- Molina Healthcare (Miami, FL)
- …reporting, and when appropriate, recovery of money related to health care fraud , waste, and abuse. Duties include performing accurate and reliable medical review ... Counsel, and Medical Officers in order to achieve and maintain appropriate anti- fraud oversight. **Job Duties** + Responsible for developing leads presented to the… more
- Zelis (St. Petersburg, FL)
- …prevention, investigations, or risk management - preferably in payments, fintech, or healthcare . + Proven expertise in fraud detection tools, behavioral ... So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more… more
- CVS Health (Tallahassee, FL)
- …and local law enforcement agencies to ensure compliance and support the prosecution of healthcare fraud and abuse matters. + Demonstrate a high level of ... proceedings. + Deliver presentations to internal and external stakeholders regarding healthcare fraud matters and the organization's approach to combating… more
- CVS Health (Tallahassee, FL)
- …investigators and analysts to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to ... a team in the planning and execution of investigations of acts of healthcare fraud and abuse by both members and providers. Provides direction and counsel on… more
- USAA (Tampa, FL)
- …claim processing, operations, or administrative experience. + 5 or more years healthcare fraud , waste, and abuse investigation and/or audit experience. + ... support and recommendations on claim settlements and assists with fraud detection and deterrence, as well as, investigate ...Advanced knowledge of healthcare benefit structures within the health insurance industry, Medicare… more
- MyFlorida (Miami, FL)
- …in Miami or West Palm Beach, Florida, and involves auditing complex multi-million-dollar healthcare fraud investigations that can result in criminal and/or civil ... as lead investigator on cases involving suspected Cost Report Fraud and Prospective Payment System Medicaid provider fraud... Fraud and Prospective Payment System Medicaid provider fraud involving: 1) Nursing Homes, 2) Hospitals, and 3)… more
- Humana (Tallahassee, FL)
- …* A minimum of 2 years' experience conducting comprehensive health care fraud investigations (Medical Coding or Healthcare (Medical Chart Review/Insurance ... part of our caring community and help us put health first** The Fraud and Waste Professional 2 is responsible for conducting comprehensive investigations of… more
- Prime Therapeutics (Tallahassee, FL)
- …+ Analyze data to find suspicious patterns and outliers using knowledge of healthcare coding conventions, fraud schemes, and general areas of vulnerability. + ... for the intake and initial handling of allegations of fraud , waste or abuse. Conducts preliminary investigation to assess...audit or investigation. Serves as a corporate resource on fraud , waste and abuse issues and maintains confidentiality and… more
- CACI International (Orlando, FL)
- …of Justice Criminal Fraud Section attorneys in the litigation of healthcare fraud cases. **Responsibilities:** + Assist trial attorneys with case ... families. At CACI, you will receive comprehensive benefits such as; healthcare , wellness, financial, retirement, family support, continuing education, and time off… more
- Humana (Tallahassee, FL)
- …investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste works within specific guidelines and procedures; applies advanced ... yrs health insurance claims or Medicare experience + Minimum 3 years of experience with Fraud , Waste, and Abuse in a Managed Care setting + Minimum 3 years of proven… more