• Manager, Special Investigation

    CVS Health (Atlanta, GA)
    …of investigators and analysts to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse , to recover lost funds, and ... Leads a team in the planning and execution of investigations of acts of healthcare fraud and abuse by both members and providers. Provides direction and… more
    CVS Health (08/01/25)
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  • Investigator, Special Investigative Unit (Remote)-…

    Molina Healthcare (Columbus, GA)
    …investigation, reporting, and when appropriate, recovery of money related to health care fraud , waste, and abuse . Duties include performing accurate and reliable ... for developing leads presented to the SIU to assess and determine whether potential fraud , waste, or abuse is corroborated by evidence. + Conducts both… more
    Molina Healthcare (08/15/25)
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  • Investigator - Medicaid Fraud

    State of Georgia (Fulton County, GA)
    …limited to, Analysts, Auditors, and Prosecutors in conducting on-site health care fraud and patient abuse investigations. Develops necessary knowledge and skills ... to assignments and requests for assistance in health care fraud and patient abuse investigations in a...Healthcare Administration, Accounting, Business and Finance. * Certified Fraud Examiner * Digital Forensics Experience * Law enforcement… more
    State of Georgia (07/30/25)
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  • Clinical Fraud Investigator II - Registered…

    Elevance Health (Atlanta, GA)
    …responsible for identifying issues and/or entities that may pose potential risks associated with fraud and abuse . **How you will make an impact:** + Performs ... billing and processing guidelines and to identify opportunities for fraud and abuse prevention and control. +...claims and medical records prior to payment. Researches new healthcare -related questions as necessary to aid in investigations. +… more
    Elevance Health (08/16/25)
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  • Investigator

    Highmark Health (Atlanta, GA)
    …3 years of relevant, progressive experience in the health insurance industry and/or healthcare fraud investigations **Preferred** + 1 year in Financial Analysis ... + Certified Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of… more
    Highmark Health (08/15/25)
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  • Director, Compliance ((Must reside…

    Molina Healthcare (Atlanta, GA)
    …SIU an active relationship with third parties who have specific experience in conducting fraud and abuse investigations. * Prepares written reports to inform the ... 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… more
    Molina Healthcare (07/12/25)
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  • SIU Specialist - Pharmacy Tech - Remote in…

    Prime Therapeutics (Atlanta, GA)
    …**Job Description** Responsible for the intake and initial handling of allegations of fraud , waste or abuse . Conducts preliminary investigation to assess the ... audit or investigation. Serves as a corporate resource on fraud , waste and abuse issues and maintains...to find suspicious patterns and outliers using knowledge of healthcare coding conventions, fraud schemes, and general… more
    Prime Therapeutics (06/24/25)
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  • Medicare Compliance Manager (Medicare Advantage…

    Molina Healthcare (Macon, GA)
    …day-to-day operations of the Compliance Program, Compliance Plan, Code of Conduct, and Fraud , Waste and Abuse Plan across the enterprise while ensuring ... for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare more
    Molina Healthcare (07/25/25)
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  • Clinical Psychologist

    CVS Health (Atlanta, GA)
    …to the investigation of suspected healthcare fraud cases. Completion of Fraud waste and abuse reviews in partnership with SIU + Provide SME support ... position will focus on utilization, quality, and review of fraud , waste, and abuse for individual Aetna...quality, and review of fraud , waste, and abuse for individual Aetna member cases. **Expectations/Responsibilities:** + Review… more
    CVS Health (08/08/25)
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  • Clinical Provider Auditor II

    Elevance Health (Columbus, GA)
    …responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse . **How you will make an impact:** + Examines ... relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control. +...next step in the claims lifecycle. + Researches new healthcare related questions as necessary to aid in investigations… more
    Elevance Health (08/13/25)
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