- Elevance Health (Louisville, KY)
- …prior to payment. Researches new healthcare-related questions as necessary to aid in investigations . + Collaborates with the Special Investigation Unit and other ... clinical evaluation of the collected data. + Performs in-depth investigations on identified providers as warranted. + Examines claims...including minimum of 1 year experience in a Clinical Fraud and Abuse Investigation area; or any… more
- Coinbase (Frankfort, KY)
- …connection, and alignment. Attendance is expected and fully supported. Senior AML Investigations Trainer provides end to end learning services, and management for ... job requirements): * Minimum 2 years of formal experience training AML, Fraud or other Compliance-related pillars. * Proven track record of successfully managing… more
- CVS Health (Frankfort, KY)
- …state and federal policies. - Identify potential billing errors, abuse, and fraud . - Identify opportunities for savings related to potential cases which may ... record review within a healthcare insurance company. - Prior special investigation unit experience. - Excellent analytical skills. - Excellent communication skills.… more
- PNC (Louisville, KY)
- …have an opportunity to contribute to the company's success. As a Detection & Investigation Analyst Lead within PNC's FDO Zelle Fraud organization, you will be ... for stopping the criminals. Responsibilities of this position includes: * Outbound Zelle fraud support o Analyzing cases generated from the enterprise fraud … more
- CVS Health (Frankfort, KY)
- …Manager will oversee a team of medical coders within the Special Investigations Unit (SIU) to ensure compliance with coding practices through comprehensive record ... federal policies, and identify potential billing errors, abuse, and fraud . + Identify opportunities for savings related to potential...of 2 years of managing staff within a Special Investigation Unit (SIU). + Excellent analytical skills and the… more
- Molina Healthcare (Lexington, KY)
- …opinions. + Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations . + Knowledge of Managed Care and the Medicaid and ... medical records and data analysis, and makes determinations as to whether the investigation and/or audit identified potential fraud , waste, or abuse. +… more
- Allied Universal (Louisville, KY)
- …(5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud + Ability to be properly licensed as ... Your Career in Insurance Claims with Allied Universal(R) Compliance and Investigation Services. Allied Universal(R) Compliance and Investigation Services is… more
- Highmark Health (Frankfort, KY)
- …years of relevant, progressive experience in the health insurance industry and/or healthcare fraud investigations **Preferred** + 1 year in Financial Analysis in ... project, potential fraud , waste and abuse case, conducting the initial investigations and coordinating the recovery/savings of money related to fraud , waste… more
- Prime Therapeutics (Frankfort, KY)
- …& Experience** + Education Level Bachelors + Experience Level 2+ years + Required Fraud Investigations and Claims experience Must be eligible to work in the ... for work visa or residency sponsorship. **Additional Qualifications** + 3+ years' fraud investigations /claims experience. + Ability to manage workload while… more
- Command Investigations (Louisville, KY)
- …a customer-centric approach, has allowed us to stand out as a leader in the investigation industry. At Command Investigations , we take pride in our proven track ... Command Investigations LLC is a dynamic and forward-thinking investigative...+ Minimum of 1 year experience relating to Work Compensation/ Fraud /Mobile and Stationary surveillance + Be able to hold… more