Healthcare Fraud Investigator & Compliance Lead
Highmark Health
Highmark Inc. is seeking an anti-fraud investigator to develop and maintain an enterprise-wide anti-fraud program. The role involves conducting investigations into suspected fraud, waste and abuse across providers, members and staff, delivering training, and coordinating audits and reports with compliance and regulators. The position requires a Bachelor’s degree and at least 3 years in health insurance or healthcare fraud investigations, with strong analytical and communication skills. #J-18808-Ljbffr Highmark Health
$65k - $88.6k
...Humana is looking for an experienced Healthcare Investigator to join its industry leading Special Investigations Unit. Do... ...you have a passion for combating Fraud, Waste, and Abuse in the Health... ...thorough investigation to maintain compliance with Humana and governmental...SuggestedFull timeTemporary workFor contractorsApprenticeshipWork experience placementWork at officeLocal areaRemote workWork from homeHome officeMonday to Friday$164.6k - $274.4k
...that touches virtually every aspect of healthcare. We are known for delivering insights, products... ...today, we want to hear from you.Title: Lead Counsel, Digital Marketing & Ad TechHub... ...advertising technologies, marketing compliance, and consumer protection matters. This role...SuggestedFull timeFixed term contractWork at officeRemote work- ...713 NW Bancshares HQJob DescriptionThe Fraud Analyst is responsible for detecting, preventing... ...activity and creating cases for Investigators to ensure timely and accurate... ...incidents. Additionally, the position ensures compliance with regulatory requirements and contributes...SuggestedFull timeWork at office
- ...You will optimize charge capture, coding, billing, collections, denials, and reimbursements while ensuring accuracy and regulatory compliance. You will analyze revenue cycle data, report trends, and propose improvements. This full‑time, onsite role requires a strategic...SuggestedFull time
- ...solve major societal problems. With a focus on innovations in healthcare, Aegis has launched four successful portfolio companies in... ...their innovative data cloud platform. About the Job As our Compliance Lead, you'll own and operationalize our compliance program - turning...Suggested
- ...seeking a Credentialing Leader to maintain provider credentials and ensure timely filing for insurance and hospital contracting. You will lead the Credentialing Coordinator team and coordinate with hospitals, medical boards, and payer contracts. The role emphasizes strong...
- Avandra Imaging is seeking a Compliance Lead to own and operationalize its compliance program across HIPAA, HITRUST, and SOC 2. You’ll build an audit-ready system protecting PHI across a growing health system network. You will work with IT & Security, manage risk assessments...
$66.64k - $78.4k
...Partners with their assigned line of business, other risk/compliance/audit (RCA) professionals, and RCA managers to create, implement... ...you peace of mind. Our benefits include the following: ~ Healthcare (medical, dental, vision) ~ Basic term and optional term life...Temporary workWork experience placementWork at officeLocal area3 days per week$26.42 per hour
...Base pay range $26.42/hr - $26.42/hr Lead Executive – US Recruitment | Talent Acquisition... ...Operations Specialist to support our fraud investigations and regulatory reporting team. This... ...and documenting findings that support compliance with federal regulations. The role...Contract work- ...Nationwide Mutual Insurance Company seeks a Senior Compliance Consultant to strengthen fraud governance across the enterprise. You will collaborate with... ...automation, and regulatory reporting, with opportunities to lead a small team and influence controls and policies....
- ...create, implement, maintain, review or oversee an effective risk management framework. You will work across multiple teams to ensure compliance with applicable laws and internal controls. The role emphasizes identifying gaps, implementing solutions to minimize losses from...
- ...Chase in Columbus, OH is seeking a Card Fraud Risk Oversight Associate to monitor... ...trends, detect anomalies, and support investigations while ensuring regulatory and audit aligned... ...collaborate with Fraud Operations, Risk, Compliance, and Technology to improve data quality...
- Highmark Health seeks a seasoned investigator to lead enterprise-scale incident management investigations, including fraud, privacy and security concerns across multiple business... ...and fraud-related audits, ensuring compliance with standards and enhancing risk controls...
- Klarna in Columbus, OH is seeking a senior fraud and AML reviewer to support high-quality financial crime monitoring... ..., Fraud, and AML, identify deviations, and strengthen investigative accuracy to empower Compliance and Operations with data-driven insights. You will own...
