Senior FWA Investigator - Healthcare Claims & Compliance
$46.99k - $112.2kHispanic Alliance for Career Enhancement
CVS Health is seeking a Sr. Analyst, Fraud, Waste, and Abuse to detect and investigate incidents related to FWA in healthcare services. The role requires strong analytical skills to review claims data and ensure compliance with federal and state regulations. Applicants should have 3-5 years of experience, a coding certification, and possess a keen attention to detail. The position includes a comprehensive benefits package and offers a salary range from $46,988 to $112,200. #J-18808-Ljbffr Hispanic Alliance for Career Enhancement
- ...CVS Health is seeking a Sr. Analyst, Fraud, Waste, and Abuse to help detect and investigate incidents of FWA. This role will involve extensive analysis of claims data, preparing detailed investigative reports, and collaborating across departments. The ideal candidate will...SeniorClaimsFull time
- ...analysis. This role demands proficiency in data review and the ability to investigate FWA complaints while ensuring compliance with applicable standards. Ideal candidates should bring 3-5 years of healthcare experience, alongside CPC certification and a strong grasp of coding...SeniorClaims
- ...Sr. Analyst for Fraud, Waste, and Abuse in Delaware. This role involves detecting and investigating incidents of FWA in healthcare services, reviewing claims, and ensuring compliance with federal and state regulations. Ideal candidates should have 3-5 years of experience...SeniorClaims
$46.99k - $112.2k
...seeking a Sr. Analyst to assist with the detection and investigation of fraud, waste, and abuse related to healthcare services. This role requires strong analytical... ...experience. Responsibilities include reviewing claims data, assisting with investigations, and referring...SeniorClaimsFull time$70k - $90k
Senior Investigator - Pre-Pay (Healthcare FWA) Job Location: US-Remote Overview As a Senior Investigator, you will... .... Utilizes data analytics, claims review, and industry intelligence... ...potential fraud, waste, abuse, or non-compliance. Leverages claims data, dashboards...SeniorClaimsWork experience placementWork at officeRemote workWork from home$66.33k - $145.86k
...Resources, LLC is hiring an individual contributor for a role focused on healthcare fraud investigations in New York. This position involves directing investigations, ensuring regulatory compliance, and analyzing data for fraud patterns. A Bachelor's degree and 5+ years...SeniorFull time$60.2k - $107.4k
A leading health care organization is looking for a Senior Investigator Pharmacy to tackle healthcare fraud, waste, and abuse. The role includes investigating... ...with relevant experience, and knowledge of pharmacy claims processing is preferred. The position requires up to...SeniorClaims$70k - $90k
A leading healthcare analytics firm is seeking a Senior Investigator to investigate incidents of healthcare fraud, waste, and abuse through data analysis. This remote... ...'s degree, 5-8 years of experience in healthcare FWA investigations, and advanced Excel skills....SeniorRemote job$66.33k - $145.86k
...contributor role supports complex investigations and contributes to organizational compliance with federal and state... ...investigations related to healthcare fraud, waste, and abuse (FWA), with a focus on... ...providers submitting non-NSA claims to CIDRE. Prioritizes and...ClaimsHourly payFull timeTemporary workLocal area- ...Conduct complex, in-depth investigations of reported fraud involving the full range of healthcare products. Develop and maintain relationships with law enforcement (HHS... ...sources to review for suspect activity. Review claim files and develop action plans for the investigation...SeniorClaimsWork experience placementRemote work
- ...for Career Enhancement is seeking an experienced investigator for healthcare fraud, waste, and abuse compliance in New York. This role requires at least 5 years in... ...healthcare fraud investigations, expertise in analyzing claims data, and strong analytical skills. The candidate...Claims
$46.99k - $122.4k
...for Career Enhancement is hiring for a position focused on investigating healthcare fraud cases. The ideal candidate will have a Bachelor’s degree... ...include handling complex cases, preventing fraudulent claims, and interacting with various stakeholders. This full-time...SeniorClaimsFull time- ...Health in Pennsylvania is seeking a skilled professional to manage complex cases involving health care fraud. The candidate will investigate claims, collaborate with law enforcement, and ensure adherence to health care regulations. Interested individuals must hold a degree...SeniorClaimsFull timeWork at office
- Centene Management Company LLC is seeking a skilled investigator to handle allegations of healthcare fraud and abuse in New York. In this role, you'll plan, organize, and execute claims investigations, utilizing your expertise in data mining and report creation. The ideal...SeniorClaimsRemote jobFlexible hours
$60.2k - $107.4k
