- MVP Health Care (Rochester, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Clinical Investigator ** to join #TeamMVP. This is the opportunity for you if you have ... justice or a related field, and minimum of five years of insurance claims investigation experience; or five years of professional investigation experience with law… more
- Sanford Health (Fargo, ND)
- …investigation/audit. - Master's Degree preferred - Accredited Health Care Fraud Investigator (AHFI) certification or Certified Fraud Examiner (CFE) preferred - ... Responsible for conducting audits and investigations of potentially fraudulent claim activity. Will plan, develop, and implement investigative processes and… more
- Elevance Health (Atlanta, GA)
- **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 days ... eliminate and prevent unnecessary medical-expense spending. The **Clinical Fraud Investigator II** is responsible for identifying issues and/or entities that… more
- 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 ... outcomes; work closely with internal and external auditors, financial investigators, and claims processing areas + Adequately staff and manage the program integrity … more
- AmeriHealth Caritas (Columbus, OH)
- …services. Discover more about us at www.amerihealthcaritas.com. The Investigator is responsible for conducting comprehensive investigations of reported, ... Proactively performs research using the Internet, data analysis tools, etc., to analyze aberrant; claims billing and practice patterns. + Analyzes data as part of the… more
- The Robison Group (Albany, NY)
- …the position will be expected to perform investigations of workers compensation claims , liability investigations, multi-line insurance claims , criminal and civil ... Candidates must be willing and able to obtain a New York Private Investigator license. + Self-motivated, determined, and intuitive. + Strong initiative and work… more
- Point32Health (Canton, MA)
- …about who we are at Point32Health (https://www.point32health.org/) . **Job Summary** The Investigator I is an essential team member of the Special Investigation Unit ... ("FWA") investigations under the direction of the Manager, FWA Prepayment Review. The Investigator I works closely with other members of the SIU to set investigative… more
- Insight Global (Norfolk, VA)
- …in support of an investigation. -Collect and evaluate potential suspicious patterns in claims data, provider enrollment data, and other sources to refer to ... Investigator for investigation or settlement. -Assures accurate reimbursement is...as required. -Pay rate between $20-40/hr We are a company committed to creating diverse and inclusive environments where… more
- Command Investigations (Syracuse, NY)
- $500 SIGN ON BONUS AIC Companies, a modern, innovative, and results-driven company that focuses on client satisfaction and employee happiness is looking for entry ... website for additional information on our investigative offerings and company background (www.aiccompanies.com). Job Description: Surveillance Investigators are the… more
- Highmark Health (Pittsburgh, PA)
- ** Company :** Highmark Inc. **Job Description :** **JOB SUMMARY** This job is responsible for developing and maintaining an anti-fraud program which includes ... Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of provider facility payment… more