Healthcare Fraud Investigator Contact Government Services LLCHealthcare Fraud InvestigatorOxford, MSThe candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently, accurately, and under pressure, and be enthusiastic about learning and applying knowledge to provide excellent litigation support to the client. Initiates contacts with federal, state, and local officials, and other organizations and individuals related to the subject of investigation, for the purpose of gathering facts, obtaining statements, learning sequences of events, obtaining explanations and otherwise advancing investigative objectives.
Healthcare Fraud Investigator CONTACT GOVERNMENT SERVICESHealthcare Fraud InvestigatorChicago, IL$85,000–$105,000 / yearCommunication skills: Ability to interact professionally and effectively with all levels of staff including AUSAs, support staff, client agencies, debtors, debtor attorneys and their staff, court personnel, business executives, witnesses, and the public. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently, accurately, and under pressure, and be enthusiastic about learning and applying knowledge to provide excellent litigation support to the client.
SIU Clinical Healthcare Fraud Investigator III Mitchell MartinSIU Clinical Healthcare Fraud Investigator IIILos Angeles, CARemote$45–$55.53 / hourBy applying for this job, you agree to receive AI-generated calls, text messages, and/or emails from Mitchell Martin Inc and its affiliates and contracted partners at various frequency through traditional and automated methods. Lead complex investigations into suspected healthcare fraud, waste, and abuse.
SIU Clinical Healthcare Fraud Investigator III (ATL) The Intersect GroupSIU Clinical Healthcare Fraud Investigator III (ATL)Los Angeles, CARemote$45–$55 / hourThe SIU Clinical Healthcare Fraud Investigator III leads complex, high impact investigations into fraud, waste, and abuse across multiple healthcare service lines. The Intersect Group partners with mission focused healthcare organizations dedicated to improving access, quality, and equity of care for large and diverse member populations.
Healthcare Fraud Investigator at Integrity Advantage (Remote) HireAlignedHealthcare Fraud Investigator at Integrity Advantage (Remote)Remote, OREGONRemoteUtilize clients fraud detection solution to identify post-payment or pre-payment opportunities for investigation as well as other applications to perform data mining or track investigative results. Integrity Advantage is a small woman owned business serving health payers and other entities challenged with the detection, investigation and prevention of healthcare fraud, waste and abuse (FWA).
Healthcare Fraud Investigator Council CapitalHealthcare Fraud InvestigatorNashville, TennesseeWhat sets us apart is the Council Model —a proven framework that surrounds founders and leadership teams with a powerful combination of support: our CEO Council of seasoned operators, our Strategic Healthcare Investors who bring real-world insight and access, and our internal Value Creation Team , focused on enabling growth through talent, systems, and strategy. Our payment integrity platform pairs analytics with expert review to surface fraud, waste, and abuse across Medicare, Medicaid, Commercial, and FEP lines of business, returning significant value to the clients we serve.
Program Integrity Investigator (Healthcare Fraud Waste & Abuse) TriWest Healthcare AllianceProgram Integrity Investigator (Healthcare Fraud Waste & Abuse)Omaha, NERemoteFull timeComplies with the Veterans Affairs Community Care Network (CCN) and TRICARE T-5 contracts; DHA and TRICARE program guidelines and pertinent Federal regulatory requirements; assists supervisors with FWA trending and reporting requirements; coordinates and assists with investigations and prosecutions by federal agencies interfaces directly with Veterans, Military members and family (as warranted), providers, subcontractors, and other TriWest departments on FWA issues; assist supervisor with the education and training of TriWest, subcontractor, and provider personnel on current FWA matters; prepares appropriate responses to provider compliance issues and complaints referred to Program Integrity by other TriWest departments or external referrals. The PI Investigator t is responsible for the identification, analysis, case development, and reporting of suspected fraud, waste and abuse (FWA) cases as defined by the Department of Veterans Affairs (VA), the Healthcare Finance Administration (HCFA) and the Department of Defense, Defense Health Agency for the TRICARE program; requests and reviews issue-related medical claims and records for FWA and/or administrative and clerical error(s).
NewFraud Investigator - Federal Healthcare Deloitte Touche Tohmatsu LtdFraud Investigator - Federal HealthcareVA$76,600–$127,600 / yearAs a Project - Consultant, Forensics and Investigations on the project, you will address the threats that perpetuate fraud, waste, and abuse, our clients look to our team to provide the guidance and solutions required to help them stay ahead of emerging issues and protect the integrity of their programs. This compensation range is specific to Arlington, Virginia and takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs.
Sr Fraud, Waste and Abuse Investigator (Investigator Sr) CalOptimaSr Fraud, Waste and Abuse Investigator (Investigator Sr)Orange, CA$72,096–$115,353 / yearWe are hoping you will join us as a Sr Fraud, Waste and Abuse Investigator (Investigator Sr) and help shape the future of healthcare where you'll be an integral part of our OOC - Fraud & Waste team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.
Fraud and Waste Investigator HumanaFraud and Waste InvestigatorOhioRemoteWork at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.
