• Clinical Fraud Investigator II - Registered…

    Elevance Health (Mason, OH)
    **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 days ... eliminate and prevent unnecessary medical-expense spending. The **Clinical Fraud Investigator II** is responsible for identifying issues and/or entities that… more
    Elevance Health (11/04/25)
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  • Senior Fraud and Waste Investigator…

    Humana (Dayton, OH)
    …community and help us put health first** This Senior Fraud and Waste Investigator will serve as Humana's Program Integrity Officer, who will oversee the monitoring ... outcomes; work closely with internal and external auditors, financial investigators, and claims processing areas + Adequately staff and manage the program integrity … more
    Humana (11/20/25)
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  • Special Investigator

    AmeriHealth Caritas (Columbus, OH)
    …services. Discover more about us at www.amerihealthcaritas.com. The Investigator is responsible for conducting comprehensive investigations of reported, ... Proactively performs research using the Internet, data analysis tools, etc., to analyze aberrant; claims billing and practice patterns. + Analyzes data as part of the… more
    AmeriHealth Caritas (10/22/25)
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  • Senior Investigator , Special…

    CVS Health (Columbus, OH)
    …passionate about transforming health care. As the nation's leading health solutions company , we reach millions of Americans through our local presence, digital ... States. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU), dedicated to a… more
    CVS Health (11/19/25)
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  • Senior Investigator (Aetna SIU)

    CVS Health (Columbus, OH)
    …passionate about transforming health care. As the nation's leading health solutions company , we reach millions of Americans through our local presence, digital ... every day. **Position Summary** **WEST VIRGINIA RESIDENCY** **REQUIRED** As a Senior Investigator you will conduct high level, complex investigations of known or… more
    CVS Health (11/14/25)
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  • Lead Investigator , Special Investigative…

    Molina Healthcare (Cincinnati, OH)
    …abuse, and over utilization by providers and recipients. The position will review claims data, medical records, and billing data from all types of healthcare ... Create, edit, and update assigned reports to apprise the company on the team's progress. + Distribute reports to...Medicare programs as well as Marketplace + Understanding of claim billing codes, medical terminology, anatomy, and health care… more
    Molina Healthcare (11/21/25)
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  • Fraud and Waste Investigator

    Humana (Columbus, OH)
    …Certifications, CPC, CCS, CFE, AHFI). + Understanding of healthcare industry, claims processing and investigative process development. + Experience in a corporate ... for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its… more
    Humana (11/21/25)
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  • Manager, Evidence Generation, IME & Sponsorship…

    Otsuka America Pharmaceutical Inc. (Columbus, OH)
    …generation of medical evidence, (eg, observational studies, registries, and investigator -initiated studies (IISs) / investigator -initiated trials (IITs)) + Manage ... generation and communication/publications teams with a pharmaceutical or biotech company , CRO, academic research, or HEOR group + Prior...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
    Otsuka America Pharmaceutical Inc. (11/14/25)
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  • Senior Director, Translational Medicine (MD)

    Otsuka America Pharmaceutical Inc. (Columbus, OH)
    …clinical development plans. + Review and approval of clinical study protocols, investigator brochures, study reports, etc. + Support budget and timeline activities ... knowledge (in the areas specified above) to further the company 's products, anticipate and identify core problems, apply insightful...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
    Otsuka America Pharmaceutical Inc. (11/19/25)
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  • Director, Congress & Medical Education Strategy…

    Otsuka America Pharmaceutical Inc. (Columbus, OH)
    …Advocacy Groups) before during and after congresses + Organize and facilitate investigator meetings and advisory boards in conjunction with congress + Coordinate ... be posted for a minimum of 5 business days. ** Company benefits:** Comprehensive medical, dental, vision, prescription drug coverage,...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
    Otsuka America Pharmaceutical Inc. (11/14/25)
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