• Senior Healthcare Fraud

    CVS Health (Hartford, CT)
    …heart, each and every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit ... you will manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct high level,… more
    CVS Health (08/30/25)
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  • Investigator

    Highmark Health (Atlanta, GA)
    …+ Certified Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge ... 3 years of relevant, progressive experience in the health insurance industry and/or healthcare fraud investigations **Preferred** + 1 year in Financial Analysis… more
    Highmark Health (08/15/25)
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  • Health Insurance Fraud Analyst II

    MyFlorida (Tallahassee, FL)
    …Preferred Qualifications: Industry certifications, eg, Certified Fraud Examiner; Accredited Healthcare Fraud Investigator ; Certified Financial Crimes ... Investigator ; Certified Insurance Fraud Investigator , Certified Compliance and Ethics Professional. Our Organization and Mission: Under the direction of… more
    MyFlorida (08/20/25)
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  • Sr. Fraud Data Analyst

    Blue Cross Blue Shield of Massachusetts (Boston, MA)
    …or a related field) preferred. + Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified Professional Coder (CPC), or ... investigation targets, proposes new methods of data analytics and healthcare informatics to discover Fraud , Waste and...data analytics and healthcare informatics to discover Fraud , Waste and Abuse activities as well as provide… more
    Blue Cross Blue Shield of Massachusetts (08/29/25)
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  • Investigations Consultant

    Highmark Health (Pittsburgh, PA)
    …+ Certified Professional Coder- Hospital(CPC-H) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have ... graphs, and charts to timely identify trends and patterns of potential healthcare fraud , waste and abuse. Communicate findings to company management of various… more
    Highmark Health (08/22/25)
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  • Investigator - Medicaid Fraud

    State of Georgia (Fulton County, GA)
    Investigator - Medicaid Fraud Georgia - Fulton - Atlanta (https://ga.referrals.selectminds.com/jobs/67636/other-jobs-matching/location-only) Hot ... Sign Up for Job Alerts The Office of the Attorney General Department of Law Medicaid Fraud Division - Investigator The mission of the Department of Law is to… more
    State of Georgia (07/30/25)
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  • Clinical Fraud Investigator II

    Elevance Health (Norfolk, VA)
    **Clinical Fraud Investigator II** **Location** : _Hybrid1:_ This role requires associates be in the office 1-2 days per week, fostering collaboration and ... accommodation is granted as required by law. The **Clinical Fraud Investigator II** is responsible for identifying...Registered Nurse strongly preferred + Law Enforcement dealing with Healthcare Fraud Please be advised that Elevance… more
    Elevance Health (08/30/25)
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  • Fraud & Investigations, Clinical…

    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 ... investigation experience involving economic or insurance related matters. + A clinical investigator must have in addition to the above requirements: A duly licensed… more
    MVP Health Care (08/31/25)
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  • Investigator , Special Investigative…

    Molina Healthcare (Lexington, KY)
    …ASSOCIATION** : + Health Care Anti- Fraud Associate (HCAFA). + Accredited Health Care Fraud Investigator (AHFI). + Certified Fraud Examiner (CFE). To all ... **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation,… more
    Molina Healthcare (08/28/25)
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  • Senior Investigator (Hybrid)

    CareFirst (Baltimore, MD)
    …+ Independently or as lead in part of an assigned team develop and conduct healthcare fraud , waste, and abuse investigations of all levels (low to complex). ... **Education Level:** Bachelor's Degree **Licenses/Certifications Preferred:** + Certified Insurance Fraud Investigator (CIFI) + Certified Expert Coder-AHIMA or… more
    CareFirst (07/12/25)
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