- MyFlorida (Tallahassee, FL)
- …broad scope of data analytics to proactively identify qualified leads for potential fraud , waste, and abuse (FWA) investigations . The incumbent will be ... DSGI. Knowledge, Skills, and Abilities: * Experience in auditing, data analysis, or fraud detection. * Knowledge of claims processing and medical terminology. *… more
- Elevance Health (Tampa, FL)
- …in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to identify ... **Clinical Fraud Investigator II - Registered Nurse and CPC...prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new… more
- MyFlorida (Orlando, FL)
- …law enforcement experience, or five (5) years of work experience conducting healthcare fraud investigations . Note: All newly hired employees must obtain CJSTC ... Statutes. These matters include but are not limited to: fraud against the Medicaid Program, false claims ...work which may include performing all aspects of Medicaid fraud investigations . This work includes but is… more
- Staples (Orlando, FL)
- …and programs in Supply Chain locations related to inventory loss, theft, and fraud . + Ensure appropriate internal risk controls are in place through the application ... of programs including data analysis, audits, training, and investigations . + Manage the Asset Protection Associate teams responsible for front line security in FCs… more
- CDM Smith (Orlando, FL)
- …CDM Smith is seeking a Forensic Accounting Specialist with expertise in disaster fraud claims . This role is critical in evaluating and analyzing financial ... data related to disaster-related claims , including property damage, business interruption, and other loss...other loss categories. The specialist will conduct thorough forensic investigations to identify discrepancies, detect potential fraud ,… more
- Elevance Health (Tampa, FL)
- …for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. **How you will make an impact:** + Examines claims ... relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control. + Reviews and...prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses… more
- Elevance Health (Tampa, FL)
- …for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. **How you will make an impact:** + Examines claims ... relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control. + Reviews and...prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses… more
- Elevance Health (Tampa, FL)
- …identification, investigation and development of complex cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on ... fraudulent claims . **How you will make an impact:** + Claim...Responsible for independently identifying and developing enterprise-wide specific healthcare investigations and initiatives that may impact more than one… more
- Elevance Health (Tampa, FL)
- …identification, investigation and development of complex cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on ... fraudulent claims . Health insurance experience required with understanding of health...Responsible for independently identifying and developing enterprise-wide specific healthcare investigations and initiatives that may impact more than one… more