Remote Medicaid Fraud & Waste Investigator (SC)
Humana
- Remote job
Humana seeks a Fraud and Waste Professional in South Carolina to lead investigations of fraud, waste, and abuse in the Medicaid program. You will gather evidence, perform on-site audits of provider records, and prepare detailed investigative summaries for leadership and external stakeholders. You will coordinate with law enforcement and internal partners, apply clinical knowledge to assess medical necessity and billing practices, and maintain compliant case files while meeting deadlines. #J-18808-Ljbffr Humana
- Humana, Inc. is seeking a Fraud and Waste Professional to conduct comprehensive investigations of alleged fraud related to Medicaid program activities in South Carolina. The role coordinates with law enforcement, assembles evidence, and conducts on-site audits of provider...Remote job
- Humana is seeking a Fraud and Waste Professional to conduct comprehensive investigations of reported, alleged, or suspected fraud involving South Carolina's Medicaid program. This role partners with law enforcement... ...investigative reports. Fully remote in South Carolina with...Remote job
- ...CenterWell Certified Healthcare Corp. is seeking a Fraud and Waste Professional to conduct comprehensive investigations of reported, alleged or suspected fraud within South Carolina's Medicaid program. Remote work option with SC residency required. You will coordinate with...Remote job
$65k - $88.6k
...of our caring communityThe Fraud and Waste Professional is responsible... ...for conducting comprehensive investigations of reported, alleged or... ...involving South Carolina's Medicaid Program. The Fraud and Waste... ...Waste Work Style Fully remote in South Carolina , with...Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday- Humana is seeking a Fraud and Waste Professional to conduct comprehensive investigations into fraud related to Medicaid programs. The role coordinates with law enforcement, assembles evidence, and performs on-site audits of provider records to ensure billing integrity....Remote job
$32.03 - $45.7 per hour
...currently hiring an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) Remote! Status: Full-time,... ..., NH, ND, OH, OK, PA, SC, SD, TN, TX, UT, WA,... ...of potential fraud, waste, and abuse. -... ...serving Medicare and Medicaid enrollees. Our quality...Remote workHourly payPermanent employmentFull timeTemporary workLive inCurrently hiringWork at officeShift work$86k - $138k
...subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent,... ...reduce, and make referrals to recover fraud, waste, and abuse. We are looking to add... ...between the SE UPIC, HHS OIG, State Medicaid Agencies (SMA), and the Department of...Remote workFull timeContract workTemporary workFor contractorsWork at officeShift workNight shift- The Investigator V at the Texas Health and Human Services Commission is responsible for conducting advanced investigations into Medicaid fraud, waste, and abuse. You will coordinate with MCOs, DMOs, and agencies, manage case files, and testify when required. The role requires...Remote work
- ...Providing investigative support for special investigation unit... ...the full-time Healthcare Fraud Investigator will focus on... ...investigation of healthcare fraud, waste, and abuse, while working remotely. Key responsibilities... ...of managed care, Medicaid, Medicare, and claim billing...Remote workFull time
- ...platform pairs analytics with expert review to surface fraud, waste, and abuse across Medicare, Medicaid, Commercial, and FEP lines of business, returning... ...success, but you will not manage anyone. Strong investigators here come from healthcare payer/vendor backgrounds...Remote work
- ...Healthcare Fwa Investigator Levels (Investigator, Sr. Investigator... ...and prevention of healthcare fraud, waste and abuse (FWA). We are... ...Support multiple clients with Medicaid, Medicare, Federal Employee... ...work independently within a remote team, under minimal supervision...Remote work
$51k - $82k
...subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent,... ...reduce, and make referrals to recover fraud, waste, and abuse. We are looking to add a... ...~ Knowledge of Medicare and/or Medicaid programs and the rules, regulations, policies...Remote workContract workTemporary workFor contractorsFlexible hoursShift workNight shift$77.1k - $92.52k
...Regular Full-Time Office: Remote Salary: $77,099.... ...HomeFirst, our Medicare and Medicaid managed care health plans,... ...: The SIU Fraud Investigator is responsible for identifying... ...allegations and indicators of fraud, waste, and abuse (FWA) involving...Remote workFull timePart timeWork at officeFlexible hours- Peraton is seeking a Fraud Investigator to join SafeGuard Services (SGS), focusing on data analysis, investigation, and medical... ...to detect, prevent, deter, reduce, and refer fraud, waste, and abuse within Medicare/Medicaid programs. The role involves high-level...Remote job
