Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

CPC Investigator: Claims & Fraud Audits

Horizon Blue Cross Blue Shield of New Jersey - Headquarters

Horizon Blue Cross Blue Shield of New Jersey is seeking a Certified Professional Coder (CPC) to oversee medical coding and claim investigations. This role involves performing audits, interpreting documentation, and managing fraud investigations. The ideal candidate will have a high school diploma, CPC certification, and 2-3 years of medical coding experience. Located in Newark, NJ, this position offers comprehensive benefits and is vital for maintaining quality health care services. #J-18808-Ljbffr Horizon Blue Cross Blue Shield of New Jersey

Vacancy posted 4 days ago
Similar jobs that could be interesting for youBased on the CPC Investigator: Claims & Fraud Audits in Newark, NJ vacancy
  • $70.5k - $94.4k

     ...The Certified Professional Coder (CPC) performs reviews, audits, and coding oversight of medical...  ...documentation to conduct low‑level investigations, supports fraud research investigators, and...  ...Special Investigations Unit pended claims to meet service level agreements... 
    Claims
    Fraud
    Work at office

    100 Horizon Healthcare Services, Inc

    Newark, NJ
    9 hours ago
  • $70.5k - $94.4k

     ...Certified Professional Coder (CPC) is responsible for performing reviews, audits and coding oversight of...  ...to conduct low level investigations. The incumbent will...  ...Unit pended claims to insure we are meeting...  ...receive and review suspected fraud and to complete cases with... 
    Claims
    Fraud
    Live in
    Local area

    Horizon Blue Cross Blue Shield of New Jersey

    Newark, NJ
    2 days ago
  • $70.5k - $94.4k

    100 Horizon Healthcare Services, Inc is seeking a Certified Professional Coder (CPC) to perform reviews and audits of medical records. The role involves coding oversight ensuring compliance with CPT, HCPCS, and ICD-10 standards. The ideal candidate will possess a high... 
    Fraud

    100 Horizon Healthcare Services, Inc

    Newark, NJ
    9 hours ago
  • $63k - $84.42k

     ...accountable for analytical and investigative activities (external and internal) related to claims, enrollment, accounting and other...  ...detect, receive and review suspected fraud and to complete cases with all...  ..., registrations: AHFI, CFE, or CPC certifications preferred... 
    Claims
    Fraud
    Live in
    Local area

    Horizon Blue Cross Blue Shield of New Jersey

    Newark, NJ
    3 days ago
  • $83.72k - $96.28k

     ...currently have a vacancy for a Senior Civil Investigator. In this role, you will be supporting...  ...Office (USAO), Health Care & Government Fraud Unit (HCGFU). If you are looking for a...  ...areas, including violations of the False Claims Act and cases against individuals as well... 
    Claims
    Fraud
    Temporary work
    Work at office

    Phase2 Technology

    Newark, NJ
    3 days ago
  • $63k - $84.42k

    Horizon Blue Cross Blue Shield of New Jersey seeks a Senior Investigator to ensure the integrity of claims and operations. You'll be responsible for detecting and analyzing potential fraud, working closely with law enforcement and preparing cases for litigation. Ideal... 
    Claims
    Fraud

    Horizon Blue Cross Blue Shield of New Jersey

    Newark, NJ
    3 days ago
  • $135k

     ...Health Plan Operations Manager (Call Center Audit Lead) Start date: ASAP...  ...reimplement audit protocols and team to address claims quality/payment integrity issues. •...  ...(e.g., Certified Professional Coder (CPC), Certified Fraud Examiner (CFE), Certified Internal... 
    Claims
    Fraud
    Contract work
    Immediate start

    Concord IT Systems

    Jersey City, NJ
    9 hours ago
  •  ...Financial Fraud Analyst Grey Street Consulting, LLC (Grey Street), a leading small...  ...statutes. Assists AUSAs in preliminary investigations to confirm such violations. Utilize standard...  ...(GAAP) and Generally Accepted Auditing Standards (GAAS) to conduct financial statement... 
    Fraud
    Full time
    For contractors
    Work at office

