Senior Claims Examiner: Fraud, Coding & Recovery Expert
Molina Healthcare of Illinois
Remote Jobs is seeking a Senior Claims Examiner to provide senior level support for claims examination activities, including evaluating adjudication to identify incorrect coding, abuse and fraudulent billing practices, waste, and processing errors. The role emphasizes managing a caseload, procuring medical records, and making recommendations for investigation and resolution. Strong organizational, data entry, and MS Office skills are essential. #J-18808-Ljbffr Molina Healthcare
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- ...Program Contractor (MIC) Recovery Audit Contractor (RAC) Zone... ...(ZPIC) Health Care Fraud Prevention and Enforcement Action... ...record audits of documentation, coding and billing for technical and... ...recommendations, which are presented to senior management of applicable...SeniorFraudFor contractorsWork at officeLocal areaShift work
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- ...SIU) III to lead high-complexity investigations into healthcare fraud, waste and abuse. This role requires strong data analysis, interviewing... ...will use knowledge of Medicaid/Medicare rules, CPT/HCPCS/ICD coding, and evidence-based methods to drive case outcomes and...SeniorFraud
$200k - $240k
...Senior Backend Engineer - Go, Fraud & Disputes Infrastructure New York City or San Francisco (Hybrid, 3 days/week) | $200k–$240k + equity | 3-stage... ...week), $200k–$240k + early-stage equity, 3-stage interview process (system design, coding round, culture & offer call),...SeniorFraudWork at office3 days per week$175k - $200k
...with a growing specialty insurance carrier seeking an experienced claims professional to join its Professional Liability Complex Claims... ...specialized Financial Institutions portfolio, including fidelity, fraud, and related professional liability exposures. As the portfolio...SeniorFraudFull timeRemote workFlexible hours- EmblemHealth seeks a Recovery Auditor to proactively assess vendor performance, monitor daily... .... The role involves analyzing claims, eligibility, contracts, and reimbursement... ...healthcare recovery/auditing experience, expert knowledge of MSP/COB, and strong analytical...Senior
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...content includes equity research, company filings, event transcripts, expert calls, news, trade journals, and clients’ own research content.... ...where a particular employee works. Recruiting Scams and Fraud We at AlphaSense are aware of frauds involving fraudulent job postings...SeniorFraudLocal areaShift work$86.8k - $160.7k
...most complex or severe property claims by investigating losses;... ...controlling independent adjusters and experts; interpreting the policy to... ...for distribution to GNY senior management. Provide good customer... ...data integrity through proper coding and system functions. Participates...SeniorWork at office- ...America's logistics backbone, combat freight fraud and cargo theft, and provide near-... ...critical impact. ABOUT THE JOB As a Senior QA Automation Engineer at GenLogs, you bring... ...test cases, and acceptance criteria before code is written. Design, build, and maintain...SeniorFraudRemote work
- ...exponentially worse, driving fraud, abuse, and manipulation at a... ...and we're looking for a second senior designer to own significant surfaces... ...technical products built for expert users. Expert in Figma:... ...grade delivery. Fluent with AI coding agents (Cursor, Claude, Codex)...SeniorFraudInterim roleWork at officeRelocation
- ...have a legal entity. Responsibilities Senior Machine Learning Engineer — Agentic Search... ....Contribute to technical design and code reviews, mentor engineers, and help the team... ...of employment with Atlassian for employment fraud purposes.Job SummaryCategory: EngineeringSeniorFraudWork at officeLocal area
$85k - $105k
...and services solutions for the marking & coding, consumer engagement, product traceability... ...through the physical world. As a Senior Media Advisor (Sr. Account Executive), you... ...alert applicants to internet job posting fraud, where parties posing as Dover employees,...SeniorFraudFull timeWork experience placementWorldwide- The University of Rochester seeks a Medical Records Coder III to perform advanced coding, abstraction, and analysis of medical documentation in a remote-work setting in New York. You will assign procedural terminology and codes (ICD-10-CM, CPT, HCPCS) in accordance with...SeniorRemote job
$110k - $140k
...experienced and strategic-minded Senior Media Manager to lead and... ...Presentation or Pair Programming/Live Coding exercise depending on the role... ...from individuals falsely claiming to be from Flywheel. We've... ...applications. Report suspected fraud to local authorities immediately...SeniorFraudFull timeWork at officeLocal areaImmediate start3 days per week$58.66k - $81.68k
