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Claims Investigator Fraud Jobs

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Job Description Job #: 662207 onsite/offsite- location flexible. We do have one spot in Jacksonville, in the greater Jacksonville FL Area Position Overview The analyst will be responsible to ensure timely response to appeals requests. Appeals responses must be completed within 5 days of receipt. The analyst will need to provide all supporting documentation to support the ZPIC claim denial. App...
Responsibilities: Participate in the detection, investigation and ongoing monitoring of member and/or provider Fraud, Waste and Abuse through random audits, data analysis, medical record review and onsite and desk audits Provide recommended action based on investigative summary Proactively apply knowledge of current FWA Schemes, coding guidelines and medical policies to identify areas of risk f...
German Claims- Investigation Specialist II (Level 4)All times are in Pacific Daylight Time.Job ID 415707Location US-WA-SeattlePosted Date 6/7/2016Company Amazon Corporate LLCPosition Category Investigation & Loss PreventionRecruiting Team ..Job DescriptionJob Description Amazon.com is seeking dedicated, hardworking, analytical candidates with a proven track record of performance and results-orient...
Chinese Claims - Investigation Specialist IIAll times are in Pacific Daylight Time.Job ID 413633Location US-WA-SeattlePosted Date 6/1/2016Company Amazon Corporate LLCPosition Category Investigation & Loss PreventionRecruiting Team ..Job DescriptionAmazon.com is seeking dedicated, hardworking, analytical candidates with a proven track record of performance and results-oriented thinking, to join the...
Japanese Claims - Investigation Specialist IIAll times are in Pacific Daylight Time.Job ID 413632Location US-WA-SeattlePosted Date 6/1/2016Company Amazon Corporate LLCPosition Category Investigation & Loss PreventionRecruiting Team ..Job DescriptionAmazon.com is seeking dedicated, hardworking, analytical candidates with a proven track record of performance and results-oriented thinking, to join th...
Chinese Claims Investigation Specialist IAll times are in Pacific Daylight Time.Job ID 412736Location US-WA-SeattlePosted Date 5/27/2016Company Amazon Corporate LLCPosition Category Investigation & Loss PreventionRecruiting Team ..Job DescriptionAmazon.com is seeking dedicated, hardworking, analytical candidates with a proven track record of performance and results-oriented thinking, to join the A...
Company Confidential
1.1 Position Description Lead Claims Review Analyst or LCRA (One full time position) - The position has the following responsibilities and must meet the following qualifications: Responsibilities: Responsible for conducting clinical reviews of medical records during the course of fraud investigations or other program integrity initiatives such as requests for information or in support of proact...
Brevard County-Melbourne
Description: Job Description The SIU Senior Investigator is responsible for preventing, detecting, investigating and correcting incidents of health care fraud, waste and abuse (FWA). This includes, but is not limited to, investigations of medical professionals, non-medical professionals, beneficiaries, brokers/sales agents, employees, or business partners and contracted entities. The SIU Senior ...
Litigation Solutions, LLC (A Division of MCMC) is a Full-Service Investigative Company. Our success can be attributed to our diverse and talented work force. Our employees are the foundation of our business and are helping Litigation Solutions grow each year. The company has been in business since 1999! Seeking Internet (Investigative) Researchers in Western Pennsylvania. Internet Investigators c...
Litigation Solutions, LLC (A Division of MCMC) is a Full-Service Investigative Company. Our success can be attributed to our diverse and talented work force. Our employees are the foundation of our business and are helping Litigation Solutions grow each year. The company has been in business since 1999! Seeking Internet (Investigative) Researchers in Western Pennsylvania. Internet Investigators c...
Litigation Solutions, LLC (A Division of MCMC) is a Full-Service Investigative Company. Our success can be attributed to our diverse and talented work force. Our employees are the foundation of our business and are helping Litigation Solutions grow each year. The company has been in business since 1999! Seeking Internet (Investigative) Researchers in Western Pennsylvania. Internet Investigators c...
Location: Bakersfield, CA The primary focus of this position is to support the Company’s anti-fraud initiatives and perform administration and investigations of suspected insurance fraud. The Special Investigations Claim Representative is responsible for reviewing reports of suspected fraud from field adjusting staff as well as the update and maintenance of accurate records related to fraud inves...
Sr. Fraud Investigator (Check Fraud) - Atlanta, GA-W427844 Description Responsible for complex duties and decisions relating to fraudulent applications, transactions, and customer fraud claims. Develops solutions to problems in situations that are atypical and/or moderately complex based on experience and existing precedents or procedures. Requires decision-making and resolution of issues not cl...
Description Responsible for complex duties and decisionsrelating to fraudulent applications, transactions, and customer fraud claims.Develops solutions to problems in situations that are atypical and/ormoderately complex based on experience and existing precedents or procedures.Requires decision-making and resolution of issues not clearly defined bypolicies and procedures. May train less experien...
Position Description: Job Summary: The SIU (Special Investigative Unit) Investigator I will assist the SIU Supervisor and SIU team in the execution and maintenance of the Navitus fraud, waste and abuse program, including controls, policies & procedures, communications and training. The Investigator I will work in a semi-professional role with an intermediate level of independence, to ensure case...
HFHP Special Investigations Unit Senior Investigator Fraud Waste and Abuse Health First, Inc. FT PC#00000001 - 026203 Job Description The SIU Senior Investigator is responsible for preventing, detecting, investigating and correcting incidents of health care fraud, waste and abuse (FWA). This includes, but is not limited to, investigations of medical professionals, non-medical professionals, bene...
Job Description The SIU Senior Investigator is responsible for preventing, detecting, investigating and correcting incidents of health care fraud, waste and abuse (FWA). This includes, but is not limited to, investigations of medical professionals, non-medical professionals, beneficiaries, brokers/sales agents, employees, or business partners and contracted entities. The SIU Senior Investigator i...
We are currently seeking to fill a Registered Nurse (RN) position in Rancho Cordova, CA. This is an excellent opportunity for someone to get out of bedside nursing and utilize their license in more of a corporate environment. Training is provided so the only skills required is a Registered Nurse license in good standing with the state of CA and a stable work history. The hours are 8am – 5pm Monday...
We are currently seeking to fill a Registered Nurse (RN) position in Rancho Cordova, CA. This is an excellent opportunity for someone to get out of bedside nursing and utilize their license in more of a corporate environment. Training is provided so the only skills required is a Registered Nurse license in good standing with the state of CA and a stable work history. The hours are 8am ? 5pm Monday...
Healthcare fraud is a serious problem affecting every patient and consumer. The devastating situation is rooted not only in the excessive financial losses incurred, which extend into the billions of dollars every year, but also in patient harm. According to the National Health Care Antifraud Association (NHCAA), health care fraud, waste and abuse strips nearly $70 billion from the industry each ye...