Senior Healthcare Claims Investigator - Fraud & Abuse
Insight Global
Insight Global is seeking a Senior Healthcare Claims Investigator in Los Angeles, California, to manage a high volume of claims for a leading healthcare client. In this role, you will lead complex fraud, waste, and abuse investigations by analyzing claims and patient records, while working closely with legal teams to ensure compliance. You will conduct interviews, gather evidence, and produce detailed reports, supporting audits and mentoring junior team members along the way. #J-18808-Ljbffr Insight Global
Vacancy posted 13 hours ago
Similar jobs that could be interesting for youBased on the Senior Healthcare Claims Investigator - Fraud & Abuse in Los Angeles, CA vacancy
- UnitedHealthcare is seeking a Senior Investigator Pharmacy to identify, investigate and prevent healthcare fraud, waste, and abuse. This role focuses on utilizing claims data and conducting field investigations. Applicants must reside within commutable distance to Los Angeles...SeniorFraudRemote jobWork experience placementWork at office
- Insight Global is seeking a Clinical Healthcare Fraud Investigator in Los Angeles to support high volume claims for a top healthcare client. This role involves conducting full-cycle investigations leveraging regulatory and clinical expertise, mentoring fellow investigators...SeniorFraud
- A government service provider in Los Angeles is seeking an experienced ACE Investigator to assist a Federal agency project. This role involves generating investigations related to fraud, analyzing data, and preparing reports for legal use. Applicants should possess strong...SeniorFraud
$72k - $141k
...limits, to manage commercial claims with high complexity and exposure... ...policy coverage, conduct investigations, develop and employ resolution... ...opportunities or potential fraud occurrences by evaluating the... ...resolved and paid timely. Keeps senior leadership informed of...SeniorFraudWork experience placementWork at officeLocal areaShift workCNA Insurance
Los Angeles, CA1 day ago- Insight Global is seeking an SIU Investigator in Los Angeles, CA to investigate healthcare fraud, waste, and abuse across providers and members. The investigator will perform thorough analyses of billing data, gather evidence, and interview individuals to build comprehensive...Fraud
$60.2k - $107.4k
...start Caring. Connecting. Growing together. The Senior Investigator Pharmacy is responsible for identification, investigation and prevention of healthcare fraud, waste and abuse. The Senior Investigator will utilize claims data, applicable guidelines and other sources...SeniorFraudMinimum wageFull timeTemporary workWork experience placementLocal areaRemote workMonday to Friday$90.2k - $175.1k
...trials. In this role, you’ll partner with investigative sites and cross-functional teams to... ...Bring Bachelor’s degree in life sciences, healthcare, or related field (or equivalent... ...a zero tolerance policy for candidate fraud. All information and credentials submitted...SeniorFraudFull timePart timeImmediate startWorldwide$105.7k - $234.5k
...Support a high-impact compliance investigation function focused on... ...regulatory accountability. The Senior Compliance Investigator... ...regulatory concerns, including fraud, waste, abuse, and violations of federal... ...with federal and state healthcare regulations, enforcement trends...SeniorFraudWork at office$105.7k - $234.5k
...Support a high-impact compliance investigation function focused on... ...regulatory accountability. The Senior Compliance Investigator... ...regulatory concerns, including fraud, waste, abuse, and violations of federal... ...with federal and state healthcare regulations, enforcement trends...SeniorFraudWork at officeLocal area- AIDS Healthcare Foundation is looking for a Claims Investigator-Examiner in Los Angeles, CA to join their dynamic Claims Department. The role involves examining and adjudicating claims for various health plans, ensuring accuracy and timeliness of payments, and providing...
- ...Clinical Healthcare Fraud Investigator We're looking for a Clinical Healthcare Fraud Investigator to support a high volume of claims for a leading healthcare client. This role owns full-cycle investigations from intake through closure, leveraging deep clinical, coding...Fraud
- California Bank of Commerce in Los Angeles seeks a Fraud Investigator dedicated to assessing and identifying risks linked to fraud. This role requires strong analytical skills and collaboration with various teams to conduct thorough investigations. Applicants should possess...SeniorFraud
- Job Description We’re looking for a Clinical Healthcare Fraud Investigator to support a high volume of claims for a leading healthcare client. This role owns full-cycle investigations from intake through closure, leveraging deep clinical, coding, and regulatory expertise...Fraud
$135k - $145k
...was founded in 2021 by mission-aligned healthcare leaders and organizations that are committed... ...for vulnerable older adults and frail seniors. We specialize in providing value-based,... ...to employment. Beware of Scams and Fraud Please beware of scams that solicit interviews...SeniorFraudTemporary workPart timeWork at officeLocal areaRemote workMonday to FridayFlexible hours$117.51k
...Job Summary The Senior Manager, Payment Integrity... ...the reliability of claims processing,... ...review or escalated investigation. Oversees operational... ...medical cost containment, Fraud Waste and Abuse (FWA), data mining,... ...Terminology (CPT), Healthcare Common Procedure Coding...SeniorFraudDaily paidFull timeContract work- ...Senior Counsel, Toxic Tort and Product Liability Defense About the Company Respected law firm Industry Legal Services Type Law Firm About... ...toxic tort, asbestos, general liability, employment, bad faith/fraud, or insurance defense. While trial experience is a plus, it is...SeniorFraud
Confidential
Los Angeles, CA5 days ago - ...INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation! Does the idea of doing... ...health. Contribution Profile The Claims Department is a dynamic department that... ...and AHF grants and contracts. The Claims Investigator-Examiner contributes to AHF's mission by...