    Grey Street Consulting, LLC

    Newark, NJ
    2 days ago
  • $61.4k - $99.68k

     ...Asset Protection Investigator We're looking for an Asset Protection Investigator to provide investigative...  ...or one of our business units. This type of fraud can be carried out through false websites, through fake e-mails claiming to be from the company or through social... 
    Claims
    Fraud
    Full time
    Work at office
    Local area
    Flexible hours
    Shift work

    Collectors Universe

    Jersey City, NJ
    2 days ago
  • $30 - $35 per hour

    Claims Investigator job at Advantage Surveillance LLC. Paterson, NJ. Job Description For the past 27 years, Advantage Investigations has been...  ..., we’re able to save our clients time and money on insurance fraud cases. Advantage Investigations is seeking a Part-Time Claims... 
    Claims
    Fraud
    Bi-weekly pay
    Hourly pay
    Part time
    Work at office
    Flexible hours

    Downtown Boulder Partnership

    Paterson, NJ
    2 days ago
  •  ...legal writing and research, to mentor in the development of a healthcare-related practice, including the defense of claims audits and healthcare fraud, both civil and criminal. As a Litigation Associate with our firm, you will: ● Hone your writing with research memoranda... 
    Claims
    Fraud

    Health Law Alliance

    Springfield, NJ
    1 day ago
  •  ...Job Description CLAIMS AUDITOR We are seeking a Claims Auditor with QI experience...  ...and accurate responses to pharmacy payer audits, desk audits, and onsite audits. · Review...  ...for identifying and escalating potential fraud, waste, or abuse. · Participate in... 
    Claims
    Fraud
    Local area
    Monday to Friday

    Specialty RX

    Ridgefield Park, NJ
    9 hours ago
  • $20 - $24 per hour

     ...Description Job Description Surveillance Investigator – Advantage Investigations WE'RE...  .... We specialize in covert surveillance, claims investigations, NetSweep investigations,...  ...our clients time and money on insurance fraud cases. Advantage Investigations is... 
    Claims
    Fraud
    Bi-weekly pay
    Hourly pay
    Daily paid
    Full time
    Remote work

    Advantage Surveillance LLC

    Newark, NJ
    3 days ago
  • $95k - $125k

     ...liability and workers’ compensation, along with claim services, providing expertise to meet the...  ...employer. Responsibilities The Premium Audit Specialist is responsible for providing...  ...Alert Premium Audit Manager of potential fraud situations. Serve as an audit liaison between... 
    Claims
    Fraud
    Full time
    Work experience placement
    Remote work
    Flexible hours

    W. R. Berkley

    Jersey City, NJ
    23 hours ago
  • $83.72k - $96.28k

    FSA seeks a Senior Civil Investigator in Newark, NJ to support the United States Attorney's Office in investigating health care fraud. The ideal candidate will have a Bachelor's degree, strong communication skills, and proficiency in MS Office tools. This position offers... 
    Fraud

    FSA

    Newark, NJ
    4 days ago
  • $83.72k - $96.28k

    FSA Federal in Newark, New Jersey is seeking a Senior Civil Investigator to support the USAO's mission in health care and government fraud investigations. Candidates with a Bachelor's degree in a relevant field are preferred, along with strong analytical and communication... 
    Fraud

    Phase2 Technology

    Newark, NJ
    3 days ago
  • A professional investigations firm in Newark is seeking motivated Surveillance Investigators to deter and combat insurance fraud. This is a field-based position requiring daily travel within the area. Responsibilities include conducting surveillance, documenting findings... 
    Fraud
    Hourly pay

    Veracity Research Company

    Newark, NJ
    1 day ago
  • A national investigative services firm is seeking a meticulous SIU Investigator in Newark, New Jersey. This role involves conducting comprehensive investigations into potential fraud and misconduct. The ideal candidate should possess strong analytical skills, attention... 
    Fraud

    ISG

    Newark, NJ
    2 days ago
  •  ...business provider of operational support services to Federal civilian and defense agencies, is seeking to hire a Senior Civil Investigator (Health Care Fraud) to support our prospective client within the United States Attorney’s Office, District of New Jersey (USAO‑NJ). This... 
    Fraud
    Full time
    Work at office