Description Responsible for office, out-patient, and inpatient physician coding. Provides education regarding documentation requirements for improved quality of coding and to ensure accurate and complete capture of revenue. Responsibilities 1.Responsible for performing...SeniorTraineeshipWork at officeLocal area- ...is seeking a skilled Medical Coder to perform thorough medical record review, abstract data for statistical requests, and assign ICD codes. The role requires extensive hospital coding experience and CCS or CIC certification, with HIPAA compliance and teamwork across the...Senior
$125k - $175k
Senior Claims Specialist Date: Jan 7, 2026 Company: Odyssey Headquartered in New York City with offices throughout the U.S. and in Vancouver... ...coverage on policies. Determine potential subrogation and fraud within complex cases. Provide timely updates to management...SeniorFraudWorldwide$136.8k - $205.2k
...organization.About the RoleWe are hiring a senior engineer to lead technical strategy work... ...automations; the API, authorization, and fraud controls that make them safe; evaluation of... ...work with vendor platforms as often as with code we write ourselves, and much of the job is...SeniorFraudFull timeTemporary workWork at officeImmediate startRemote work- PMA Companies seeks a Remote Full-time Claims Investigator to independently analyze and resolve complex workers' compensation claims. You will assess coverage, reserves, and settlement options while coordinating with medical and nurse teams to support return-to-work strategies...SeniorRemote jobFull time
- ...more.Job DescriptionWe are looking for a senior engineer who can operate at the intersection... ...Own and maintain infrastructure-as-code across (e.g., Terraform) cloud providers,... ...audit logs, identity provider logs, payment/fraud logs, WAF logs) Design, build, and tune detection...SeniorFraud
$196.5k - $291.5k
...as developers shift from docs-first integration toward LLMs and coding agents, getting Braintree built into major LLMs as native plugins... .... To learn more about how to identify and avoid recruitment fraud please visit . For the majority of employees, PayPal's balanced...SeniorFraudFull timeWork at officeLocal areaImmediate startFlexible hoursShift work$225k - $300k
...frictionless experiences.We are seeking a Senior Product Security Engineer to serve as a... ...customers to provide insight and support their fraud and identity initiatives.Mentor and grow... ...teams, measured by uptake of secure coding practices and reduction in security debt....SeniorFraudCasual workWork at officeFlexible hours- ...York. You will independently manage accounts, follow up on outstanding claims, and prepare resubmissions and appeals to maximize reimbursement. The ideal candidate has hands-on CPT/ICD-10-CM coding knowledge, thrives in a fast-paced environment, and communicates effectively...Senior
$56.16k - $99.36k
...performance to ensure contractual targets and quality expectations are met. Monitor and support daily financial recovery activities to ensure negative balance claims and identified overpayments are recovered timely and appropriately. Engage directly with Special Handling,...SeniorContract workWork experience placement- ...focused, and intent on shipping high-quality code that best leverages our efforts. We're... ...interests different from our own. As a Senior Backend Engineer, you will develop reliable... ...in conferences and events Recruitment Fraud Alert: If you receive an email from a...SeniorFraudWork at officeWorldwide
$230k - $285k
...We are seeking an exceptional Senior Software Engineer to join our... ...complex systems using AI coding agents (we use Claude Code) ~... ..., Teladoc Health and more. Fraud and Security Notice: Please be... ...have been contacted by someone claiming to be a Garner recruiter or a...SeniorFraudWork at officeFlexible hours3 days per week- ...tasks and projects. Are you looking for an opportunity to join a claims team with a fast-growing company that has consistently outpaced... ...and expectations. Alerts Unit Leader to the possibility of fraud or subrogation potential for claims being processed. Qualifications...SeniorFraudWork at officeLocal areaRemote work
$151.59k - $183.8k
...seeks Marketing Reporting and Analytics Senior Manager at its facility located at 155 E... ...skills to accurately interpret and editing coding languages and scripts to extract large datasets... ...(live or video), and screen for fraud or misrepresentation. Applicants who falsify...SeniorFraudFull timePart timeRemote workVisa sponsorshipWork visaFlexible hours
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