waste Professional 2 is responsible for conducting comprehensive investigations of… more
- LA Care Health Plan (Los Angeles, CA)
- …or Related Field Experience Required: At least 7 years of experience in healthcare compliance, fraud investigations, law enforcement, or related field. At least ... Preferred And/Or any of the following Licenses/ Certifications: Certified Fraud Examiner (CFE) Certified HealthCare Compliance (CHC) Certified… more
- Molina Healthcare (Covington, KY)
- …insurance company + Minimum of two (2) years' experience working on healthcare fraud related investigations/reviews + Proven investigatory skill; ability to ... Certification, Association + Valid driver's license required. **Preferred Experience** + Healthcare Anti- Fraud Associate (HCAFA), Accredited Health Care Fraud… more
- Meta (Salt Lake City, UT)
- … Compliance, you will provide strategic legal support and guidance on complex healthcare fraud & abuse laws, medical device compliance (FDA) requirements, and ... experience 11. Experience in medical device, life sciences, or healthcare industry 12. In-depth knowledge of fraud ...or healthcare industry 12. In-depth knowledge of fraud & abuse laws, regulations, and enforcement 13. Demonstrate… more
- CVS Health (Richmond, VA)
- …communication skills + Advanced experience in Excel **Preferred Qualifications** + Experience in healthcare fraud , waste and abuse + Knowledge of Medicaid ... skills in SQL and Python who can transform complex healthcare data into actionable insights to support fraud... healthcare data into actionable insights to support fraud , waste, and abuse (FWA) detection and Medicaid regulatory… more
- Zelis (St. Petersburg, FL)
- …prevention, investigations, or risk management - preferably in payments, fintech, or healthcare . + Proven expertise in fraud detection tools, behavioral ... So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more… more
- BlueCross BlueShield of North Carolina (NC)
- …Stay informed about changes in laws, regulations, and industry practices related to healthcare fraud . + Assist in preparing documentation for audits, compliance ... partners. **What You Bring:** + Minimum 7+ years of experience in healthcare fraud detection, investigation, or auditing + Bachelor's degree preferred in … more
- CVS Health (Columbus, OH)
- …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 ... national in scope, complex cases, or cases involving multiple perpetrators or intricate healthcare fraud schemes. + Investigates to prevent payment of fraudulent… more
- Magellan Health Services (Boise, ID)
- …Certifications - Required License and Certifications - Preferred AHFI - Accredited Healthcare Fraud Investigator - EnterpriseEnterprise, CFE - Certified Fraud ... and prioritize leads from internal and external sources + Use knowledge of healthcare coding conventions, fraud schemes, and general areas of vulnerability,… more
- Highmark Health (Pittsburgh, PA)
- …+ Certified Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of ... :** **JOB SUMMARY** The job is responsible for developing and maintaining an anti- fraud program which includes development and delivery of training and filing of … more
- Highmark Health (Harrisburg, PA)
- …3 years of relevant, progressive experience in the health insurance industry and/or healthcare fraud investigations **Preferred** + 1 year in Financial Analysis ... Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of provider… more
- New York State Civil Service (Hauppauge, NY)
- …the unit's forensic accountants/auditors, detectives, and analysts to identify and prosecute financial fraud in the healthcare industry and abuse and neglect of ... Attorney General, Office of the Title Attorney: Prosecute Medicaid Fraud /Nursing Home Abuse (3844) Occupational Category Legal Salary Grade...residents in healthcare facilities, present evidence to grand juries, and conduct… more
- AmeriHealth Caritas (Columbus, OH)
- …An associate's degree, with a minimum of four years of experience working in healthcare fraud , waste, and abuse investigations and audits. + Experience and ... + Bachelor's degree with a minimum of two years of experience in the healthcare field working in fraud , waste, and abuse investigations and audits OR +… more
- Centene Corporation (Columbus, OH)
- …within the state of Ohio **Position Purpose:** Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and ... executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse. + Conduct investigations of potential waste,… more
