Fraud & Abuse Investigator: Data-Driven Recoveries
1199SEIU Benefit and Pension Funds
1199SEIU Benefit and Pension Funds seeks a dedicated investigator to manage the Fraud & Abuse hotline, conduct confidential investigations, and coordinate evidence-based reporting. The role involves analyzing medical records for billing appropriateness, maintaining case files, and liaising with providers and vendors. The candidate will prepare reports, support strategic case development, and ensure compliance with civil evidence rules while upholding confidentiality and professional standards. #J-18808-Ljbffr 1199SEIU Benefit and Pension Funds
- ...Responsible for operating the Fraud & Abuse hotline involving the intake... ...database. • Conduct confidential investigations of all assigned cases: collect support evidence, data analysis, identify... ...sharing, etc. • Manage the recovery of overpayments, issue refund...DataPermanent employmentFull timeWork at office
$66.96k
...General’s (OAG) Medicaid Fraud Control Unit (MFCU)... ...attorneys, detectives, data analysts, nurses, and... ...complex healthcare fraud investigations. The Medicaid program... ...reports of abuse and neglect in nursing... ...resulting in convictions and recovery of funds. Highlighting...DataWork experience placementWork at officeLocal areaRemote workFlexible hours$77.1k
...Program (PSLF) Responsibilities The Investigator will be responsible for triaging,... ...be utilizing information from claims data analysis, tips, complaints from plan members... ...+ years of experience in health care fraud, waste and abuse investigations. ~ Certified Coding...DataFull timePart timeFlexible hours- ...living life on their own terms. The SIU Fraud Investigator is responsible for identifying, investigating... ...and indicators of fraud, waste, and abuse (FWA) involving providers, vendors,... ...enrollment, medical record, and provider data; conducts interviews, field investigations...Data
- ...Litigation Support CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large... ...Review, sort, and analyze data using computer software programs such as... ...Analyze data for evidence of fraud, waste and abuse Review and evaluate referrals to determine...DataFull timeWork experience placementWork at officeLocal area
$15 - $25 per hour
...Fraud Analyst - Content & Reviews Abuse is a remote review track for evaluating AI outputs across fraud analyst content reviews abuse specialist operations workflows. Reviewers grade workflow correctness, policy adherence, and stakeholder fit; flag operational risk; and...For contractorsWork experience placementRemote work10 hours per week$26 - $33 per hour
...time, Part-time Description Command Investigations LLC is seeking an Insurance Claims... ...Ability to thrive in a focused, detail-driven, and repetitive environment. Strong computer... ...will be required to enter text or data into a computer or other machine by means...DataHourly payFull timePart timeSecond jobWork at officeRemote workFlexible hoursNight shift$22.65 per hour
...About the Role: Fraud Analysts are responsible for reviewing user activity, identifying fraudulent... ...guidelines. Success in this role is driven by productivity, accuracy, and adherence... ...with minimal rework Comfortable with tools, data, and case-based review work Strong time...DataHourly payFull timeMonday to FridayWeekend workDay shift$70k - $105k
...rare chance to join a mission-driven fintech at an inflection... ...Family banking has a distinct fraud profile. Minor cardholders face... ...monitoring, and suspicious activity investigation, reporting directly to the... ...working with transaction data, identifying patterns, and explaining...DataH1bRemote workVisa sponsorshipWork visaFlexible hours$104.9k - $174.7k
...and predicting risk and enhancing fraud detection. We use the power of data and advanced analytics to help our... ...combine technical expertise, data-driven insights, and industry knowledge to... ...role blends data analytics, fraud investigation, technical consulting, and client...DataFull timeLocal areaWork from home- ...claims and provider behavior for indications of potential fraud, waste and abuse. Knowledge of Medicare requirements, laws, rules and... ...Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce,...DataRemote work
- Proactively identifying instances of fraud, waste, and abuse, the full-time Senior Fraud Analyst will analyze medical billing data and collaborate with engineering and data science... ...approach to tasks Background in Special Investigations Unit (SIU) or Payment Integrity...DataFull timeRemote work
- ...remotely, the full-time hourly Fraud Operations Analyst will... ...transactions for fraudulent behavior, investigate flagged activities, and... ...behaviors flagged for fraud and abuse Investigate transactions using... ...Collaborate with analysts and data scientists to improve fraud detection...DataHourly payFull timeRemote work
