- MyFlorida (Tallahassee, FL)
- …Analyst I and will assist with performing activities related to data analytics to identify fraud , waste , or abuse in claims data. The Program Integrity Unit was ... established to detect and prevent fraud , waste and abuse related to the...Health Insurance Fraud Analyst III, Health Insurance Fraud Analyst II, Audit Manager , and the… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …Investigations or prepayment team. This position reports directly to the Data Science Fraud Manager and assists in the development of investigation targets, ... proposes new methods of data analytics and healthcare informatics to discover Fraud , Waste and Abuse activities as well as provide program-wide trend analysis.… more
- Blue KC (Kansas City, MO)
- …**Employee discount program** **Job Description Summary:** As part of Blue KC's Special Investigations Unit (SIU), the Fraud Investigator conducts reviews to ... identify potential fraud , waste , and abuse (FWA) and claim overpayments. Assigned cases...peers and clinical standards, etc. In conjunction with the Manager and/or Senior Investigator, evaluate FWA risks and prioritize… more
- CVS Health (Salem, OR)
- …federal and state audits. **Required Qualifications** + 2 to 5 years of managing healthcare fraud , waste and abuse investigations and audits. + 3 to 5 years of ... activities related to the prevention, investigation, and prosecution of health care fraud to recover lost funds. Responsible for compliance with state and federal… more
- Molina Healthcare (Louisville, KY)
- …and actions. + Works with leadership to maintain and revise policies and procedures, fraud , waste , and abuse plans, annual audit work plans, including department ... License, Certification, Association + Active and unrestricted Accredited Health Care Fraud Investigator (AHFI) designation or Certified Fraud Examiner (CFE)… more
- Providence (Oakland, CA)
- …education related to coding, medical record documentation requirements, healthcare compliance and fraud , waste and abuse to Health Plan staff, vendors and ... **Description** **Investigator External Audit Special Investigations Unit \*Remote The SIU Audit Investigator supports the compliance related activities of the … more
- CVS Health (Hartford, CT)
- …within the Special Investigations Unit (SIU) plays a key role in supporting fraud , waste , and abuse investigations by managing and responding to Requests for ... best practices. The analyst will also provide **leadership support** to the Manager by assisting with team coordination, reporting, and strategic planning efforts.… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …on the specific position **Required Training:** + HIPAA Privacy & Security Course + Fraud , Waste and Abuse Course **Job Skill Requirements:** + Business to ... As the primary point of contact for ProAct clients, the Account Manager is responsible for building relationships with new clients and coordinating internal… more
- Air Combat Command (Tyndall AFB, FL)
- …performance. Administers internal control system to preclude or minimize the potential for fraud , waste , and abuse. Arranges for equipment repairs and other ... at a level that meets current business trends and minimizes waste . Establishes financial goals, prepares budgets, analyzes financial results, maintains solid… more
- Customs and Border Protection (Washington, DC)
- …are covered by internal controls and that appropriate precautions are taken to prevent fraud , waste , and misuse of resources in accordance with the Federal ... 1) to $131,826.00 (GS-12, Step 10). In this Program Manager position you will become a key member of...Office Providing administrative program direction to various directors and special staff for a variety of diverse programs and/or… more