Senior Consultant, Federal Healthcare Financial Crime and Fraud Policy
$95.6k - $188.4kDeloitte
Position Summary Our Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk and an evolving regulatory environment into defensible actions that strengthen, protect, and transform their organization. Join our team and use advanced data, AI, and emerging technologies with industry insights to help clients bring clarity from complexity and accelerate their path to value creation. Work You’ll Do As a Senior Consultant, Financial Crime and Fraud, you will support the client by researching and interpreting relevant regulations, policies, and program rules that inform detection strategies and analytic products. You will reviews policy guidance, open-source resources, and public information to identify vulnerabilities, ensures analytic and rules-based detection logic reflects current policy requirements, and connects findings to broader program integrity concerns. You will also partners with Analytics / Rules Engineers and Data Scientists to translate policy and regulatory requirements into detection criteria, and supports the development of referrals and findings for further investigation by appropriate agencies or stakeholders. Key Responsibilities: Research and interpret relevant regulations, policies, and program rules affecting detection strategiesReview open-source resources and public information to identify potential fraud, waste, and abuse vulnerabilitiesTranslate policy and regulatory requirements into detection criteria for Analytics / Rules EngineersSupport development of referrals and documented findings for further investigationConnect specific findings to broader program integrity vulnerabilities and trendsMonitor policy and regulatory changes and assess their impact on existing detection logicDocument policy research, findings, and rationale per SOPsParticipate in stand-ups, sprint planning, and reviews within the SAFe Agile team The successful candidate would possess these skills: Ability to work independently and collaborate as part of a teamEffective written and verbal communication skillsMeticulous attention to detail and quality of work productAbility to build and sustain professional relationships Ability to lead projects or workstreamsAbility to manage and prioritize multiple tasks in a fast-paced and dynamic environmentStrong interpersonal skills and professional demeanor Ability to meet deadlinesAbility to provide clear guidance to others The Team Deloitte’s Government & Public Services (GPS) practice – our people, ideas, technology and outcomes – is designed for impact. Serving federal, state, & local government clients as well as public higher education institutions, our team of professionals brings fresh perspective to help clients anticipate disruption, reimagine the possible, and fulfill their mission promise. Our Enterprise Operations & Risk offering enables clients to achieve profitable growth and competitive advantage by optimizing “heart of the business” operations. Leverages deep domain expertise to extend enterprise resilience, agility and remediation. Addresses client needs which span the organization and impact strategy, operations, performance and reputation. Qualifications Required: Bachelor’s degree3+ years of experience utilizing research and analytical skills to interpret regulations or policy documents3+ years of experience supporting programs identifying and mitigating fraud, waste, or abuse. Ability to travel 5-25%, on average, based on the work you do and the clients and industries/sectors you serveMust be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future Preferred: Strong research and analytical skills, with experience interpreting regulations or policy documentsExcellent written communication skills, including experience drafting findings or referral documentationAbility to synthesize open-source and public information into actionable insightsExperience collaborating with technical teams to translate policy into detection criteriaExperience in healthcare policy, program integrity, or regulatory compliance domainsFamiliarity with fraud, waste, and abuse detection methods The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $95,600 to $188,400. You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance. Deloitte is committed to providing reasonable accommodations for people with disabilities. If you require a reasonable accommodation to participate in the recruiting process, please direct your inquiries to the Global Call Center (GCC) at View email address on click.appcast.io. Recruiting tips From developing a stand out resume to putting your best foot forward in the interview, we want you to feel prepared and confident as you explore opportunities at Deloitte. Check out recruiting tips from Deloitte recruiters. Benefits At Deloitte, we know that great people make a great organization. We value our people and offer employees a broad range of benefits. Learn more about what working at Deloitte can mean for you. Our people and culture Our inclusive culture empowers our people to be who they are, contribute their unique perspectives, and make a difference individually and collectively. It enables us to leverage different ways of thinking, ideas, and perspectives, and bring more creativity and innovation to help solve our clients' most complex challenges. This makes Deloitte one of the most rewarding places to work. Our purpose Deloitte’s purpose is to make an impact that matters for our people, clients, and communities. At Deloitte, purpose is synonymous with how we work every day. It defines who we are. Our purpose comes through in our work with clients that enables impact and value in their organizations, as well as through our own investments, commitments, and actions across areas that help drive positive outcomes for our communities. Learn more. Professional development From entry-level employees to senior leaders, we believe there’s always room to learn. We offer opportunities to build new skills, take on leadership opportunities and connect and grow through mentorship. From on-the-job learning experiences