Nurse Medical Claims Reviewer — Fraud Analytics (Remote)
Peraton
Peraton’s SafeGuard Services seeks a Nurse Reviewer to conduct medical record reviews, applying clinical judgment to claim payments and supporting fraud investigations.
Telework is available from any state. The ideal candidate will hold a US nursing license, have 5+ years with a Bachelor's (or 3 years with a Master's, or 7 with an Associate), and demonstrate strong investigative, communication, and organizational skills.
#J-18808-Ljbffr$67.7k
...innovation. Medical Claims Reviewer Overall Purpose... ...referrals for potential fraud and/or abuse, and... ...license as defined by the Nurse Licensure Compact (... ...or influence others. Analytical or critical thinking... ...Work Location: remote within three hour driving...Remote workClaimsFraudFull timeContract workFor contractorsLive inWork at officeWork from homeHome officeMonday to FridayFlexible hoursShift work- ...you a registered nurse ready to take your... ...setting to review and audit claims, supportprogram integrity... ...to analyze medical records, documentation... ...nursing judgment analytically Interest in... ...vulnerable populations Remote work - enjoy the... ...potential fraud, waste, or abuse...Remote workClaimsFraudFull timeTemporary workWork at office
- ...Registered Nurse: Review and Evaluation Are... ...review and audit claims, support program... ...judgment to analyze medical records, documentation... ...nursing judgment analytically Interest in... ...populations Remote work enjoy the convenience... ...potential fraud, waste, or abuse....Remote jobClaimsFraudFull timeTemporary workWork at officeWork from home
$100k - $120k
...change. Position: Nurse Subject Matter... ...(SME) Location: Remote About J29... ...specializes in processing, reviewing, and analyzing medical claims, records, disputes,... ...healthcare reviews, fraud, waste, and abuse (FWA... ...experience and analytical expertise to support...Remote workClaimsFraudFull timeContract workFor contractors$161k - $378k
Data Platform Analytics ArchitectThis role has been designated as ‘Remote/Teleworker’, which means you will primarily work from... ...criminal histories.Recruitment Fraud AlertWe have become aware of an... ...credentials of any third party claiming to represent the company. Any reliance...Remote workClaimsFraudFull timeWork experience placementLocal areaImmediate startWork from homeFlexible hours- ...on us to manage their fraud, credit, and compliance... ...data layer behind our analytics product and design of our... ...benchmarks rather than vendor claims. Build observability... ...: 100% of your Medical/Dental (Care Plus) for... ...allowance. Flexibility: Remote first culture....Remote workClaimsFraudFull time
$100k - $166k
...The Manager, Marketing Analytics leads measurement, analysis,... ...an annual performance bonus, Medical, dental and vision benefits,... ...Fair Chance Act. JOB ALERT FRAUD: We have become aware of... ...organizations, and internet sites claiming to represent Pharmavite in recruitment...Remote workClaimsFraudLocal areaWork from home$138.75k - $161.25k
...alongside Extend's best-in-class fraud detection. By integrating... ...Role: We're looking for an Analytics Engineer to help ensure data integrity... ...and external systems. Claim Reimbursement & Contract Sales... ...on experience, with full medical and dental & vision benefits....Remote workClaimsFraudContract workFlexible hours$100k - $120k
...It takes great medical minds to create powerful... ...a Medical Reviewer (Optometrist) to provide... ...medical records, claims, Treatment... ...previously sanctioned for fraud or abuse.... ...time position. Remote work environment.... ...with physicians, nurses, other clinical specialists...Remote workClaimsFraudFull timeWork from homeHome officeMonday to FridayFlexible hours$100k - $140k
...It takes great medical minds to create powerful... ...a Medical Reviewer (Pharmacist) to provide... ...pharmacy review, claim adjudication, drug... ...with physicians, nurses, pharmacy teams, operations... ...sanctioned for fraud or abuse. Three... ...time position. Remote work environment....Remote workClaimsFraudFull timeWork from homeHome officeMonday to FridayFlexible hours$88k - $115k
...Requirements The Senior Nurse Reviewer performs complex medical record reviews of... ...A/B and DMEPOS claims that require... ...for overpayment or fraud. Using established... ...application ~ Strong analytical, written, and verbal... ...functions. This is a remote position. While...Remote workClaimsFraudFull timeContract workLocal area$40 - $55 per hour
...Medical Reviewer, RN - Temporary Position Location: Remote *This role is a temporary position and that employment is expected... ...review, and analysis of medical claims, records, data, and audits... ...Active license as a Registered Nurse, in good standing, in the United...Remote workClaimsHourly payTemporary workFor contractorsLocal area- ...Registered Nurse Dialogue is the #1 virtual care... ...an efficient and fair review process, we utilize artificial... ...role. Recruitment Fraud Notice Dialogue only... ...communication claiming to be from Dialogue, do... ...located at the time of the remote consultation. Upon hiring...Remote workClaimsFraudFull timePart timeWeekend workAfternoon shift
- ## Utilization Review NurseApplyremote... ...Review Nurse, LPN** to evaluate... ...This role reviews medical information submitted... ...in an analytical, process-driven... ...and three days remote. Candidates must... ...healthcare providers, claims professionals,... ....**Recruitment Fraud:** Please visit...Remote workClaimsFraudWork at officeImmediate startFlexible hours2 days per week
