- General Dynamics Information Technology (Fairfax, VA)
- …**Public Trust/Other Required:** None **Job Family:** Ancillary Health **Skills:** Healthcare Fraud (Inactive),Insurance Fraud Investigations,Insurance ... for Medicare and Medicaid (CMS), you will be trusted to research healthcare fraud trends and draft supporting documenting for cross payer analytics for the… more
- CVS Health (Richmond, VA)
- …communication skills + Advanced experience in Excel **Preferred Qualifications** + Experience in healthcare fraud , waste and abuse + Knowledge of Medicaid ... skills in SQL and Python who can transform complex healthcare data into actionable insights to support fraud... healthcare data into actionable insights to support fraud , waste, and abuse (FWA) detection and Medicaid regulatory… more
- CVS Health (Richmond, VA)
- …you will conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high ... involving multi-lines of business, or cases involving multiple perpetrators or intricate healthcare fraud schemes. + Investigates to prevent payment of… more
- CVS Health (Richmond, VA)
- …in the United States. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna ... 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 (Richmond, VA)
- …3-5 years. + Strong analytical and investigative skills, with experience in healthcare fraud detection. + Proficiency in interpreting claims data, medical ... Aetna International plays a pivotal role in safeguarding the organization against fraud , waste, abuse (FWA), and compliance violations. This position is embedded… more
- Serco (Herndon, VA)
- …in Herndon, VA is seeking a highly skilled (10-12 years of experience) **Document Fraud Detection Subject Matter Expert** to join our team. This role is ideal for ... professional who combines deep expertise in identifying and understanding document fraud with knowledge of industry trends and the latest detection tools… more
- ICF (Reston, VA)
- …the larger organization. Projects have included augmenting technical assistance teams for healthcare , data extraction and fraud detection for energy utilities, ... and natural language exploration of large datasets. Our clients include both internal teams and external clients. We're looking for a curious and driven developer intern to join our product engineering team and help us apply AI to custom applications for teams… more
- General Dynamics Information Technology (Fairfax, VA)
- …information at various provider associations meetings + Provide testimony for Medicaid fraud legal proceedings + Travel quarterly/yearly to the Albany, NY area for ... independently or as a part of a group + Preferred Qualifications: + Healthcare billing and claims experience + Teaching/training experience + Experience with Zoom,… more
- Highmark Health (Richmond, VA)
- …Analytics will work closely with Senior Data Scientists to support Highmark's Fraud , Waste, and Abuse identification efforts. Daily responsibilities will involve the ... in-depth analysis of complex healthcare claims data utilizing advanced analytical techniques to detect...the business. - Collaborate with senior team members on Fraud , Waste, and Abuse identification initiatives to develop and… more
- Otsuka America Pharmaceutical Inc. (Richmond, VA)
- …factors influencing US market access, including reimbursement trends, payer concerns and healthcare policy + Strong understanding of the US payer environment, payer ... market dynamics, payer marketing principles and how healthcare players make decisions across private & public channels + Proven track record of developing and… more