$77.1k - $92.52k
...Investigator PositionThe Investigator will be responsible for triaging, investigating and resolving instances of healthcare waste and billing... ...community. You will be utilizing information from claims data analysis, tips, complaints from plan members, the medical community...Data- 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...DataRemote work
- ...CVS Health is seeking a Senior Investigator for the Aetna Special Investigations Unit. The role focuses on complex national healthcare fraud investigations across multiple lines of business... .... You will conduct research, perform data mining, analyze claims data for...Data
- ...trading systems. The role requires deep proficiency in C++, strong mathematical background, and experience with large data sets. You will work on data-driven projects, improve risk controls, and mentor junior traders in a dynamic, #J-18808-Ljbffr United States Digital...DataWorldwide
$100k - $135k
...teammates.ABOUT THE ROLE:We are seeking a Fraud Analyst to join our BSA/AML team. In this role, you will support the detection, investigation, and mitigation of financial crime risks,... ...with the ability to interpret complex data and identify patterns of suspicious or fraudulent...DataPermanent employmentFull timeTemporary workWork at officeRemote workWeekend work- ...appoint a Managing Director within its investigations practice in New York. This is a senior... ..., financial crime compliance, fraud prevention, business intelligence and risk... ...Experience leading complex forensic accounting, data analytics or fraud investigation...DataFull time
- ...seeking an experienced software engineer with expertise in C/C++ and familiarity with storage technologies to help enhance our data recovery toolset. This is a highly technical, hands‑on position focused on analyzing proprietary storage and backup formats, and developing...DataRemote jobWorldwide
$90k - $142k
...litigation support engagements, providing expertise in financial fraud investigations, damage calculations, and dispute resolution. The role... ...attorneys, clients, and internal teams to analyze financial data, prepare expert reports, and support legal proceedings. RESPONSIBILITIES...DataFull time$70k - $75k
...Forensic Accountants in conducting forensic audits and investigations, corporate compliance programs, fraud examinations, construction monitoring and litigation... ...assisting in compiling and analyzing documents and data, participating in site visits and interviews, performing...DataFull timeBank staffWork at officeMonday to FridayNight shiftWeekend 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...DataFull timeFor contractorsWork at office
$136.1k - $182.4k
...subscriber base Work with fellow Search PMs, design, engineering, data science and research teams to help inform the future of the... ...product. Familiar with A/B experimentation methods and hypothesis-driven development. You’re passionate about machine learning and love speaking...DataWork experience placement- Independently leading complex fraud, waste, and abuse investigations, the full-time Senior Fraud Investigator will utilize advanced investigative techniques and data analysis to identify misconduct and support corrective actions in a remote work environment. Key responsibilities...DataFull timeRemote work
- Conducting comprehensive fraud, waste, and abuse investigations, the full-time SIU Investigator will analyze claims data, medical records, and provider information while collaborating with stakeholders to support case resolution in a remote setting. Key responsibilities...DataFull timeRemote work
- MaziCTools is seeking candidates for a full-time role focused on fraud investigations and analytics. The position involves engaging with engineering teams and non-technical stakeholders to enhance workflows. Ideal candidates will have a Bachelor's degree in a technical...Full timeWeekend work
- ...Quantitative Researcher — Equity Derivatives | Event-Driven | New York / Miami Our client is a seasoned... ...offering and block trade price pressure and post-deal recovery • Feature engineering from options market data — skew, term structure, vol of vol, open interest...DataWork at office
- ...MaziCTools is looking for a Full-time Fraud and Chargeback Analyst, responsible for identifying fraudulent activities and optimizing chargeback processes. This position allows for a remote-first approach and embraces a collaborative and diverse culture. The ideal candidate...DataFull timeRemote work
- ...strategy development for onboarding and KYC. Collaborate with Product, Data, Compliance, and external vendors. Balance security, conversion,... ...SQL and BI tools (Databricks) experience. Strong KYC and fraud prevention knowledge. Fully remote work within Brazil. Medical,...DataRemote jobHome officeFlexible hours
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