- ...& Joint to oversee staffing, operations and patient experience. You will lead recruiting, onboarding, scheduling, payroll coordination, and liaise with providers and HR to ensure HIPAA compliance and efficient daily workflows. This role requires strong leadership, communication...Full timeWork at office
- ...gathered for billing, clinical, physicians’ relations, clergy, compliance and statistical purposes. Accurate data is gathered prior to or... ...days per week. Position Summary The Registration Coordinator Lead carefully and patiently interviews patients and/or family members...
- JPMorgan Chase & Co. is seeking a Card Fraud Risk Oversight Associate to transform large... ..., strengthen governance, and support investigations while aligning with regulatory and... ...Collaboration with Fraud Operations, Risk, Compliance, and Technology is essential. #J-18808...
- Lynx EMS is seeking a Day Shift Paramedic in Ohio to lead clinical operations during peak daytime periods. You will oversee ALS care, guide EMT partners, and ensure protocol compliance while delivering high-quality patient care. The role emphasizes strong clinical judgment...Full timeDay shift
$173.3k - $288.8k
..., Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services... ...is seeking a Senior Director, SOX Governance & Enterprise Compliance to lead enterprise-wide Sarbanes-Oxley (SOX) management, governance,...Full time- Mount Carmel Health System in Columbus, OH, seeks a Regulatory Specialist to design and facilitate compliant processes across facilities. You will drive accreditation readiness and integrate regulatory requirements into daily patient care and planning. The role emphasizes...
$64.25 per hour
...financial auditing position. Responsibilities include analyzing and reviewing financial statements of insurance companies to ensure compliance with regulations. The ideal candidate should hold an AFE, CPA, or CFE designation, with relevant experience. The position offers...Full time$32.08 per hour
...Field Investigator (Public Utilities Gas Pipeline Safety Compliance Investigator) Field Investigator (Public Utilities Gas Pipeline Safety Compliance Investigator... ...utility service. FOFD staff also acts as the agency lead for the damage prevention complaint reporting and...Hourly payFull timeContract workFor contractorsLocal areaRelocationLong distanceFlexible hoursNight shift- ...comprehensive real estate solutions for the healthcare industry. With a team of over 150... ...transactions, operations, and regulatory compliance. We are honored to have received the "Best... .... Specific Responsibilities Include Lead business development efforts for the Rocky...Contract workWork at officeNight shift
- ...Management System across project locations in Ohio. You will lead safety staff, drive compliance, and champion continuous improvement. The role... ...knowledge and data analysis. You will coordinate audits, investigations, and training, ensuring safe operations with a high-...
$158.3k - $263.9k
...driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services... ...experienced and hands-onLead Integration/EDI Architect to lead the design, modernization, and ongoing evolution of enterprise...Full time- ...Quality Lead ODW Logistics, a Top 50 Third Party Logistics provider, has strong company values of Respect-Trust-Team-Opportunity... ...setting up procedures and inspect all incoming materials to verify compliance to specifications. Responsibilities include: Accept or...
$70k - $74k
...reputable staffing agency is seeking a Production Supervisor to lead packaging operations in the South Columbus, OH area. The... ...will oversee production, manage inventory, and ensure regulatory compliance. Ideal candidates will have a background in regulated environments...Full time$85.9k - $167.02k
...retail, hospitality, light industrial, healthcare, and worship, CESO has the opportunity for... ...connect! At CESO, an Architecture Team Lead brings advanced architectural expertise... .... Offer expert guidance on design, code compliance, and technical problem-solving, including...Temporary workCasual workWork at officeFlexible hours- ...a commitment to its workforce, Kokosing is the winning team.Job Description:We are looking for a Security Governance, Risk, and Compliance (GRC) Analyst to support and mature our security and compliance programs across a large construction organization. This role focuses...Full timeFor contractors
- ...Lead Renal Dietitian - Ohio & Michigan Concerto Renal Services is an industry leader in nursing home dialysis. We are a rapidly... ...quarterly audits to ensure documentation accuracy and regulatory compliance. Monitor staff competency, productivity, and clinical...Temporary work
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