$150k - $175k
...It takes great medical minds to create powerful... ...a Medical Reviewer (Radiologist) to provide... ...radiology-related claims, Treatment... ...with physicians, nurses, other clinical specialists... ...sanctioned for fraud or abuse. Strong... ...time position. Remote work environment....Remote workClaimsFraudFull timeWork from homeHome officeMonday to FridayFlexible hours$109.75k - $116k
...activities related to nursing homes (long... ..., providers, medical and... ...investigative and analytical skills. Strong... ...approved to work remotely, must have secure... ...site facilities review assignments.... ...utilization review, claims adjudication, medical review, fraud investigation,...Remote workClaimsFraudHourly payWork at office- ...the infrastructure that makes medical practices actually get paid. We... ...Process medical billing claims accurately and efficiently using... ...specific to podiatric procedures. Review patient records to ensure all... ...of HIPAA compliance, fraud prevention, and audit readiness...Remote workClaimsFraudHourly payFull timeContract workFor contractorsWork at officeTrial period
$80k - $90k
...Clinical Coder (Inpatient Facility Coding) – Remote $80,000–$90,000 | Contract-to-Hire | 10... ...operations team supporting complex medical claims reviews and coding accuracy. This is a fully... ...discrepancies, quality concerns, and potential fraud Serve as a coding subject matter...Remote workClaimsFraudPermanent employmentFull timeContract work- ...RN / Medical Reviewer / Remote Job Details Professional Discipline : Registered Nurse Specialty : Utilization Review Employment Type : Full Time City : Columbia... ...necessity using your clinical proficiency and claims knowledge. This is a REMOTE opportunity...Remote workClaimsFull timeContract workLocal areaShift work
- ...Position: AI Engineer Location: Remote/Hybrid (subject to contract requirements... ...datasets, including Medicare, Medicaid, claims, provider, beneficiary, or clinical data... ...Snowflake, Spark/PySpark Healthcare analytics, fraud/waste/abuse detection, risk adjustment,...Remote workClaimsFraudFull timeContract work
$60 - $70 per hour
Position: Senior Fraud Operations SpecialistLocation... ...response times.Strong analytical and critical thinking... ..., Monday to Friday remote) 6 Infinite Loop Cupertino... ...to benefits including medical, dental, vision and 40... ...email, or phone call claiming to be from PTR Global...Remote workClaimsFraudFull timeMonday to Friday- ...Duration : Fulltime Location : Remote (100%) - TX / NY / DE Preferred Industry... ...investigation & Streamlining Consumer claims for fraud & disputes Responsibilities :... ...architecture. Strong problem-solving and analytical skills. Excellent communication and...Remote workClaimsFraudFull time
$21 per hour
...seeking an RN Clinical Reviewer - Remote for a temp-to-hire... ...opportunity supporting clinical claims review within the... ...Rico Registered Nurse or certified coding professional... ...who enjoys reviewing medical documentation,... ...are detail-oriented, analytical, and comfortable working...Remote jobClaimsHourly payContract workTemporary work- ...CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical... ...for reviewing and making medical determinations as to the validity of health claims and levels of payment in meeting... ...includes surfacing potential fraud and abuse or practice concerns...Remote workClaimsFraudPermanent employmentWork at officeLocal area
- ...including HIPAA, the False Claims Act, the Anti-Kickback... ...: Hybrid (Remote/On-Site). Must reside in... ...across ARH.• Periodically review contracts for compliance... ...education on HIPAA and fraud and abuse laws as appropriate... ....• Strong writing and analytical skills. • Ability to convert...Remote workClaimsFraudWork experience placementWork at officeDay shift
$100 per hour
...Claims Specialist | $100/hr Remote | Mercor This range is provided by Crossing... .... Documentation Review: Review third-party... ...police reports, medical records, and vendor... ...liability assessments. Fraud Detection: Identify... ...communication and analytical skills....Remote workClaimsFraudHourly payContract workFor contractorsFlexible hours- ...Solution Consultant Location: Remote (USA) About the Role We... .... Analyze healthcare claims data to provide relevant, customer... ...Background in healthcare fraud, waste & abuse (FWA), investigations... ...abilities. Strong analytical and problem-solving skills....Remote workClaimsFraud
- ...shape the future of healthcare. Alivia Analytics helps healthcare payers find and... ...platform pairs analytics with expert review to surface fraud, waste, and abuse across Medicare, Medicaid... ...paired with real healthcare-claims depth. What You Will Do Identify...Remote workClaimsFraud
- ...Medical Reviewer PositionJoin our team serving active and retired... ...and review of medical claims and utilization... ...This position will be remote after 6 months of onsite... ...of Licensed Practical Nursing or Licensed Vocational... ..., and grammar skills. Analytical or critical thinking skills...Remote workClaimsFull timeContract workFor contractorsWork at officeLocal areaMonday to FridayNight shift
- ...SIU) activities specific to medical provider coding fraud, waste and abuse (FWA).... ...Independently re-evaluates medical claims and associated records by... ..., and Molina policies. • Reviews post-pay claims against... ..., problem-solving and analytical skills. • Knowledge of investigative...Remote workClaimsFraudContract workWork at officeLocal area
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