to formal development programs, our professionals have a variety of opportunities to continue to grow throughout their career. As used in this posting, "Deloitte" means Deloitte Transactions and Business Analytics LLP, a subsidiary of Deloitte LLP. Please see for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or protected veteran status, or any other legally protected basis, in accordance with applicable law. Qualified applicants with criminal histories, including arrest or conviction records, will be considered for employment in accordance with the requirements of applicable state and local laws, including the Los Angeles County Fair Chance Ordinance for Employers, City of Los Angeles’s Fair Chance Initiative for Hiring Ordinance, San Francisco Fair Chance Ordinance, and the California Fair Chance Act. See notices of various fair chance hiring and ban-the-box laws where available. Fair Chance Hiring and Ban-the-Box Notices | Deloitte US Careers Requisition code: 370988 Job ID 370988 Risk, Compliance, and Governance | Financial Crime and FraudSame job available in 16 locations
$95.6k - $188.4k
...creation.Work You’ll DoAs a Senior Consultant, Financial Crime and Fraud, you will work with a... ...accelerator for a large federal health care program.Key... ...years of experience in healthcare fraud and/or program integrity... ...in healthcare policy, program integrity, or regulatory...FinancialSeniorPolicyFraudLocal area$43.89k - $69k
As a Senior Financial Crimes Investigator , you will leverage your... ...terrorist financing, fraud, and sanctions violations... ...with all relevant federal and state laws,... ..., as well as company policies, procedures, and client... ...expertise, technology, and consulting to help clients with...FinancialSeniorPolicyFraudLocal areaWork from homeMonday to Friday$46.99k - $102k
...Senior Investigator We're building a world of... ...or suspected acts of healthcare fraud and abuse. Routinely... ...necessary Cooperates with federal, state, and local law... ...Knowledge of Aetna's policies and procedures.... ...physical, emotional, and financial well‑being of...FinancialSeniorPolicyFraudHourly payFull timeTemporary workWork at officeLocal areaRemote work$46.99k - $112.2k
...investigation and prosecution of Fraud, Waste and Abuse.... ...and cooperates with federal, state, and local law... ...~3-5 years of healthcare fraud investigations experience... ...Knowledge of Aetna's policies and procedures... ...physical, emotional, and financial well‑being of colleagues...FinancialSeniorPolicyFraudHourly payFull timeTemporary workLocal area$41.25k - $82.5k
...AML Sanctions Analyst Senior within PNC's AML organization... ...AML and Sanctions policies and procedures as needed... ...Compliance Function, Fraud Management, Internal Controls... ...wellness program with financial incentives. In addition... ...of Section 19 of the Federal Deposit Insurance Act (...FinancialSeniorPolicyFraudFull timeTemporary workPart timeWork experience placementWork at officeRemote workWork from home$43.89k - $93.57k
...transportation and other healthcare providers. The CPC... ...ensure that the state, federal and company requirements... ..., state and federal policies. Identify potential... ...billing errors, abuse, and fraud. Identify... ...physical, emotional, and financial well?being of colleagues...FinancialPolicyFraudHourly payFull timeTemporary work- ...SENIOR LICENSED PRACTICAL NURSE - 67013431 The State... ...25,000 life insurance policy (100% employer paid)... ...possess and maintain CPR Healthcare Provider Certification... ...your account at your financial institution. This will... ...Law Enforcement and Federal criminal records checks...FinancialSeniorPolicyLocal areaImmediate startMonday to Friday
$104k - $143k
...caring community The Senior Research Scientist... ...methods to large, complex healthcare datasets to evaluate... ...clinical, utilization, and financial performance of... ...Employer It is the policy of Humana not to discriminate... ...with all applicable federal civil rights laws and...FinancialSeniorPolicyFull timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome office- AML RightSource is seeking a Senior Financial Crimes Investigator to detect suspicious activity, ensure regulatory compliance, and lead investigations... ...cases. You will analyze money laundering, sanctions, and fraud indicators, prepare SARs, and ensure strict adherence to AML...FinancialSeniorFraudRemote jobHome office
$61.9k - $141k
...within secure and air-gapped federal environments, including on-prem... ...Designer, business rules, UI policies and actions, client scripts,... ...health, life, disability, financial, and retirement benefits, as... ...and protect against identity fraud. You are expected to be on camera...FinancialSeniorPolicyFraudFull timeContract workPart timeLocal areaRemote work$40k
...you build a career in financial crime compliance. As an Entry... ...client-operating policies related to financial data... ...terrorist financing, fraud, sanctions violations,... ...Ensure compliance with federal and state laws, regulations... ..., technology, and consulting to help clients with AML...FinancialPolicyFraudOngoing contractWork at officeLocal areaWork from homeVisa sponsorshipMonday to Friday- ...recruiting and training top healthcare workers from across the... ...working knowledge of applicable Federal, State, and local laws and... ...Mount Sinai and Eldercare policies on compliance, Fraud Waste and Abuse, Code of... ...the IDT. Assists with the financial eligibility process for...FinancialPolicyFraudLocal area
- ...range of industries, including healthcare, retail, government,... ..., technology e-commerce, and financial services. Our contact centers... ...customers to select the insurance policies that best meet their needs.... ...manner consistent with local and federal requirements. MCI will not tolerate...FinancialPolicyFull timeContract workTemporary workCasual workWork at officeLocal areaRemote workWork from homeFlexible hours
$68.5k - $78.24k