$33 - $45 per hour
F&A Federal Credit Union is seeking a Sr Fraud Analyst/Fraud Manager to monitor, detect, and investigate suspicious transactions. In this role, you will work closely with credit union management and law enforcement while developing fraud prevention strategies. The ideal...SeniorFraudHourly pay- Dormont Manufacturing Co is seeking an Affirmative Civil Enforcement (ACE) Investigator to conduct investigations and civil actions related to fraud in various sectors, including healthcare and federal funds. The ideal candidate will demonstrate strong analytical skills...SeniorFraud
- F&A Federal Credit Union seeks a Sr Fraud Analyst/Fraud Manager responsible for monitoring transactions and investigating fraudulent activities. Key responsibilities include analyzing trends and preparing reports on fraud. The ideal candidate holds a Bachelor’s in accounting...SeniorFraudHourly pay
- ...Healthcare Fraud Investigator Employment Type: Full-Time, Mid-Level Department: Litigation Support CGS is seeking a Healthcare Fraud Investigator... .... Analyze data for evidence of fraud, waste and abuse. Review and evaluate referrals to determine the need...FraudFull timeWork experience placementWork at officeLocal area
$102.18k - $163.49k
L.A. Care Health Plan is seeking a Manager for the Special Investigations Unit. This role involves overseeing fraud investigations and managing a team to ensure operational efficiency and compliance. The ideal candidate will have at least 5 years of experience in fraud...FraudFull timeContract work- JOB SUMMARY This role is dedicated to assessing and identifying risks associated with fraud impacting the bank and its customers. The investigator collaborates closely with banking, treasury, and operations teams to conduct comprehensive fraud investigations. This position...SeniorFraudWork experience placementWork at officeLocal area
- Insight Global is looking for a skilled individual to detect and investigate healthcare fraud. Duties include evaluating leads, ensuring compliance with reporting deadlines, and supporting investigators through data analysis. The ideal candidate will have at least 4 years...Fraud
$88.85k
...Utilization Management (UM) Claims Review Nurse RN II is... ...and monitors for potential fraud, waste, and abuse (FWA). The UM Claims Review... ...Preferred: Strong analytical and investigative skills with the ability to... ...Nurse, EMR, Medicare, Healthcare, Insurance #J-18808-Ljbffr...FraudFull timeL.A. Care Health Plan
Los Angeles, CA13 hours ago$141.83k - $263.41k
Senior Counsel-AML/Financial Crimes job at City National Bank. Los... ...financial crimes, including fraud and elder abuse. Provide legal support for relevant investigations, regulatory reporting, and regulatory... ...including: Comprehensive healthcare coverage, including Medical,...SeniorFraudRemote work- ...Activity Reports of the activity identified as suspicious or fraud related. Is the primary person responsible to maintain the records... ...the Bank Secrecy Act. Develops, implements, and manages the investigation of SARWs and related fraudulent activity. Prioritize focus...SeniorFraud
$92.5k - $120k
...an opportunity has been created for a Senior Associate to join our nationally distributed... ...and controls automation Forensic/investigative/internal review assistance (not to... ...Demonstrated experience with forensic reviews (fraud/waste/abuse) What you can expect from us: Our...SeniorFraudWork experience placementWork at officeLocal areaRemote workCherry Bekaert
Los Angeles, CA1 day ago- A financial institution is seeking a Fraud Investigation Specialist in Los Angeles. This role requires a minimum of 7 years of experience in the financial sector and at least 5 years focused on fraud investigation. Candidates should possess excellent knowledge of banking...SeniorFraud
$115k - $165k
UCLA Outpatient Clinics is seeking a Senior Compliance Investigator in Los Angeles to lead complex compliance investigations regarding potential regulatory concerns. The role involves gathering and analyzing evidence, conducting interviews, and preparing comprehensive...Senior
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Senior Healthcare Claims Investigator - Fraud & Abuse. Be the first to apply!
Related searches
- senior data management analyst Los Angeles, CA
- senior app developer Los Angeles, CA
- senior game producer Los Angeles, CA
- senior retail sales associate Los Angeles, CA
- senior manager quality engineering Los Angeles, CA
- senior software test automation engineer Los Angeles, CA
- senior quantitative risk analyst Los Angeles, CA
- senior broker Los Angeles, CA
- senior financial systems analyst Los Angeles, CA
- senior compensation manager Los Angeles, CA