Fraud & Payment Integrity Program Lead (Remote/Hybrid)
Centene Corporation
- Remote job
Centene Corporation is hiring for a strategic role to develop, implement, and manage fraud, waste and abuse activities across health plans. You will lead teams to investigate referrals, ensure compliance with billing and claims processes, and tailor plans to meet federal requirements. Applicants should have a bachelor’s degree in a related field and 4+ years in medical claim investigation or compliance, preferably within managed care, with strong knowledge of medical terminology and leadership #J-18808-Ljbffr Centene Corporation
- ...California is seeking a Program Integrity Analyst to initiate investigations... ...and analyze suspected fraud and abuse in the Child Care Payment Program (CCPP). The role... ...‑time position offers a hybrid schedule (training... ..., then up to 24 hours remote) and a benefits package...Remote workFraudFull timeWork at office
$99k - $225k
Program Integrator, LeadThe Opportunity: As a Program Integrator... ...someone like you to lead a team of experienced... ...protect against identity fraud. You are expected to... ...cameras on during meetings.Remote: If this position is... ...or customer facility.Hybrid: If this position is...Remote workFraudFull timeContract workPart timeWork at officeLocal area- CVS Health is seeking a Program Integrity Manager to lead Medicaid, Payment Integrity and SIU activities, ensuring compliance with state and federal requirements and promoting fraud, waste and abuse prevention. You will partner with health plan leadership, compliance, and...Fraud
$87.7k - $157.8k
...and manage strategic fraud, waste and abuse activities... ...COB/TPL/Subrogation programs, including savings,... ...and systems to assure integrity and compliance in billing and claims payment Lead teams of analysts to appropriately... ...approach to work with remote, hybrid, field or office work...Remote workFraudFull timeContract workPart timeWork at officeImmediate startFlexible hours- Inland Empire Health Plan (IEHP) is seeking a Senior Payment Integrity Program Development Specialist in Rancho Cucamonga, CA. The role drives research... ...into actionable outcomes, enhance FWA detection, and lead cost-avoidance strategies across operations. #J-18808-...Remote job
- PacificSource is seeking a Senior Fraud, Waste and Abuse (FWA) Specialist to lead the organization’s FWA program, enhance payment integrity, and ensure regulatory compliance. The role requires collaboration with CMS, state agencies, and internal teams to detect, prevent...Remote jobFraud
- Centene is seeking a Senior Fraud and Abuse Investigator to develop... ...plan portfolio. You will lead analyst teams to investigate... ..., monitor billing and claims integrity, and ensure compliance with state... ..., with flexibility for remote or hybrid #J-18808-Ljbffr Centene Management...Remote jobFraud
- NICE in Atlanta is seeking a Lead Client Services Program Manager to organize and lead project teams for... ...delivering high-quality analytics services for fraud detection and compliance. Ideal... ...compliance. This position offers a hybrid working model with a focus on teamwork...Remote jobFraud
- ...a dynamic role focused on advocacy and program integrity through compliance management. Here, you... ...-driven work with Pennsylvania's leading Quality Improvement OrganizationMake a... ...with MA policies and identify potential fraud, waste, or abuse.Review clinical documentation...Remote workFraudFull timeTemporary workWork at officeWork from home
$112.8k - $257k
SOC Task & Integration LeadThe Opportunity:As a... ...Center (SOC) Task Lead, you’re in the middle... ..., work-life programs, and dependent care... ...against identity fraud. You are expected... ...on during meetings.Remote: If this position... ...customer facility.Hybrid: If this position...Remote workFraudFull timeContract workPart timeWork at officeLocal area$99k - $225k
Palantir Mission Integration LeadThe Opportunity... ...Mission Integration Lead, you will lead... ...assistance, work-life programs, and dependent... ...against identity fraud. You are expected... ...on during meetings.Remote: If this position... ...customer facility.Hybrid: If this position...Remote workFraudFull timeContract workPart timeWork at officeLocal area$99k - $225k
Network Architect and Integration LeadThe... ...Integration leadership and program management in... ...authorization boundaries. Lead cross-functional... ...against identity fraud. You are expected... ...during meetings.Remote: If this position... ...customer facility.Hybrid: If this position...Remote workFraudFull timeContract workPart timeWork at officeLocal area$107.7k - $199.3k
...editing, and audit programs. Provide guidance... ...accurate and timely payments of coding and... ...internal payment integrity edit and audit programs... ...coding Direct and lead Prepay Compliance... ...waste, abuse, and fraud Performs other duties... ...to work with remote, hybrid, field or office work...Remote workFraudFull timePart timeWork at officeFlexible hours- ...on, customer-focused Lead Client Services Program Manager to join our dynamic... ...solutions for Fraud and Anti-Money Laundering... .... High level of integrity and discretion, handling... ...to the NiCE-FLEX hybrid model, which enables... ...office and 3 days of remote work, each week. Naturally...Remote workFraudWork at officeFlexible hours
- PacificSource is seeking a Senior Fraud, Waste and Abuse (FWA) Specialist to advance the organization’s Payment Integrity and FWA programs. You will lead program development, compliance oversight, fraud prevention, and regulatory reporting, partnering with internal teams...Fraud
$99k - $225k
Enterprise Cybersecurity Program Manager, LeadThe... ...experience with leading technical... ...strategiesExperience with integrating complex... ...against identity fraud. You are expected... ...on during meetings.Remote: If this position... ...customer facility.Hybrid: If this position...Remote workFraudFull timeContract workPart timeWork at officeLocal area- ...for the Special Investigations Unit and Payment Integrity teams. You will deliver business... ...with stakeholder engagement to identify fraud, waste, abuse, and payment accuracy opportunities... ..., overpayment recovery, and audit programs, translating #J-18808-Ljbffr Blue Cross...Fraud
$110k - $140k
...matter expertise in Medicaid payment integrity to support Hawaiʻi Med-QUEST's (MQD) Fraud, Waste, and Abuse (FWA), program integrity, audit, third... ...including fully onsite, hybrid, or remote arrangements. The... ...and related team members. Lead identification, documentation...Remote workFraudPermanent employment- ..., coding, editing, and audit programs, ensuring compliance with state... ...to senior management, and leading Prepay Compliance Managers to reduce waste, abuse, and fraud. Responsibilities also include designing and implementing payment integrity edits, monitoring regulatory...Remote jobFraud
$34.18 per hour
...Family and Provider Programs Administrator, the Program Integrity Analyst will initiate... ...determine suspected fraud and abuse in the Child Care Payment Program (CCPP). Summary... ...be eligible for a hybrid work schedule of up to... ...twenty‑four (24) hours remote and sixteen (16)...Remote workFraudHourly pay16 hoursFull timeWork at officeLocal areaMonday to FridayFlexible hours- PacificSource is seeking a Senior Fraud, Waste and Abuse (FWA) Specialist to lead the Payment Integrity and FWA programs, ensuring compliance and effective fraud prevention across health care operations. This senior role requires strong analytical skills and the ability...Remote jobFraud
$85k - $100k
...expertise in Medicaid program integrity and claims audits to support... ...fully onsite, hybrid, or remote arrangements. The preferred... ...and elevate potential fraud, waste, abuse, improper payments, compliance issues, and... ...leadership, and workstream leads. Key Tools and Systems...Remote workFraudPermanent employmentWork at office- Inland Empire Health Plans (IEHP) seeks a Senior Payment Integrity Program Development Specialist to lead research, analysis, and development of initiatives that... ...into actionable outcomes, and help enhance fraud, waste, and abuse #J-18808-Ljbffr Inland Empire Health...Fraud
$92.6k - $213.5k
...Global Employee Mobility Program Lead to join our Global... ...compliance, cross-border remote work, tax equalization... ..., workforce integrations, and organizational transformations... .... Recruitment Fraud Alert We have become aware... ...or make any payments and report the incident...Remote workFraudWork experience placementLocal areaImmediate start$86.8k - $198k
Counter Improvised Threat Integration Cell Program AnalystThe... ...stakeholders and government leads. You Have:2+ years of... ...against identity fraud. You are expected to... ...cameras on during meetings.Remote: If this position is... ...or customer facility.Hybrid: If this position is...Remote workFraudFull timeContract workPart timeWork at officeLocal area$104.04k - $137.84k
...to the Director of Payment Integrity, the Manager,... ...aligned intervention programs. This role oversees... ...guidelines. The Manager leads a team responsible... ...cycle, and/or fraud, waste, and abuse... ...position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs...Remote workFraudDaily paidTemporary workWork at officeFlexible hoursShift work$112.7k - $193.2k
...Growing together.The Payment Integrity Platform organization... ..., provider integrity, fraud detection, clinical review... ...healthcare costs.As a Lead Technical Product... ...the flexibility to work remotely * from anywhere within... ...incentive and recognition programs, equity stock purchase...Remote workFraudMinimum wageFull timeWork experience placementWork at officeLocal area- ...seeks a strategic analytics partner for the Special Investigations Unit and Payment Integrity teams. Deliver actionable insights from healthcare data, build dashboards, and support audit programs. You will translate complex claims data into metrics that drive savings,...Fraud
$112.7k - $193.2k
...strategy for one of Optum Payment Integrity's Intelligent Fraud Detection products. This... ...the flexibility to work remotely * from anywhere within the... ...enabled platformsExperience leading or mentoring other... ...incentive and recognition programs, equity stock purchase and...Remote workFraudMinimum wageFull timeWork experience placementWork at officeLocal areaShift work- BerryDunn is seeking a Senior Consultant with Medicaid program integrity expertise to support Hawaiʻi MQD initiatives as a forensic analyst... ...with cross-functional teams. The role offers onsite, hybrid, or remote options with ~30-50% travel, primarily to Hawaiʻi and the...Remote job
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Fraud & Payment Integrity Program Lead (Remote/Hybrid). Be the first to apply!
- anti fraud Kansas City, MO
- financial fraud Kansas City, MO
- fraud manager Kansas City, MO
- fraud prevention Kansas City, MO
- system engineer remote Kansas City, MO
- remote recruitment consultant Kansas City, MO
- remote insurance agent Kansas City, MO
- remote no experience Kansas City, MO
- remote medical coding supervisor Kansas City, MO
- business development representative (remote) Kansas City, MO

