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
$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...ClaimsFraudWork at office$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...ClaimsFraudLive inLocal area$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$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...ClaimsFraudLive inLocal area$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...ClaimsFraudTemporary workWork at office$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...ClaimsFraud$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...ClaimsFraudContract workImmediate start- ...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...FraudFull timeFor contractorsWork at office
$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...ClaimsFraudFull timeWork at officeLocal areaFlexible hoursShift work$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...ClaimsFraudBi-weekly payHourly payPart timeWork at officeFlexible hours- ...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...ClaimsFraud
- ...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...ClaimsFraudLocal areaMonday to Friday
$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...ClaimsFraudBi-weekly payHourly payDaily paidFull timeRemote work$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...ClaimsFraudFull timeWork experience placementRemote workFlexible hours$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$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- 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...FraudHourly pay
- 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
- ...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...FraudFull timeWork at office
- 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...FraudFull timeWork at office
- ...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...ClaimsContract workWork at office
- 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
- ...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
- ...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,...ClaimsFull time
- ...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...ClaimsPermanent employmentFull timeWork at officeMonday to Friday
- ...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...ClaimsContract workImmediate start
- ...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...FraudFull timeLocal areaNight shiftWeekend work
- ..., 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...ClaimsFraudContract workWork at officeLocal area
$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,...ClaimsFraudFull timeContract workFor contractorsFor subcontractorWork at office$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...ClaimsFraudFull timeFor contractorsLocal areaRemote workFlexible hours
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