Senior Claims Auditor - Fraud & Compliance
Molina Healthcare
Molina Healthcare is seeking a Senior Claims Examiner in the United States (Florida) to provide senior-level support for claims examination, including evaluation of adjudication for incorrect coding, abuse, fraud, waste, overpayments, and processing errors. The role requires managing a caseload, procuring medical records, making recommendations for investigation or resolution, and ensuring compliance with regulations across multiple lines of business. #J-18808-Ljbffr Molina Healthcare
Vacancy posted 5 days ago
Similar jobs that could be interesting for youBased on the Senior Claims Auditor - Fraud & Compliance in Tallahassee, FL vacancy
- ...The Medical Science Liaison/Senior Medical Science Liaison is a... ...legal, regulatory, privacy, and compliance requirements. Maintain... ...misrepresenting EVERSANA. Recruitment fraud is a sophisticated scam... ...mails, or even text messages claiming to be a legitimate company. Some...SeniorClaimsFraudLocal areaNight shift
- ...licensure and the 503A and 503B frameworks; storefront claims, catalog gating, FTC and LegitScript compliance; and Better Business Bureau, state board, and agency... ...and change of ownership, payor audits, HIPAA, and fraud and abuse analysis. Draft and negotiate MSAs, PC...SeniorClaimsFraudHourly payContract workFor contractorsFixed term contractWork at officeRemote work
$79.7k - $105.48k
...Full time 20189391 What Ethics & Compliance contributes to Cardinal Health Ethics... ...policies. Job Summary The Compliance Auditor is responsible for conducting coding, documentation... ...Compliance Auditor performs detailed claim reviews, identifies coding and...ClaimsFull timeTemporary workLocal areaImmediate startRemote workFlexible hoursCardinal Health
Tallahassee, FL3 days ago- ...Senior Business Analyst Anywhere Type: Contract-to-Hire Category: Business Analysis... ...solutions. The role focuses on claims insurance, with Guidewire Claims Center experience... ...fraudulent activity, please contact fraud@eliassen.com . About Eliassen Group...SeniorClaimsFraudHourly payContract workLocal areaRemote work
Eliassen Group
Tallahassee, FL3 days ago - Overview The Specialty Risk Auditor will perform on-site and desk audits, fraud investigations and special projects involving affiliated and independent agents... ...records, strong internal control environments, and compliance with company standards, accounting standards, and...FraudFlexible hours
- AmTrust Financial Services in Florida is seeking a Senior Claim Examiner to manage complex workers’ compensation claims from start to resolution... ...settlements, while mentoring junior examiners and ensuring compliance with state regulations. The role requires 5+ years of workers...SeniorClaims
$20 - $25 per hour
...ESSENTIAL DUTIES Individual will work closely with Firm’s Compliance Team to facilitate the organization’s compliance with consumer... ...of consumer disputes, verification of debt requests, fraud and hardship claims to ensure proper tracking, reporting and organization. Job...ClaimsFraudHourly payTemporary workWork at officeMonday to FridayMandarich Law Group
Tallahassee, FL1 day ago- ...develop, implement, and administer environmental, fleet safety, and occupational health programs to ensure legal compliance and a safe workplace. You will manage claims, security planning, and disaster preparedness while contributing as a team member. Responsibilities include...SeniorClaims
- AML RightSource is seeking a Senior Financial Crimes Investigator to detect suspicious activity, ensure regulatory compliance, and lead investigations from a remote home office. The... ...analyze money laundering, sanctions, and fraud indicators, prepare SARs, and ensure...SeniorFraudRemote jobHome office
- Solis-Health-Plans in Doral, FL is seeking a supervisor of claims processing to lead the quality and auditing program. You will configure... ...processes to ensure accurate payments and regulatory compliance. This role requires coordinating with network services, reviewing...SeniorClaims
$72.7k
...responsible for developing and maintaining an anti-fraud program which includes development and... ...provider facility payment methodology, claims processing systems and coding and billing... ...required of employees to do this job. Compliance Requirement : This job adheres to the...SeniorClaimsFraudContract workFor contractorsWork at officeLocal areaHighmark Health
Tallahassee, FL5 days ago- ...Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations... ...findings, ensuring accuracy and compliance with legal and regulatory requirements.... ...providing training and support to other auditors/investigators, contributing to the continuous...Fraud
$56.2k - $101k
...Business Area: Legal & Compliance Job Type: Full time You could be the one who changes everything... ...allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate...ClaimsFraudFull timePart timeWork at officeRemote workFlexible hoursCentene Corporation
Tallahassee, FL2 days ago$17 per hour
...often (in days) to receive an alert: OPS Senior Word Processing Systems Operator Date:... ...INVESTIGATIONS DIVISION BUREAU: INSURANCE FRAUD CITY:TALLAHASSEE COUNTY:LEON The Criminal... ...numbers, etc.)should be completed. If claiming Right to Interview, candidateMUSTattach a...SeniorClaimsFraudPart timeWork at officeImmediate startRemote workMonday to FridayFlexible hours- ...development opportunities.Job Purpose:The Senior Legal Counsel serves as a trusted legal... ..., corporate, regulatory, employment, compliance, governance, dispute resolution, and strategic... ...pre-litigation disputes and claims.Oversee litigation and other contentious...SeniorClaimsContract workWorldwide
Deutsche Post DHL
Tallahassee, FL2 days ago - ...calculations, credits and payments, tracking, reconciliation, and compliance. The Sr. Analyst serves as an escalation point for complex... ...and timely in accordance with contractual terms, eligible sales, claims, and applicable program requirements. Own the rebate credit and...SeniorClaimsContract work
