- 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 (Santa Fe, NM)
- …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
- Humana (Lincoln, NE)
- …a part of our caring community and help us put health first** The Fraud and Waste Professional 2 is responsible for conducting comprehensive investigations of ... reported, alleged or suspected fraud involving Florida's Medicaid Program. The Fraud and Waste Professional 2 coordinates investigation with law enforcement… 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
- Point32Health (Canton, MA)
- …groups, and committees. + Responsible for leading complex provider investigations related to fraud , waste and abuse, and developing action plans to address the ... currently seeking highly motivated individuals to join our organization as a Fraud Operations Specialist within our Special Investigations Unit ("SIU"). The Fraud… 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
- Centene Corporation (Frankfort, KY)
- …A license in one of the following is required: Other Accredited Health Care Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE). Other Pharmacy ... subject matter expert for the Contractor's Program Integrity unit to reduce Fraud , Waste and Abuse of Medicaid services within Kentucky. Provides direction and… 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
- Centene Corporation (Columbus, OH)
- …and measure potential healthcare fraud and abuse. + Conduct investigations of potential waste , abuse, and fraud + Document activity on each case and refer ... in claims + Develop new queries and reports to detect potential waste , abuse, and fraud + Provide case updates on progress of investigations and coordinate with… 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
- 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