- Sedgwick (Columbus, OH)
- …Marine Investigator **PRIMARY PURPOSE** **:** To perform detailed admiralty claims investigation and analysis through examination of the loss, collection of ... or other stakeholders. + Runs and interprets formal background checks related to claims through online resources, evaluating the results as it relates to policy… more
- 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
- 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
- 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
- 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 (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
- 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
- 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
- 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. (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