- Humana (Dayton, OH)
- …**Required Qualifications** + Must reside in Ohio + At least 2 years of healthcare fraud investigations and auditing experience + Knowledge of healthcare ... part of our caring community and help us put health first** This Senior Fraud and Waste Investigator will serve as Humana's Program Integrity Officer, who will… more
- Molina Healthcare (Cincinnati, OH)
- …insurance company + Minimum of two (2) years' experience working on healthcare fraud related investigations/reviews + Proven investigatory skill; ability to ... data, medical records, and billing data from all types of healthcare providers that bill Medicaid/ Medicare /Marketplace. **KNOWLEDGE/SKILLS/ABILITIES** + Ensure… more
- Molina Healthcare (OH)
- …The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses ... oral and written communication skills and presentation skills. + Medicare and Marketplace experience **JOB QUALIFICATIONS** **Required Education** High School… more
- CVS Health (Columbus, OH)
- …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
- AmeriHealth Caritas (Columbus, OH)
- …An associate's degree, with a minimum of four years of experience working in healthcare fraud , waste, and abuse investigations and audits. + Experience and ... + Bachelor's degree with a minimum of two years of experience in the healthcare field working in fraud , waste, and abuse investigations and audits OR… more
- CVS Health (Columbus, OH)
- …financial integrity with sound pricing and risk management practices. The Medicare Actuarial Pricing team is responsible for anticipating and recognizing matters ... to the broader actuarial team. **A Brief Overview** Senior Analysts on the Medicare Actuarial team leverage strong technical skills to analyze data and pricing… more
- Humana (Columbus, OH)
- …identify and collect overpayment of claims. Contributes to the investigations of fraud waste and our financial recovery. The Senior Payment Integrity Professional ... an impact** **Required Qualifications** + Bachelor's degree in Business, Finance, Healthcare Administration, Data Analytics, or a related field, or equivalent work… more