- Humana (Frankfort, KY)
- …investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste works within specific guidelines and procedures; applies advanced ... Medicare experience + Minimum 3 years of experience with Fraud , Waste, and Abuse in either a Managed Care...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Molina Healthcare (Covington, KY)
- …reporting, and when appropriate, recovery of money related to health care fraud , waste, and abuse. Duties include performing accurate and reliable medical review ... Medical Officers in order to achieve and maintain appropriate anti- fraud oversight. **Job Duties** + Responsible for developing leads... investigations. + Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace. +… more
- CVS Health (KY)
- …Python who can transform complex healthcare data into actionable insights to support fraud , waste, and abuse (FWA) detection and Medicaid regulatory & compliance ... maintain complex data analyses to support investigations of potential fraud , waste, and abuse in Medicaid claims...of potential fraud , waste, and abuse in Medicaid claims and provider activity. + Prepare timely and… more