- Molina Healthcare (Dayton, OH)
- …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
- CVS Health (Columbus, OH)
- …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 (Columbus, OH)
- …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
- Elevance Health (Independence, OH)
- …for the identification, investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client funds ... pharmacy claims. + Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company health plan,… more
- Prime Therapeutics (Columbus, OH)
- …+ 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
- Elevance Health (Mason, OH)
- **Clinical Fraud Investigator Senior** **Location:** _Hybrid1:_ This role requires associates be in the office 1-2 days per week, fostering collaboration and ... unless an accommodation is granted as required by law. The **Clinical Fraud Investigator Senior** is responsible for identifying issues and/or entities that may… more
- Humana (Columbus, OH)
- …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
- US Bank (Columbus, OH)
- …include the following (some may vary based on role, location or hours): + Healthcare (medical, dental, vision) + Basic term and optional term life insurance + ... Short-term and long-term disability + Pregnancy disability and parental leave + 401(k) and employer-funded retirement plan + Paid vacation (from two to five weeks depending on salary grade and tenure) + Up to 11 paid holiday opportunities + Adoption assistance… more
- Molina Healthcare (Columbus, OH)
- …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
- Grant Thornton (Cleveland, OH)
- …for business and IT process optimization, profit improvement, cost reduction, fraud prevention, internal control, and compliance. + Perform engagement management ... 4 years of direct experience with diverse life sciences companies or healthcare providers, including hospitals, academic medical centers, healthcare systems, and… more