Senior Investigator Pharmacy At UnitedHealthcare, we're simplifying... ...and prevention of healthcare fraud, waste and... ...investigator will use claims data, applicable guidelines... ...referrals Ensure compliance with applicable... ...fraud, waste and abuse (FWA) 2+ years of experience...SeniorClaimsFull timeTemporary workWork experience placementLocal areaRemote work- ...to manage strategic fraud, waste, and abuse activities. This position requires knowledge in healthcare and compliance, with strong experience in medical claims and investigations. Candidates should have a Bachelor's degree and at least 4 years in relevant fields. The...SeniorClaimsRemote workFlexible hours
$216.42k - $324.63k
...Lyric, an AI-first healthcare technology company, is seeking a Clinical Ambassador. This full-time role involves engaging with payer clients... ...success is shared. Candidates should have an understanding of claims operations and payment integrity programs. #J-18808-Ljbffr...SeniorClaimsFull time- ...platform for consumers and customers. As a Senior Fraud and Abuse Operations Analyst ,... ...responding to fraud and abuse events, investigating claims, and triaging incidents. We also... ...communicate effectively with internal Legal, Compliance, Comms and other risk management teams...SeniorClaimsWork experience placementLocal area
- ...Responsibilities Conducts investigations into allegations of fraud, waste... ...and analyzes medical records, claims data, enrollment data, and... ...documentation to evaluate potential FWA. Performs coding, billing,... ...Coder (CPC), Accredited Healthcare Fraud Investigator (AFHI), Certified...SeniorClaimsWork at office
$120k - $150k
...Recruitment is actively seeking two Actuarial Analysts to support a healthcare client in New York. These analysts will play a crucial role in... ...of relevant actuarial experience, particularly with Medicare claims data and Value Based Care. The ideal applicants will also...SeniorClaims$120k - $150k
...looking to drive change in the marketplace. Healthcare client from the Northeast is in search... ..., including experience in Medicare claims data, Value Based Care &emerging ACO models... ...be able to speak confidently to clients &senior leaders and possess strong technical...SeniorClaims- ...technology platform that helps healthcare providers get paid fairly in... ...dispute underpaid claims, reduce administrative burden... ...for a strategic, high-impact Senior HR Business Partner to play a... ...healthtech, or highly regulated/compliance-driven industries Prior people...SeniorClaimsRemote workFlexible hours
- ...seeks a Program Integrity Auditor who will review records for various healthcare providers, ensuring compliance with coding and documentation standards. Responsibilities include auditing Medicaid claims and providing education to providers on coding rules. The ideal...Claims
$87.65k - $98.6k
Senior Actuarial Data Analyst - Healthcare Salary: $87,647.11 - $98,603.00 Must reside in NY, NJ or CT Join VillageCare... ...monthly close process, conducting claim reserve analysis, and creating... ...financial statements, and ensure compliance with regulatory reporting...SeniorClaimsFull timeWork experience placementWork from home- ...financial and operational performance. Compiles claims, enrollment, revenue, and other... ...Monitors and translates key reimbursement, healthcare reform, and regulation policy issues... ...implement these changes and presents to senior management. Work is typically performed...SeniorClaimsWork experience placementWork at office
- ...Senior Recruiter Brellium's mission is a big one – to improve... ...standard of care across the US healthcare system. We've built AI-... ...platform built to fix clinical and compliance risks before they impact... ...aware of fraudulent job offers claiming to be from Brellium. All legitimate...SeniorClaims
$230k - $300k
...standard of care across the US healthcare system. We've built AI-... ...platform built to fix clinical and compliance risks before they impact... ...THE ROLE We're hiring a Senior Backend / Infrastructure Engineer... ...of fraudulent job offers claiming to be from Brellium. All legitimate...SeniorClaims$230k - $300k
...standard of care across the US healthcare system. We've built AI-... ...platform built to fix clinical and compliance risks before they impact... ...The Role We're hiring a Senior AI Engineer to own and evolve... ...aware of fraudulent job offers claiming to be from Brellium. All legitimate...SeniorClaims- ...Innovaccer in New Jersey is looking for a Medical Coder to ensure accurate coding and claims submission. The role involves reviewing documentation, correcting coding issues, and maintaining coding accuracy. Strong attention to detail and coding knowledge are essential...SeniorClaims
$122.44k
...oversee program performance, compliance, quality control, training,... ...proactive working relationship. Investigate and resolve action items... ...related field. 10+ years of healthcare program management, utilization... ...pricing large stop‑loss claims in coordination with clinical...SeniorClaimsFor contractorsWork at officeRemote workMonday to Friday
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