...is responsible for conducting financial and operational audits to ensure compliance with policies, procedures, regulations and laws... ...audit project activities and fraud investigations. Applies knowledge... ...any other status protected by federal, state or local law. #J-18808-...FinancialSeniorPolicyFraudTemporary workWork experience placementLocal areaRemote workFlexible hours$71.2k - $166.1k
...create a human-centric healthcare experience powered by unified... ...with the advancement of Federal Healthcare systems. If... ...a skilled Federal Senior Engineer/Architect (Principal Consultant) to join our mission-driven... ...Stock Purchase Plan # Financial planning and group legal...FinancialSeniorTemporary workFlexible hours- ...is currently initiating a search for a Senior Consultant to support our company’s growing Resilience... ..., team management, and project financials.This position will also support business... ...scientists, engineers, planners, economists, policy specialists, and risk modelers....FinancialSeniorPolicyFull timeWork experience placementFor subcontractorInternshipWork at officeLocal areaRemote workFlexible hours
- ...Responsibilities: Maintain and update client financial and bond files Receive and dispatch... ...and interpret documents such as insurance policies, contractual insurance requirements,... ...California Applicant Privacy Policy. Recruitment Fraud: Please visit here to learn more about...FinancialSeniorPolicyFraudWork at officeImmediate startFlexible hoursShift workNight shift
- ...and Long Term Disability The Senior Fraud Operations Specialist is... ...ensuring adherence to Bank policies, regulatory requirements, and... ...and outcomes. Escalate and consult on emerging fraud trends or... ...investigation experience within a financial institution. Direct...FinancialSeniorPolicyFraudFull timeTemporary workCasual workWork at officeMonday to FridayAfternoon shift
- ...Coder II, and Physician Senior Coder positions.... ...rules set forth by the federal government. Submits to... ...documentation of a particular healthcare provider for... ...consistently monitor financial goals within their specialty... ...with Orlando Health policies, the ADA, FMLA and other...FinancialSeniorPolicyWork at officeLocal area
- ...sectors including hospitality, senior housing, healthcare, commercial offices,... ...relevant regulations and company policies. Essential Duties and... ...control measures to ensure financial objectives are met. Contract... ...comply with local, state, and federal regulations, as well as...FinancialSeniorPolicyContract workFor subcontractorLocal area
$92.48k - $160.29k
As a Senior Underwriting Consultant - Internal Auditor, you will be part of the US Life Underwriting Risk... ....Assess medical, non-medical, financial, compliance, retention, and reinsurance... ...applicable laws and Manulife/John Hancock policies. To request a reasonable...FinancialSeniorPolicyFull timeTemporary workLocal areaRemote workFlexible hours$65k - $75k
...Care is a nonprofit healthcare organization... ...with organizational policies, processes, and... ...matters require consultation or escalation. Confidentiality... ...other applicable federal, state, and local... .... Recruitment Fraud Awareness Midway... ...or personal financial information...FinancialPolicyFraudHourly payContract workLocal area- ...recording of revenue transactions in locations operating in the healthcare industry. Job Duties and Responsibilities include, but are... ...staff in multiple locations. Monitor, update and train financial policies and procedures related to current Company policy and industry...FinancialSeniorPolicyFull timeWork at officeLong distance
$125k - $210k
...common purpose to help make financial lives better through... ...model stakeholders and senior management with regard... ...validate enterprise fraud prevention and detection... ...practices and Model Governance Policy, Guidelines, Testing... ...or related financial crime areas. A solid grasp of...FinancialSeniorPolicyFraudWork experience placementWork at officeFlexible hoursShift workDay shift- Synovus Financial Corp seeks a Financial Specialist to deliver distinctive service to clients, handling inquiries and promoting... ..., and expanding relationships while ensuring compliance with federal regulations and firm policies. #J-18808-Ljbffr Synovus Financial Corp.FinancialSeniorPolicy
- ...or platforms that improve the healthcare experience. We remain focused... ...make our vision a reality. Senior Representative, HR Shared Services... ..., workers’ compensation, policy, and other teammate relations... ...From health and wellness to financial security and career growth, we...FinancialSeniorPolicyTemporary workFlexible hours
- ...platforms that improve the healthcare experience. We remain... ...activities, including policy governance, compliance... ...violations, fraud, conflicts of interest... ...government inquiries, and senior leadership reporting to... ...health and wellness to financial security and career growth...FinancialPolicyFraudTemporary workWork at officeRemote workFlexible hours2 days per week
- ...Description Civil Engineering Senior Project Manager Job... ...Clients will include Federal, State, Municipal, and... ...company standards and policies, achieving shared... ...projections Track project financial performance and ensure... ...the design team, sub-consultants, subcontractors, and...FinancialSeniorPolicyContract workFor subcontractor
- ...The Senior Clinical Coder serves as a subject matter expert in medical... ...continuous improvement in healthcare operations. Duties &... ...coding discrepancies, potential fraud, and quality concerns Provide... ...Research and apply medical policies, benefits, limitations, and current...SeniorPolicyFraudFull timeWork at officeRemote workWork from homeHome office
- Molina Healthcare in Florida is seeking a Senior Claims Examiner to provide expert support in adjudication, coding accuracy, fraud prevention, and compliance with state and federal regulations. The role manages a varied caseload, procures medical records, and recommends...SeniorFraudWork at office
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