- ...Inspector General (OIG) - Career Brochure To conduct investigations of fraud, waste or abuse by recipients, non-Medicaid providers and vendors of all MDHHS administered... ...be notified of the results. Position Location/Remote Office The physical location of this position is...Remote workFull timeWork at office
$45.5 per hour
CPC/CPMA required Nov 16th to Feb 8th might extend Fraud Waste Abuse exp Commercial Medicare/ Medicaid on site Bowie MD 3 days a week SQL exp Exp with Health... ...with product and data science teams to translate investigative judgment into refined detection rules Track...3 days per week- ...Centene Corporation is seeking an SIU Investigator in the United States to conduct fraud, waste, and abuse investigations using referrals, claims data, medical records, and interviews. You will prepare reports, coordinate with internal teams, and support program integrity...Remote work
- ...reside across the U.S. — with a variety of remote, hybrid and in-person roles. We enjoy... ...MS, MO, MT, NE, NH, NC, ND, OH, OK, PA, SC, SD, TN, TX, UT, WV, WI, WY. Some of... ...full potential Responsibilities The Fraud Investigator II role is focused on independently...Remote workFull timeWork experience placementWork at officeLocal areaWork from home
$65.6k - $98.4k
...flexible work arrangements that include remote and hybrid opportunities and paid... ...of potential provider or member fraud and abuse cases. Conduct the investigation of fraudulent and abusive... ...emerging issues in healthcare fraud, waste, and abuse. Conduct audits and interviews...Remote workContract workWork at officeLocal areaWork from homeFlexible hours2 days per week1 day per week- ...Conducting fraud, waste, and abuse investigations, the full-time SIU Investigator will review referrals, claims data, and medical records to identify... ...misconduct while collaborating with various stakeholders in a remote setting. Key responsibilities Conducts investigations...Remote workFull time
- ...Centene Corporation is seeking an investigator to conduct fraud, waste, and abuse investigations across referrals, claims data, and medical records.... ...healthcare investigations, with opportunities to work in a remote, hybrid, or onsite setting and benefit from Centene's...Remote work
$79.56k - $115.72k
...at identifying potential fraudulent, wasteful, or abusive claim submissions. In... ...Responsible for conducting confidential investigations of suspected fraud, waste & abuse (FWA) involving... ...generally 8:30-5:00 PM Eastern Time Remote workspace requirements, including privacy...Remote workFull timeContract workWork at officeLocal areaMonday to FridayFlexible hoursShift work- ...Centene Corp. is hiring a SIU Investigator to conduct fraud, waste, and abuse investigations remotely in Texas. You will review referrals, claims data, medical records, and provider information to identify misconduct and support case resolution. Prepare investigative reports...Remote work
- Cotiviti is seeking an Investigator to scrutinize suspected healthcare fraud, waste, or abuse using data analysis. This is a remote, work-from-home role within the United States. Responsibilities include analyzing patterns, producing written summaries, and supporting legal...Remote jobWork from home
- Cotiviti is hiring a Senior Investigator to analyze data and investigate suspected healthcare fraud, waste, and abuse from a remote/home-based position aligned with the post-pay Fraud Waste & Abuse team. The role involves interviews, reporting findings, and may require...Remote jobCasual workWork from home
- The Oregon Department of Justice is seeking an experienced Investigator 3 to join the Medicaid Fraud Unit in the Civil Enforcement Division. This role conducts statewide investigations of Medicaid provider fraud, abuse, and financial exploitation in long-term care settings...
- The City of New York seeks a Fraud Investigator II to join the Medicaid Provider Investigation Division (MPID) within the Department of Social Services in New York City. The role includes reviewing data from the Medicaid Data Warehouse, investigating suspected Medicaid...
$62.4k - $71.76k
State of Florida, Office of the Attorney General, Medicaid Fraud Control Unit in Miami, seeks a Law Enforcement Investigator II to conduct investigations into Medicaid fraud and patient abuse. The role requires U.S. citizenship, a high school diploma, and successful completion...Work at office$57.98k - $69k
...Division DOJ Legal Services Job Classification Title Financial Investigator I (NS) Position Number 60010403 Grade NC16 About Us The... ...to perform investigations in the area of criminal and civil Medicaid fraud schemes, patient abuse or neglect, and misappropriation of recipient...Local areaNight shift- The Office of the Attorney General in Florida's Medicaid Fraud Control Unit is seeking a Senior Investigator in Miami. The role involves independent investigations of Medicaid fraud and patient abuse, gathering evidence, interviewing witnesses, and preparing reports and...Work at office
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