$32.03 - $45.7 per hour
...Health Plan is currently hiring an Associate Fraud and Abuse Investigator/Certified... ...reimbursement systems relating to health insurance claims processing and ensures adherence to... ...OR Internal/External Audit OR Regulatory/Compliance OR Claims Investigations OR Criminal Investigation...ClaimsFraudHourly payPermanent employmentFull timeTemporary workLive inCurrently hiringWork at officeRemote workShift work$95.2k - $155.9k
Senior Construction Specialties Risk Engineering Consultant: Florida, ideally located in the central, west coast area.Zurich is currently... ...provide technical support to customers, underwriters and the claims department by identifying improvement strategies, preparing external...SeniorClaimsTemporary workApprenticeshipWork at officeLocal areaRemote workWork from homeZurich Insurance Group
Tallahassee, FL4 days ago$138.9k - $191k
...rules and regulations and related health care fraud and abuse laws, including the Anti-kickback statute and False Claims Act; Drafting contract provisions to address... ...the company in order to ensure full compliance with applicable laws and regulations, and protection...ClaimsFraudFull timeContract workTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeHumana
Tallahassee, FL1 day ago$33.41k
...highly motivated and technically skilled Senior IT Professional / Business Analyst to... ..., Finance, Corporate Real Estate (CRE), Compliance, Risk Management, and other corporate functions... ...supporting Legal, Claims, Finance, Corporate Real Estate, Compliance...SeniorClaimsHourly payVDart
Tallahassee, FL2 days ago- ...how often (in days) to receive an alert: SENIOR CONSUMER SERVICE ANALYST - 41002040 Date:... ...protections for Floridians against consumer fraud through enforcement of state laws. At the... ...educational requirements. Candidates claiming Veterans’ Preference must attach supporting...SeniorClaimsFraudWork experience placementSelf employmentInternshipWork at officeMonday to Friday
$65k - $88.6k
...Become a part of our caring community The Fraud and Waste Professional is responsible for... ...accuracy, documentation integrity, and compliance with applicable policies and regulations.... ...and external stakeholders. Review claims, provider billing patterns, medical records...ClaimsFraudFull timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to FridayHumana
Tallahassee, FL1 day ago- Lead Operations. Strengthen Compliance. Build the Systems Behind Exceptional... ...operations. This is a senior leadership opportunity for... ...documentation-to-bill readiness, claims, denials, appeals, accounts... ...action Maintain appropriate fraud, waste, and abuse controls Report...ClaimsFraudWork at officeMonday to Friday
- ...Responsible for assisting with fraud and security related... ...fraud, examining data to ensure compliance with internal Policies and Procedures... ...include approving or denying claims and/or possible account... ...and/or compliance issues to Senior Management. Review Digital deposits...ClaimsFraudTemporary workBank staffWork at office
$43.89k - $69k
As a Senior Financial Crimes Investigator , you will leverage your expertise to detect suspicious... ...financial activity, ensure regulatory compliance, and perform quality control. You will... ...money laundering, terrorist financing, fraud, and sanctions violations, escalating cases...SeniorFraudLocal areaWork from homeMonday to Friday$146.2k - $211.6k
Senior Manager, Proprietary Programs Integrated Planning and SchedulingCompany:The Boeing... ...programs, ensuring schedule integrity, process compliance, and cross-functional alignment, while... ...of America)Stay safe from recruitment fraud! The only way to apply for a position at...SeniorFraudPermanent employmentFull timeWork at officeImmediate startRelocationVisa sponsorshipWork visaFlexible hoursShift workBoeing
Tallahassee, FL2 days ago$70.1k - $126.2k
...Actuarial Analyst Role, You Will Apply principles of mathematics, probability, statistics, finance, and business to analyze Medicare FFS claims, savings initiatives, and provider risk-sharing arrangements. Develop and maintain quarterly forecasts for Medicare fee-for-...SeniorClaimsFull timePart timeWork at officeRemote workFlexible hours- ...opportunities and grow your career with us. The Senior HR Generalist serves as initial point of HR contact... ...for information, administration of unemployment claims, HRIS transactions, new hire orientation, ethics compliance, performance appraisal process, and internal correspondence...SeniorClaimsTemporary workLocal area
$98.5k - $188k
...seeking a highly analytical and proactive Senior Manager to join our team in Cyber... ...investigating complex operational, security, and fraud threats across our wireline and wireless... ...ensuring timely deliverables and operational compliance. Cross-Functional Collaboration: Build...SeniorFraudFull timeTemporary workPart timeWork experience placementWork at officeWork from homeShift workWeekend work3 days per week$75k - $105k
...on Repo / Stock Loan positions and settle claims. Respond to both internal and external... ...Efficiently maintain documentation for regulatory, compliance, and audit purposes. Drive new business... ...these areas Leads capacity analysis for Fraud software to determine appropriate...ClaimsFraudWork experience placementLocal areaWork from homeFlexible hours
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Senior Claims Auditor - Fraud & Compliance. Be the first to apply!
Related searches
- security auditor Tallahassee, FL
- medical records auditor Tallahassee, FL
- data auditor Tallahassee, FL
- sales auditor Tallahassee, FL
- lease auditor Tallahassee, FL
- field auditor Tallahassee, FL
- remote auditor Tallahassee, FL
- safety auditor Tallahassee, FL
- remote nurse auditor Tallahassee, FL
- energy auditor Tallahassee, FL