- Molina Healthcare (Ann Arbor, MI)
- …Tricare, Pharmacy, etc.) + Experience with UNET, Comet, Macess/CSP, or other similar claims processing systems . + Demonstrated ability to use MS Excel/Access ... **JOB DESCRIPTION** **Job Summary** The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical… more
- Idaho Division of Human Resources (Lewiston, ID)
- Senior Agricultural Investigator - Lewiston or Post Falls Posting Begin Date: 2025/09/09 Posting End Date: 2025/12/11 Category: Agriculture Sub Category: Natural ... The Idaho Department of Agriculture is currently recruiting for an Agriculture Investigator Senior in the division of Agriculture Resources located in Lewiston or… more
- CVS Health (Columbus, OH)
- …it all with heart, each and every day. **Position Summary** As a Senior Investigator you will conduct high level, complex investigations of known or suspected acts ... fraud schemes. + Investigates to prevent payment of fraudulent claims submitted to the Medicaid lines of business +...+ Documents all appropriate case activity in case tracking system + Facilitates feedback with providers related to clinical… more
- Elevance Health (St. Louis, MO)
- …data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims ... in order to recover corporate and client funds paid on fraudulent Medicaid claims . **How You Will Make an Impact:** + Responsible for identifying and developing… more
- Marshfield Clinic (Marshfield, WI)
- …most exciting missions in the world!** **Job Title:** Subrogation Investigator **Cost Center:** 682891012 SHP-Legal-Subrogation **Scheduled Weekly Hours:** 40 ... Required: Two years previous work experience in collections, legal, claims processing, or subrogation related field. Preferred/Optional Experience: Qualified… more
- City and County of San Francisco (San Francisco, CA)
- …and submission of claims to the California Victim Compensation and Government Claims Board, and monitor claim progress and payment. 5. Assist with the ... the San Francisco District Attorney's Office strives to make the criminal justice system humane and accessible by providing support and assistance to victims and… more
- Allied Universal (Portland, OR)
- Company Overview: Advance Your Career in Insurance Claims with Allied Universal(R) Compliance and Investigation Services. Allied Universal(R) Compliance and ... is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic...information: www.aus.com If you have difficulty using the online system and require an alternate method to apply or… more
- CVS Health (Topeka, KS)
- …States. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU), dedicated to a ... abuse. + Conduct Investigations to prevent payment of suspect or fraudulent claims submitted by insured's, providers, claimants, and customers. + Research and… more
- Highmark Health (Pittsburgh, PA)
- … (AHFI) **SKILLS** + Must have knowledge of provider facility payment methodology, claims processing systems and coding and billing proficiency + Must have ... understanding of technical and financial aspects of the health insurance industry + Strong personal computer skills, along with the ability to use fraud/abuse data mining tools are required + Must possess excellent communication skills and be detailed oriented… more
- Molina Healthcare (Covington, KY)
- …abuse, and over utilization by providers and recipients. The position will review claims data, medical records, and billing data from all types of healthcare ... the Medicaid and Medicare programs as well as Marketplace + Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems … more