Manager, Financial Crime Services - Federal Healthcare Fraud, Waste, and Abuse
$110.7k - $218.3kDeloitte
Position Summary Our Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk and an evolving regulatory environment into defensible actions that strengthen, protect, and transform their organization. Join our team and use advanced data, AI, and emerging technologies with industry insights to help clients bring clarity from complexity and accelerate their path to value creation. Work You’ll Do As a Manager, Financial Crime Services, you will work with a cross disciplinary team to deploy a fraud detection accelerator for a large federal health care program. Key Responsibilities: Analyze health insurance claims data, open source, and public information to identify new and emerging fraud schemes and identify suspicious billing patterns or other activities indicative of potentially fraudulent behavior.Conduct analysis of open source and public information to identify sources of identity theft.Perform proactive referral generation based on external data, such as government furnished reports and open source information, such as social media. Develop fraud referrals for presentation to the client, law enforcement, and other government agencies. Identify public health insurance program vulnerabilities through data analytics and open-source information. The successful candidate would possess these skills: Ability to work independently and collaborate as part of a teamEffective written and verbal communication skillsMeticulous attention to detail and quality of work productAbility to build and sustain professional relationships Ability to lead projects or workstreamsAbility to manage and prioritize multiple tasks in a fast-paced and dynamic environmentStrong interpersonal skills and professional demeanor Ability to meet deadlinesAbility to mentor and provide clear guidance to others The Team Deloitte’s Government & Public Services (GPS) practice – our people, ideas, technology and outcomes – is designed for impact. Serving federal, state, & local government clients as well as public higher education institutions, our team of professionals brings fresh perspective to help clients anticipate disruption, reimagine the possible, and fulfill their mission promise. Our Enterprise Operations & Risk offering enables clients to achieve profitable growth and competitive advantage by optimizing “heart of the business” operations. Leverages deep domain expertise to extend enterprise resilience, agility and remediation. Addresses client needs which span the organization and impact strategy, operations, performance and reputation. Qualifications Required: Bachelor’s degree6+ years of experience in healthcare fraud and/or program integrity6+ years of experience supporting programs identifying and mitigating fraud, waste, or abuse. Ability to travel 5-25%, on average, based on the work you do and the clients and industries/sectors you serveMust be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future Preferred: Experience presenting to clients or other decision makers to represent and articulate ideas to various audiences (technical and non-technical)Excellent written communication skills, including experience drafting findings or referral documentationAbility to synthesize open-source and public information into actionable insightsExperience in healthcare policy, program integrity, or regulatory compliance domains The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $110,700 to $218,300. You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance. Deloitte is committed to providing reasonable accommodations for people with disabilities. If you require a reasonable accommodation to participate in the recruiting process, please direct your inquiries to the Global Call Center (GCC) at View email address on click.appcast.io. Recruiting tips From developing a stand out resume to putting your best foot forward in the interview, we want you to feel prepared and confident as you explore opportunities at Deloitte. Check out recruiting tips from Deloitte recruiters. Benefits At Deloitte, we know that great people make a great organization. We value our people and offer employees a broad range of benefits. Learn more about what working at Deloitte can mean for you. Our people and culture Our inclusive culture empowers our people to be who they are, contribute their unique perspectives, and make a difference individually and collectively. It enables us to leverage different ways of thinking, ideas, and perspectives, and bring more creativity and innovation to help solve our clients' most complex challenges. This makes Deloitte one of the most rewarding places to work. Our purpose Deloitte’s purpose is to make an impact that matters for our people, clients, and communities. At Deloitte, purpose is synonymous with how we work every day. It defines who we are. Our purpose comes through in our work with clients that enables impact and value in their organizations, as well as through our own investments, commitments, and actions across areas that help drive positive outcomes for our communities. Learn more. Professional development From entry-level employees to senior leaders, we believe there’s always room to learn. We offer opportunities to build new skills, take on leadership opportunities and connect and grow through mentorship. From on-the-job learning experiences to formal development programs, our professionals have a variety of opportunities to continue to grow throughout their career. As used in this posting, "Deloitte" means Deloitte Transactions and Business Analytics LLP, a subsidiary of Deloitte LLP. Please see for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or protected veteran status, or any other legally protected basis, in accordance with applicable law. Qualified applicants with criminal histories, including arrest or conviction records, will be considered for employment in accordance with the requirements of applicable state and local laws, including the Los Angeles County Fair Chance Ordinance for Employers, City of Los Angeles’s Fair Chance Initiative for Hiring Ordinance, San Francisco Fair Chance Ordinance, and the California Fair Chance Act. See notices of various fair chance hiring and ban-the-box laws where available. Fair Chance Hiring and Ban-the-Box Notices | Deloitte US Careers Requisition code: 373357 Job ID 373357 Risk, Compliance, and Governance | Financial Crime and FraudSame job available in 16 locations
$34 per hour
...program multiple healthcare plans to fit... ...accordance with current federal, state, and... ...of Nursing Services or Nurse Supervisor... ...incidents of fraud to the... ...OSHA, TB, HIPAA, Abuse Prevention, Safety... ...manner to avoid waste. Ensure that... ...questions from managers and employees....FraudDaily paidTraineeshipReliefWork at officeLocal areaShift work- ...incumbent provides primary healthcare services for non-acute or... ...other duties such as manage outpatient concerns and... ...Certificate Act 33 Child Abuse Clearance Certificate... ...to applicable federal and state laws, rules,... ...and Applicants Notice Recruitment Fraud Alert...FraudFor contractorsSecond jobWork at officeLocal areaWeekend work
- ...families, physicians and other healthcare team members regarding... ...Certificate Act 33 Child Abuse Clearance Certificate Act... ...limited to adherence to applicable federal and state laws, rules, and regulations... ...Contractors, and Applicants Notice Recruitment Fraud Alert...FraudFull timeFor contractorsSecond jobLocal area
- ...documenting the course of management discussed with the... ...to appropriate healthcare services.Attend and provide coverage... ...33 Child Abuse Clearance CertificateAct... ...adherence to applicable federal and state laws, rules... ...and Applicants NoticeRecruitment Fraud Alert...FraudPart timeFor contractorsSecond jobLocal area
- ...transforming the future of healthcare by providing highly effective services to customers,... ...directs and manages the activities of the... .... ~ Act 33 Child Abuse Clearance Certificate... ...adherence to applicable federal and state laws,... ...Notice Recruitment Fraud Alert Highmark...FraudFull timeFor contractorsSecond jobLocal areaShift workWeekend work
- Job Description SummaryThe Manager, Financial Crimes Analytics is responsible for designing, testing,... ...models across Anti-Money Laundering (AML), Fraud, Know Your Customer (KYC), and... ...analytics, or related work in financial services, FinTech, or consulting.Licenses / Certifications...FraudFull time
- ...operationally effective, financially sound, and compliant... ...whether billed services are appropriately documented... ...impact analysis to management and senior... ...Four years of clinical healthcare experience. Four... ...integrity, claim editing, fraud, waste, and abuse, coding review,...FraudFull timeWork at officeLocal areaRemote work
- ...accordance with current federal, state, and local... ...of Nursing Services or Nurse Supervisor... ...suspected incidents of fraud to the... ...OSHA, TB, HIPAA, Abuse Prevention, Safety... ...efficient manner to avoid waste. • Ensure that appropriate... ...to questions from managers and employees....FraudPart timeTraineeshipWork at officeLocal areaShift work
- ...maintain a safe and effective healthcare environment.Essential... ...nationally accredited central service exam within 18 months of hire... ...limited to adherence to applicable federal and state laws, rules, and regulations... ..., Contractors, and Applicants NoticeRecruitment Fraud Alert...FraudFor contractorsLocal area
- ...maintain a safe and effective healthcare environment. Essential... ...nationally accredited central service exam within 18 months of hire... ...limited to adherence to applicable federal and state laws, rules, and... ...Contractors, and Applicants Notice Recruitment Fraud Alert...FraudFor contractorsLocal area
- ...Background Clearance CertificateAct 33 Child Abuse Clearance CertificateAct 73 FBI... ...is not limited to adherence to applicable federal and state laws, rules, and regulations as... ...Consumer Privacy Act Employees, Contractors, and Applicants NoticeRecruitment Fraud Alert...FraudFull timeFor contractorsSecond jobLocal areaNight shift
- ...agreements are financially optimized, operationally... ...Director, Healthcare Payer oversees... ...Relationship Management Establish and... ...Monitor and interpret federal and state... ...enrollment requirements, fraud/waste/abuse regulations, etc... ...care, fee‑for‑service, and value‑based...FraudFull timeContract workWork at officeShift work
- ...-oriented Revenue Operations Manager to join our Revenue Operations... ...role in a SaaS company (healthcare experience is a plus).Extensive... ...Forming Benefits: Resources and financial support to help you build... ...yourself from these types of fraud by referring to this article....FraudHourly payFull timeFlexible hours
- ...patients and other members of the healthcare team as needed.Performs other... ...Certificate.Act 33 Child Abuse Clearance Certificate.Act 73... ...limited to adherence to applicable federal and state laws, rules, and... ..., Contractors, and Applicants NoticeRecruitment Fraud Alert...FraudTemporary workFor contractorsSecond jobLocal area
- ...Background Clearance CertificateAct 33 Child Abuse Clearance CertificateAct 73 FBI... ...is not limited to adherence to applicable federal and state laws, rules, and regulations as... ...Consumer Privacy Act Employees, Contractors, and Applicants NoticeRecruitment Fraud Alert...FraudFor contractorsCasual workSecond jobLocal area
- ...promise to continually improve healthcare.TeleTracking builds... ...Finance provides strategic financial leadership and governance to... ...payment approvals, liquidity management, line of credit administration... ...compliance activities, including federal, state, local, and foreign...Local areaVisa sponsorshipWork visa
- ...phlebotomy certification, or healthcare experience What We Offer... ...workplace and comply with state and federal affirmative action... ...information. Beware of Recruitment Fraud DaVita will never ask for payment or personal financial information at any point in...FraudMinimum wageLocal areaFlexible hoursShift workDay shiftAfternoon shift
- ...provider of digital transformation services that accelerates business outcomes... ...2000 businesses in banking and financial services, insurance, healthcare/life sciences, and telecommunications... ...business through the development, management, and execution of strategic and...Second jobWorldwide3 days per week
- ...effective, professional patient care services to obtain expected outcomes.... ...Certificate Act 33 Child Abuse Clearance Certificate Act 7... ...to adherence to applicable federal and state laws, rules, and regulations... ...Notice Recruitment Fraud Alert Highmark Blue Cross Blue...FraudFor contractorsSecond jobLocal area
- ...Partially sub-specialized clinical service at Allegheny General Hospital... ...Why AHN? It's a blended healthcare organization providing... ...category protected by applicable federal, state, or local law. California... ...Notice Recruitment Fraud Alert Highmark Blue Cross Blue...FraudFull timeFor contractorsLocal area
- ...professional respiratory care services in the treatment and care of patients... ...Certificate. Act 33 Child Abuse Clearance Certificate. Act... ...to adherence to applicable federal and state laws, rules, and... ...Applicants Notice Recruitment Fraud Alert Highmark Blue Cross...FraudFull timeTemporary workFor contractorsSecond jobLocal area
- ...Medical and surgical management of complex voiding... ...CME allowance EY financial planning services student loan, PSLF assistance... ...AHN? It's a blended healthcare organization... ...protected by applicable federal, state, or local law... ...Recruitment Fraud Alert Highmark Blue...FraudFor contractorsLocal areaImmediate startRelocation package
- ...Research Nurse Job Description Manages research projects via study... ...Certificate Act 33 Child Abuse Clearance Certificate Act 7... ...to adherence to applicable federal and state laws, rules, and regulations... ...Notice Recruitment Fraud Alert Highmark Blue Cross Blue...FraudFor contractorsSecond jobLocal area
- ...eNLC) Preferred: ~1 year healthcare experience. ~ State approved... ...: Act 33 Child Abuse Clearance Certificate Act... ...limited to adherence to applicable federal and state laws, rules, and regulations... ...Notice Recruitment Fraud Alert Highmark Blue Cross Blue...FraudFull timeFor contractorsSecond jobLocal area
- ...patient condition and managing overall nursing care of... ...Certificate. Act 33 Child Abuse Clearance Certificate.... ...to applicable federal and state laws, rules,... ...requests, please contact HR Services Online at ****@*****.***... ...Notice Recruitment Fraud Alert Highmark Blue...FraudFor contractorsSecond jobLocal areaNight shift
- ...specialty and critical care healthcare services in physician office(s) and non... ...Association Act 33 Child Abuse Clearance Certificate Act... ...to adherence to applicable federal and state laws, rules, and... ...Applicants Notice Recruitment Fraud Alert Highmark Blue Cross...FraudFor contractorsSecond jobWork at officeLocal areaWeekend work
$420k
...Sciences by adding several services and locations to their... ...Complimentary financial planning services. The... ...AHN? AHN is a blended healthcare organization providing... ...protected by applicable federal, state, or local law.... ...Notice Recruitment Fraud Alert Highmark Blue...FraudRemote jobFull timePart timeFor contractorsLocal areaImmediate startRelocation packageWeekend workAfternoon shift- ...pre-registration, financial clearance,... ...validation and pre-serviceability estimations and collections... ...offices, case management department, and... ...with Healthcare Financial Management... ...adherence to applicable federal and state laws, rules... ...Recruitment Fraud Alert Highmark...FraudFor contractorsLocal area
- ...rounding/discharge management, observation care, swing... ...CME Allowance EY Financial Planning Services Student Loan, PSLF... ...AHN? It's a blended healthcare organization... ...protected by applicable federal, state, or local law... ...Notice Recruitment Fraud Alert Highmark Blue...FraudContract workFor contractorsLocal areaImmediate startRelocation packageFlexible hoursShift workAfternoon shift
- ...critical care ground transportation services for critically ill and injured... ...Certificate Act 33 Child Abuse Clearance Certificate Act 7... ...to adherence to applicable federal and state laws, rules, and... ...Applicants Notice Recruitment Fraud Alert Highmark Blue Cross Blue...FraudFull timeFor contractorsSecond jobLocal areaImmediate startShift work
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