- Elevance Health (Tampa, FL)
- **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 days ... to recover, eliminate and prevent unnecessary medical-expense spending. The **Clinical Fraud Investigator II** is responsible for identifying issues and/or entities… more
- AssistRx (Orlando, FL)
- …Knowledge of regulatory requirements affecting pharmacy and medical copay programs, including healthcare compliance and fraud prevention. + . Ability to analyze ... company's offerings competitiv + Education: + . Bachelor's degree in business, healthcare management, pharmacy, or a related field (required). + . Master's degree… more
- Elevance Health (FL)
- …+ Marketing experience preferred. + Medicare Part D experience preferred. + Fraud waste and abuse experience preferred. For candidates working in person or ... dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with...Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of… more
- Molina Healthcare (Jacksonville, FL)
- …Enforces, as a representative of management, the Compliance Plan, Code of Conduct and Anti- Fraud Plan. * Establishes, at the direction of the AVP of Compliance or ... an active relationship with third parties who have specific experience in conducting fraud and abuse investigations. * Prepares written reports to inform the AVP of… more
- Zelis (St. Petersburg, FL)
- …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 ... top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across… more
- Molina Healthcare (Tampa, FL)
- …standards and requirements contained in the Molina Medical Compliance and Fraud , Waste and Abuse Program. **KNOWLEDGE/SKILLS/ABILITIES** + Coordinates, conducts, and ... for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- Molina Healthcare (Tampa, FL)
- …operations of the Compliance Program, Compliance Plan, Code of Conduct, and Fraud , Waste and Abuse Plan across the enterprise while ensuring compliance with ... for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- City National Bank (Tallahassee, FL)
- …handling lender self-reporting requirements, and coordinating regulatory audits and fraud reporting. The ideal candidate brings strong analytical skills, attention ... * Manage the intake, documentation, and submission of suspected or confirmed fraud to the appropriate internal departments and external agencies. * Ensure compliance… 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 for ... compliance with relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control. + Reviews and conducts analysis… 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 for ... compliance with relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control. + Reviews and conducts analysis… more