• Medicare Compliance Manager…

    Molina Healthcare (Houston, TX)
    …for compliance by overseeing, follow-up and resolution of investigations . **Knowledge/Skills/Abilities** * Assists with implementation and day-to-day operations ... of the Compliance Program, Compliance Plan, Code of Conduct, and Fraud , Waste and Abuse Plan across the enterprise while ensuring compliance with governmental… more
    Molina Healthcare (07/25/25)
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  • Senior Analyst, Special Investigative Unit

    CVS Health (Austin, TX)
    …manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct high level, complex ... investigations of known or suspected acts of healthcare fraud , waste and abuse. + Conduct Investigations ...federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud . +… more
    CVS Health (09/02/25)
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  • Senior Risk Partner - Compliance Officer

    Highmark Health (Austin, TX)
    …including auditing/monitoring operational processes, conducting or overseeing compliance investigations , and ensuring that adequate training takes place under ... and external audit progress, recurring risk and compliance reporting, mandated training, investigations , and the impacts of new and changing laws, regulations, and… more
    Highmark Health (07/29/25)
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  • Healthcare Data Analyst

    Zelis (Plano, TX)
    …We do not use WhatsApp or personal emails for recruitment. Forward any suspected fraud to ###@zelis.com for prompt investigation . Thank you for staying vigilant. ... claim data, with a focus on various pricing methodologies including Medicare , Medicaid, and commercial reimbursements. This role involves leveraging data to… more
    Zelis (08/28/25)
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  • Sr. Medicaid Regulatory Pricer Analyst

    Zelis (Plano, TX)
    …We do not use WhatsApp or personal emails for recruitment. Forward any suspected fraud to ###@zelis.com for prompt investigation . Thank you for staying vigilant. ... billing, reimbursement, claim payment or cost reporting. + Experience with Medicare / Medicare Advantage or commercial billing and reimbursement a plus + Ability… more
    Zelis (08/27/25)
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