- State of Colorado (Denver, CO)
- …Only: Experience Only: Ten (10) years of relevant experience in overseeing Medicaid or Medicare fraud , waste, and abuse (FWA) operations that includes work on: + ... Program Integrity + Provider Payment Reviews + Fraud Investigation + Waste and abuse reviews...groups, specifically focusing on program integrity, provider payment reviews, fraud investigations , waste and abuse reviews and… more
- BlueCross BlueShield of North Carolina (NC)
- …$62,100.00 - $111,800.00 **Skills** Depositions, Evidence Collection, Forensic Accounting, Fraud Investigations , Investigation Techniques, Investigative ... is responsible to conduct timely and thorough health care fraud investigations on behalf of the Company....gaps on the business/organization. + In the course of investigation , may be required to provide deposition and/or testimony… more
- USAA (San Antonio, TX)
- …and assists with fraud detection and deterrence, as well as, investigate fraud investigations that may have significant financial impact to Life Company ... agencies as appropriate.As a Mid-Level Life SIU Investigator for ** Medicare Supplement Fraud , Waste, and Abuse** you...claims, and underwriting. + Proficient knowledge and understanding of fraud investigations as well as application of… more
- State of Colorado (Pueblo, CO)
- …CBI name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure ... 8:00am - 5:00pm This position has primary responsibility for HIPAA risk assessment, investigation and data tracking related to HIPAA. Abstracts data from charts to… more
- State of Colorado (Jefferson County, CO)
- …CBI name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure ... of fingerprinting, polygraph, drug screen, physical exam and an extensive background investigation ) will be conducted as part of the selection process. Felony… more
- Methodist Health System (Dallas, TX)
- …including, but not limited to, state specific health care laws and regulations, Medicare /Medicaid rules, fraud and abuse including Stark and anti-kickback laws ... and state laws relating to healthcare, including but not limited to Medicare /Medicaid reimbursement, HIPAA, AKS, self-referral prohibitions, and fraud and abuse.… more
- Corewell Health (Grand Rapids, MI)
- Job Summary Performs activities related to the detection and investigation of fraud and abuse within Priority Health. Utilizes knowledge/expertise of health care ... provider and agent agreements, products offered, State and Federal laws related to fraud , waste or abuse, Medicare and Medicaid regulations, etc. + Ability… more
- Molina Healthcare (Idaho Falls, ID)
- …opinions. + Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations . + Knowledge of Managed Care and the Medicaid and ... medical records and data analysis, and makes determinations as to whether the investigation and/or audit identified potential fraud , waste, or abuse. +… more
- CVS Health (Hartford, CT)
- …and every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU). In ... investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct...federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud . +… more
- Humana (Oklahoma City, OK)
- …Qualifications** + **Must be an Oklahoma resident** + 2+ years of healthcare fraud investigations and auditing experience + Knowledge of healthcare payment ... community and help us put health first** Humana's Special Investigations Unit is seeking a Senior Fraud ...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more