- Magellan Health Services (Boise, ID)
- …and Certifications - Required License and Certifications - Preferred AHFI - Accredited Healthcare Fraud Investigator - EnterpriseEnterprise, CFE - Certified ... from internal and external sources + Use knowledge of healthcare coding conventions, fraud schemes, and general...Power Point. General Job Information Title SIU Program Integrity Investigator - Remote (In Idaho) Grade 24 Work Experience… more
- Highmark Health (Pittsburgh, PA)
- …+ Certified Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge ... :** **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)
- …+ Certified Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge ... 3 years of relevant, progressive experience in the health insurance industry and/or healthcare fraud investigations **Preferred** + 1 year in Financial Analysis… more
- BlueCross BlueShield of North Carolina (NC)
- …**:** + Relevant certifications (eg, Certified Fraud Examiner (CFE), accredited healthcare fraud investigator (AHFI) **What You'll Get** : + ... Stay informed about changes in laws, regulations, and industry practices related to healthcare fraud . + Assist in preparing documentation for audits, compliance… more
- Humana (Oklahoma City, OK)
- …**Required Qualifications** + **Must be an Oklahoma resident** + 2+ years of healthcare fraud investigations and auditing experience + Knowledge of healthcare ... 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 team… more
- City National Bank (Los Angeles, CA)
- * FRAUD INVESTIGATOR SPECIALIST* WHAT IS THE OPPORTUNITY? Responsible for performing and documenting through root cause analysis on clients' transactions ... activities that impact CNB's clients, and corporate losses. Additionally, the Fraud Investigator will quarterback internal events and investigation activities… more
- Humana (Hartford, CT)
- …and help us put health first** Humana is looking for an experienced Healthcare Investigator to join its industry leading Special Investigations Unit. Do ... EST/CST time zones **Required Qualifications** * Bachelor's degree * 2 years of healthcare fraud investigations and auditing experience * Knowledge of … more
- Elevance Health (Seattle, WA)
- **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role enables associates to work virtually ... to recover, eliminate and prevent unnecessary medical-expense spending. The **Clinical Fraud Investigator II** is responsible for identifying issues and/or… more
- MyFlorida (Pensacola, FL)
- …or education requirements of s. 943.135. Preference will be given to candidates with healthcare fraud investigative experience working in a Medicaid Fraud ... LAW ENFORCEMENT INVESTIGATOR II - 41001250 1 Date: Dec 10,...experience, or five (5) years of work experience conducting healthcare fraud investigations. Note: All newly hired… more
- State of Colorado (CO)
- CDOC - Criminal Investigator IV (Statewide) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5188689) Apply CDOC - Criminal Investigator IV ... + Independently investigate crimes in a prison facility; + As lead investigator / team leader, direct field investigations on a continuing basis, inclusive of… 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
- Louisiana Department of State Civil Service (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 1-4 Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/5143725) Apply ...in cybercrimes, white collar crimes, and public corruption. Medicaid Fraud Control Unit: The Louisiana Medicaid Fraud … more
- UPMC (Pittsburgh, PA)
- …review, witness interviews, and data analysis to identify, evaluate and measure potential healthcare fraud , waste and abuse to determine valid cases for ... Under the direction of the manager, the Special Investigations Unit (SIU) Investigator is responsible for investigating assigned dental fraud , waste and… more
- AmeriHealth Caritas (Columbia, SC)
- …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
- Point32Health (Canton, MA)
- …health and well-being organization dedicated to delivering high-quality, affordable healthcare . Serving nearly 2 million members, Point32Health builds on the ... behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it's at the core of… 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
- Centene Corporation (Frankfort, KY)
- …for the Bachelors Degree . 5+ years of management experience Investigations and healthcare fraud -related investigations with audit and risk analysis. 1+ year of ... license in one of the following is required: Other Accredited Health Care Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE). Other Pharmacy … more
- MVP Health Care (Schenectady, NY)
- …investigation experience involving economic or insurance relatedmatters. + A clinical investigator must have in addition to the above requirements: A duly ... York State Nursing license required (RN preferred). Experience in health insurance fraud investigations preferred. + Obtain CPC and/or COC credential. + Maintain… more
- General Dynamics Information Technology (Fairfax, VA)
- …**Experience:** 3 + years of related experience **Job Description:** **Marketplace Investigator ** **The Affordable Care Act (ACA) requires every state to establish ... administrative actions to CMS; and recommend referrals to law enforcement if potential fraud and abuse is identified.** **HOW YOU WILL MAKE AN IMPACT:** **Conducts… more
- Centene Corporation (Columbus, OH)
- …CA, HI, IL, NE, and OH.** **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
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