Senior Health Care Fraud Investigator
Highmark Health
Highmark Health is seeking a Senior Anti-Fraud Investigator to develop and maintain our anti-fraud program and conduct investigations across providers, members, facilities and employees. The role requires coordinating field investigations, testifying when needed, and ensuring compliance with HIPAA and internal policies. The position involves auditing, data analysis, and collaboration with law enforcement to recover funds and prevent improper payments. Travel is up to 25% as required by cases. #J-18808-Ljbffr Highmark Health
- ...A healthcare company in New York is seeking a Fraud Investigator to conduct in-depth investigations of reported fraud. Responsibilities include mentoring other investigators, investigating Medicaid fraud cases, and maintaining relationships with law enforcement. Candidates...Senior
$46.99k - $122.4k
CVS Health is looking for a skilled individual to manage healthcare fraud investigations in New Jersey. The role entails handling complex cases, facilitating legal proceedings, and working closely with law enforcement agencies. The ideal candidate will have a Bachelor'...SeniorFull time- ...claims processes in Idaho. The role involves conducting audits and investigations into customer claims, analyzing data, and communicating... ...Bachelor's Degree and 0-2 years of experience, with healthcare fraud experience preferred. This position offers a chance to contribute...Suggested
$65k - $88.6k
...Become a part of our caring community 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 Care Industry? If this resonates with...SuggestedWeekly payFull timeTemporary workFor contractorsApprenticeshipWork experience placementLocal areaRemote workWork from homeHome officeMonday to Friday- ...excellence. We are bold, we care less about what others are doing... ...About the Role As our Senior Fraud Analyst for Consumer Lending... ...automated block and manual investigation policies. Advanced Risk... ...Annual performance bonus Health, dental, and vision plans...SeniorRemote work
$90k - $142k
A financial advisory firm is seeking a Senior/Supervisor in Litigation to oversee forensic accounting and litigation support engagements in New York. The ideal candidate has over 5 years of relevant experience and strong proficiency in financial analysis and forensic methodologies...Senior- Magnus Management Group LLC is seeking a Senior Forensic Accountant to support financial investigations involving fraud, money laundering, asset tracing, and federal benefit programs. The role focuses on forensic analyses to aid oversight organizations and law enforcement...SeniorRemote job
- Félix is seeking a Senior Fraud Analyst for Consumer Lending in New York City. In this hybrid role, you will protect the unit economics of our Send Now Pay Later product by defining and mitigating fraud. Responsibilities include fraud analytics, KPI management, and collaboration...SeniorRemote job
$90k - $142k
...time Location: New York, NY (Hybrid) ABOUT THE POSITION: The Senior/Supervisor - Litigation will oversee forensic accounting and... ...support engagements, providing expertise in financial fraud investigations, damage calculations, and dispute resolution. The role involves...SeniorFull time$50k - $70k
EXL is hiring for their Insurance Premium Audit Team, offering a competitive compensation package between $50K and $70K in total earnings. The role includes remote work options, comprehensive training, and career advancement opportunities. Benefits feature 17 days of paid...SeniorRemote job$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 complex cases and preparing detailed reports based on findings. Candidates must have a Bachelor's or Associate'...Senior- ...Liability claims, with and without attorney involvement. You will analyze coverage, communicate with policyholders and witnesses, pursue fraud referrals, and ensure regulatory compliance across jurisdictions. This full-time role offers a competitive US salary and strong...SeniorFull time
- Intuit in New York is expanding its Fraud Policy team. The Staff Fraud and Risk Analyst will design and implement fraud mitigation policies for consumer lending and money movement products, collaborating with Risk Operations, Data Science, Product, Engineering and Compliance...Senior
- Betterment is seeking a Senior Fraud Analyst in New York City to own customer risk rating, KYC, and fraud monitoring models, partnering with Data, Compliance and Product to shape controls and monitoring. You will design rules, advise leadership on model performance, and...SeniorWork at office
- MetroPlusHealth in New York seeks a Clinical Certified Coder to support fraud detection and investigations in the Special Investigations Unit. The successful candidate will review medical records and claims, conduct audits, and collaborate with the team on suspected fraudulent...
