- MyFlorida (Tallahassee, FL)
- …(EG), R, and Excel. Preferred Qualifications: Industry certifications, eg, Certified Fraud Examiner; Accredited Healthcare Fraud Investigator; Certified ... HEALTH INSURANCE FRAUD ANALYST II - 72004150 Date: Aug 19,...reports, business correspondence and technical documents. * Experience using Healthcare -related software applications including data quality. * Experience in… more
- Elevance Health (Tampa, FL)
- …Coding Certificate or Registered Nurse strongly preferred + Law Enforcement dealing with Healthcare Fraud Please be advised that Elevance Health only accepts ... **Clinical Fraud Investigator II** **Location** : _Hybrid1:_ This role...and medical records prior to payment. + Researches new healthcare related questions as necessary to aid in investigations.… 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
- MyFlorida (Orlando, FL)
- …or education requirements of s. 943.135. Preference will be given to candidates with healthcare fraud investigative experience working in a Medicaid Fraud ... enforcement experience, or five (5) years of work experience conducting healthcare fraud investigations. Note: All newly hired employees must obtain CJSTC Sworn… more
- CVS Health (Tallahassee, FL)
- …conducts investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to ... and local law enforcement agencies in the investigation and prosecution of healthcare fraud and abuse matters. - Demonstrates high level of knowledge and… more
- Highmark Health (Tallahassee, FL)
- …3 years of relevant, progressive experience in the health insurance industry and/or healthcare fraud investigations **Preferred** + 1 year in Financial Analysis ... Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of provider… more
- CVS Health (Tallahassee, FL)
- …and every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Dental/Pharmacy/Broker Investigative Team ... you will manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct high level,… 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
- Elevance Health (Tampa, FL)
- …independent identification, investigation and development of complex cases against perpetrators of healthcare fraud in order to recover corporate and client ... claims. + Responsible for independently identifying and developing enterprise-wide specific healthcare investigations and initiatives that may impact more than one… more