Clinical Fraud Investigator II Elevance Health IncClinical Fraud Investigator IIAtlanta, GAMinimum Requirements: Requires an Associate Degree in Nursing and/or current certification as a Certified Professional Coder (AAPC or AHIMA) and minimum of 4 years related experience, including minimum of 1 year experience in a Clinical Fraud and Abuse Investigation area; or any combination of education and experience, which would provide an equivalent background. Locations: This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance.
Senior Fraud and Abuse Investigator/CPC/CFI/CFS/CHC/CFE/AHFI Sentara HospitalsSenior Fraud and Abuse Investigator/CPC/CFI/CFS/CHC/CFE/AHFIVirginiaRemoteExperience utilizing data analytics to identify high-risk providers and claims for pre-payment review within a healthcare payer, SIU, Program Integrity, or Payment Integrity environment is strongly preferred . Experience conducting pre-pay investigations, provider risk assessments, data mining, fraud, waste and abuse (FWA) analysis, and proactive identification of billing anomalies and emerging provider trends.
Fraud Investigator - Medicare Peraton IncFraud Investigator - MedicareRemote$66,000–$106,000 / yearInvestigators are expected to research and understand the relevant offenses being investigated; conduct efficient and effective investigations concerning those alleged offenses and detect or verify suspected violations; obtain information and evidence by observation, record examination, and interview. What you''ll do: The position is expected to perform high level complex investigations of medical professional service providers and develop cases for future action, including referral to law enforcement, education, over payment recovery and other administrative actions.
NewFraud Investigator Peraton IncFraud Investigator$66,000–$106,000 / yearInvestigators are expected to research and understand the relevant offenses being investigated; conduct efficient and effective investigations concerning those alleged offenses and detect or verify suspected violations; obtain information and evidence by observation, record examination, and interview. Telework-Ideally the candidate will be located in Maine, New Hampshire, Vermont, New York, Rhode Island, Connecticut, Massachusetts, Pennsylvania, Delaware, District of Columbia, New Jersey, Maryland, Northern Virginia.
Fraud Investigator City of FlintFraud InvestigatorFlint, MI$35.60–$39.47 / hourUnder general direction, performs advanced professional investigative work involving allegations of employee misconduct, fraud, abuse, theft, ethics violations, misuse of City assets, procurement irregularities, payroll fraud, workers compensation fraud, residency violations, conflicts of interest, and other violations of City policies, collective bargaining agreements, and applicable federal, state, and local laws. Do you have three (3) to five (5) years of progressively responsible professional experience conducting fraud investigations, administrative investigations, internal investigations, compliance investigations, internal auditing, human resources investigations, law enforcement investigations, or other closely related investigative work?
Fraud Investigator II University of Massachusetts Medical SchoolFraud Investigator IIWestborough, Massachusetts5-7 years of related experience in fraud examination, healthcare, business, finance or related field; with at least 2 years of experience conducting data mining in the healthcare insurance industry and claims related experience. The Investigator II collaborates with the Associate Director on more complex case reviews as needed, in addition to performing activities related to data mining, data analysis and recoveries.
NewFraud Investigator PeratonFraud Investigator$66,000–$106,000 / yearFull timeInvestigators are expected to research and understand the relevant offenses being investigated; conduct efficient and effective investigations concerning those alleged offenses and detect or verify suspected violations; obtain information and evidence by observation, record examination, and interview. Telework-Ideally the candidate will be located in Maine, New Hampshire, Vermont, New York, Rhode Island, Connecticut, Massachusetts, Pennsylvania, Delaware, District of Columbia, New Jersey, Maryland, Northern Virginia.
Senior Civil Health Care Fraud Investigator CONTACT GOVERNMENT SERVICESSenior Civil Health Care Fraud InvestigatorHarrisburg, PA$100,000–$200,000 / yearFor the past nine years we've been growing our government-contracting portfolio, and along the way we've created valuable partnerships by demonstrating a commitment to honesty, professionalism, and quality work. Here at CGS we value honesty through hard work and self-awareness, professionalism in all we do, and to deliver the best quality to our consumers mending those relations for years to come.
Senior Civil Health Care Fraud Investigator Contact Government Services LLCSenior Civil Health Care Fraud InvestigatorHarrisburg, PA$100,000–$200,000 / yearFor the past nine years we've been growing our government-contracting portfolio, and along the way we've created valuable partnerships by demonstrating a commitment to honesty, professionalism, and quality work. Here at CGS we value honesty through hard work and self-awareness, professionalism in all we do, and to deliver the best quality to our consumers mending those relations for years to come.
Fraud Investigator Eagle Bancorp IncFraud InvestigatorSilver Spring, MD$69,844–$108,847 / yearRequires direct and productive interaction with the Fraud Investigations Manager, BSA/AML, clients, and other fraud personnel within financial services organizations entities, and federal/local/state law enforcement agencies. The Fraud Investigator develops and conducts fraud investigations, monitors and dispositions fraud alerts, and mitigates financial losses through asset recovery for EagleBank Corp.