    Grey Street Consulting LLC

    Newark, NJ
    4 days ago
  • Grey Street Consulting LLC is seeking a Senior Civil Investigator (Health Care Fraud) to join our team supporting the United States Attorney’s Office in Newark, NJ. This full-time position involves planning and conducting investigations, preparing reports, and preparing... 
    Fraud
    Full time
    Work at office

    Grey Street Consulting LLC

    Newark, NJ
    4 days ago
  •  ...other public agencies. Carrying out negotiations in adjusting of claims and entering of settlements with attorneys. Obtaining...  ...to prior statements of witnesses, photographs, and other claim investigation undertaken. Preparing cover letters, releases, and other documents... 
    Claims
    Contract work
    Work at office

    NJ TRANSIT

    Newark, NJ
    3 days ago
  • A leading transportation agency in New Jersey is seeking an experienced claims investigator to join their team. The role involves interviewing claimants and witnesses, obtaining necessary documentation, negotiating settlements, and attending trials. Ideal candidates will... 
    Claims

    NJ TRANSIT

    Newark, NJ
    3 days ago
  •  ...seeking a detail-oriented Social Media Investigator to support active litigation and investigative...  ...with investigative, litigation, SIU, fraud, research, or analytical backgrounds are...  ...in Criminal Justice, Insurance claims, Paralegal studies, Journalism, or digital... 
    Fraud

    CFI Consultants

    West Orange, NJ
    18 days ago
  •  ...experience in a Personal Injury, MedMal, or Insurance Defense legal practice. Responsibilities include conducting interviews, handling investigations, reviewing medical records, and ensuring proper communication with claimants. The ideal candidate is a quick learner,... 
    Claims
    Full time

    Coda Search│Staffing

    Newark, NJ
    9 hours ago
  •  ...the Case Management department working on all phases of injury claims. This is a full-time, permanent position. Ideal candidate...  ...a general personal injury claim Conducts pre-litigation investigations, aspects of discovery work, reviewing records, drafting correspondence... 
    Claims
    Permanent employment
    Full time
    Work at office
    Monday to Friday

    Coda Search│Staffing

    Newark, NJ
    1 day ago
  •  ...Certified Professional Coder (CPC) Lead/Provider Liaison A Few Words About Us Integrated...  ...Validates documentation against submitted claims diagnosis codes and prepares detailed...  ...Supports Risk Adjustment Data Validation audits Drives communication with pertinent staff... 
    Claims
    Contract work
    Immediate start

    Careers Integrated Resources Inc

    Newark, NJ
    2 days ago
  •  ...Description Job Description ABOUT US: Ethos Risk Services is a leading insurance claims investigation and medical management company, specializing in surveillance and fraud detection. At the forefront of, we provide accurate data and actionable insights that translate... 
    Fraud
    Full time
    Local area
    Night shift
    Weekend work

    Ethos Risk Services

    Kearny, NJ
    3 days ago
  •  ..., administrative code, and Board of Trustees policy. 3. Audits all claims, invoices, and demands; prepares items for Board of Trustees...  ...of internal controls, including segregation of duties and fraud prevention measures, to safeguard district assets and ensure... 
    Claims
    Fraud
    Contract work
    Work at office
    Local area

    MPTCS

    Newark, NJ
    24 days ago
  • $225k - $240k

     ...pleadings, discovery, depositions, motion practice, and trial preparation. Defend and prosecute claims involving breach of contract, construction defects, delay, payment disputes, fraud, and related statutory issues. Draft, review, and negotiate construction contracts,... 
    Claims
    Fraud
    Full time
    Contract work
    For contractors
    For subcontractor
    Work at office

    Creative Solutions Services, LLC

    Newark, NJ
    4 days ago
  • $68.1k - $125k

     ...assumes responsibility for handling property claims including high severity and complex...  ...damage of the loss. Determines the investigative needs to assess damages, the cause of the...  ..., as needed. Identifies potential fraud indicators. Assesses the salvage/subrogation... 
    Claims
    Fraud
    Full time
    For contractors
    Local area
    Remote work
    Flexible hours

    Argonaut Management Services, Inc

    Newark, NJ
    2 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to CPC Investigator: Claims & Fraud Audits. Be the first to apply!