- Elevance Health (Houston, TX)
- …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
- Highmark Health (Austin, TX)
- …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
- Centene Corporation (Austin, TX)
- …years project implementation, product or program management experience. 5+ years in Healthcare Fraud Investigation highly preferred. Experience in developing ... Program Manager role will support the organizations efforts to detect and prevent fraud and abuse by supporting the partnership with our analytics team by… more
- CVS Health (Austin, TX)
- …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
- CVS Health (Austin, TX)
- …Managers, and Directors as appropriate in matters pertaining to the investigation of suspected healthcare fraud cases. Completion of Fraud waste and abuse ... position will focus on utilization, quality, and review of fraud , waste, and abuse for individual Aetna member cases....resources and technology in developing evidence, supporting allegations of fraud and abuse. + Research and prepare cases for… more
- Prime Therapeutics (Austin, TX)
- …+ 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 (Grand Prairie, TX)
- …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
- Danaher Corporation (Austin, TX)
- …industry + Drafting, reviewing, and negotiating various types of agreements + US healthcare fraud and abuse laws, rules, regulations, regulatory guidance, and ... various legal issues and associated risks, including transactions with healthcare providers, research institutions, and promotional programs. + Provide… more
- US Bank (Irving, TX)
- …and discover what you excel at-all from Day One. **Job Description** The Fraud Identity Evaluation Analyst will support identity fraud mitigation and vendor ... efficacy evaluations. This includes involvement in identification of fraud risks (1st Party, 3rd Party, Account Take Over...may vary based on role, location or hours): + Healthcare (medical, dental, vision) + Basic term and optional… more
- Elevance Health (Houston, TX)
- …+ 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