- Humana (Dayton, OH)
- …community and help us put health first** This Senior Fraud and Waste Investigator will serve as Humana's Program Integrity Officer, who will oversee the monitoring ... and claims processing areas + Adequately staff and manage the program integrity investigator (s) responsible for all FWA detection programs and activities + Assist in… more
- Molina Healthcare (OH)
- **JOB DESCRIPTION** **Job Summary** The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical ... and/or CPMA) **Preferred Education** Bachelor's degree (or higher) **Preferred Experience** + 2 + years of experience working in the group health business preferred,… more
- Molina Healthcare (Cincinnati, OH)
- …Managed Care Organization or health insurance company + Minimum of two ( 2 ) years' experience working on healthcare fraud related investigations/reviews + Proven ... investigatory skill; ability to organize, analyze, and effectively determine risk with corresponding solutions; ability to remain objective and separate facts from opinions + Knowledge of investigative and law enforcement procedures with emphasis on fraud… more
- Elevance Health (Mason, OH)
- **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 ... eliminate and prevent unnecessary medical-expense spending. The **Clinical Fraud Investigator II** is responsible for identifying issues and/or entities that… more
- Parexel (Columbus, OH)
- …to design, development and implementation of major business initiatives or special projects. Applies technical skills and discipline knowledge to contribute to ... or clinical trial outsourcing OR + Juris Doctorate or equivalent and 2 + years of experience in clinical development operations or clinical trial outsourcing… more