$85k - $105k
...Healthcare Fraud Investigator Employment Type: Full-Time, Mid-Level CGS is seeking a Healthcare Fraud Investigator to provide legal support for a large government project in Nashville, TN. The candidate must take the initiative to ask questions to successfully complete...Full timeWork experience placementWork at officeLocal area- ...Humana Inc. is seeking an experienced Healthcare Investigator to join its industry-leading Special Investigations Unit (SIU). The role involves... ...investigations. Ideal candidates have 2+ years in healthcare fraud investigations, strong data analysis skills (Excel/PowerBI),...Remote work
- A leading health organization seeks an investigator for healthcare fraud allegations. Responsibilities include conducting investigations, analyzing claims data, and preparing reports. A bachelor's degree and 1+ years in medical claim analysis are essential. Preferred candidates...Remote work
- ...Provider Careers at NYC Health + Hospitals NYC Health + Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient... ...or governmental agency in the field of investigation, auditing, law enforcement, security, inspections...Full timeFor contractorsWork from homeShift work
- A government services contractor is seeking a Healthcare Fraud Investigator to provide legal support on a large Government project. You will analyze data, review financial and legal documents, and support the development of case referrals. Candidates should have a relevant...Full timeFor contractorsWork at office
- ...in Manhattan, New York. I plan to hire a dedicated, ethical employee with live-in availability. Details: My family needs personal care, assessments, and respite work. It is preferable if you have personal transportation available. The perfect home caregiver would be...SeniorLive in
- Location: Albany, New York, United StatesCompany: HumanaPosted: 2026-08-10Humana Inc. is seeking a Senior Medical Coding Professional (Inpatient) to support payment integrity by reviewing inpatient claims for coding accuracy and DRG assignment. You report to the Manager...SeniorRemote work
$86k - $131.38k
...A top-ranked healthcare facility in New York is looking for a Mid-Senior level SEO Manager. The role involves leading SEO initiatives, collaborating with various teams, and utilizing advanced tools for analysis and optimization. Ideal candidates should have over 6 years...SeniorFull time- ...partnered with a leading consultancy seeking an Actuarial Manager or Senior Manager to join their Healthcare practice with a focus on... ...or ASA designationExtensive actuarial experience from within the health insurance or healthcare provider market Experience of working on...Senior
- A leading healthcare organization is seeking a Care Manager to ensure continuity of care for newly enrolled members. The role involves developing care plans, conducting assessments, and managing community resources to facilitate member independence. The ideal candidate...Senior
$175k - $225k
...A leading biotechnology company in New York is seeking a Senior Director of Medical Affairs to shape its medical affairs strategy. The ideal candidate will have over 15 years of experience in medical affairs with strong expertise in immuno-oncology. Responsibilities include...Senior- Location: Florida, New York, United StatesCompany: NeueHealthPosted: 2026-08-04NeueHealth, a value-driven healthcare provider, seeks a Manager of Medical Auditing to lead coding audit programs across our Centrum facilities and affiliated centers. You will guide audit practices...Senior
- ...Natera is seeking a Senior Phlebotomist for an onsite role in Methuen, MA. The successful candidate will be responsible for obtaining... ...offers benefits including comprehensive medical plans, fertility care benefits, and 401(k). Join a company dedicated to innovative genetic...Senior
- Build the career you want and make a powerful impact.NursingAs a professional and skilled home care nurse with VNS Health, you will flourish in an environment which encourages growth and provides opportunities to advance your nursing career. While using your expertise...SeniorLive in
- Commercial Cards Fraud - Fraud Ops Sr. Analyst - C12 Job Req Id: 26982815 Location(s):... ...Overview The Fraud Ops Sr Analyst is a senior level positions responsible for contributing... ...models Proven experience in the Investigation and Fraud claims process Experience in trend...SeniorFull timeWork at office
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