Remote Medicaid Fraud Investigator
Humana
- Remote job
Humana is seeking a Fraud and Waste Professional to conduct comprehensive investigations into fraud related to Medicaid programs. The role coordinates with law enforcement, assembles evidence, and performs on-site audits of provider records to ensure billing integrity. You will prepare complex reports and work with cross-functional teams to improve program integrity. The position requires a Bachelor's degree, 2+ years in healthcare fraud investigations, and strong analytical skills. #J-18808-Ljbffr Humana
- Humana seeks a Fraud and Waste Professional in South Carolina to lead investigations of fraud, waste, and abuse in the Medicaid program. You will gather evidence, perform on-site audits of provider records, and prepare detailed investigative summaries for leadership and...Remote job
- Humana, Inc. is seeking a Fraud and Waste Professional to lead investigations of suspected fraud within South Carolina's Medicaid program. You will coordinate with law enforcement, assemble... ...program integrity and protect members. Remote work is possible in SC with occasional...Remote job
- Humana is seeking a Fraud and Waste Professional to conduct comprehensive investigations of reported, alleged, or suspected fraud involving South Carolina's Medicaid program. This role partners with law enforcement... ...investigative reports. Fully remote in South Carolina with...Remote job
$86k - $138k
...subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent,... ..., reduce, and make referrals to recover fraud, waste, and abuse. We are looking... ...between the SE UPIC, HHS OIG, State Medicaid Agencies (SMA), and the Department of Justice...Remote workFull timeContract workTemporary workFor contractorsWork at officeShift workNight shift$32.03 - $45.7 per hour
...Sentara Health Plan is currently hiring an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) Remote! Status: Full-time, permanent position (40... ...Programs and plans serving Medicare and Medicaid enrollees. Our quality provider network features...Remote workHourly payPermanent employmentFull timeTemporary workLive inCurrently hiringWork at officeShift work$65k - $88.6k
...part of our caring communityThe Fraud and Waste Professional is... ...for conducting comprehensive investigations of reported, alleged or suspected... ...involving South Carolina's Medicaid Program. The Fraud and Waste... ...Waste Work Style Fully remote in South Carolina , with occasional...Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday- ...platform pairs analytics with expert review to surface fraud, waste, and abuse across Medicare, Medicaid, Commercial, and FEP lines of business, returning... ...success, but you will not manage anyone. Strong investigators here come from healthcare payer/vendor backgrounds...Remote work
- ...Healthcare Fwa Investigator Levels (Investigator, Sr. Investigator,... ...and prevention of healthcare fraud, waste and abuse (FWA). We are... ...Support multiple clients with Medicaid, Medicare, Federal Employee... ...work independently within a remote team, under minimal supervision...Remote work
$51k - $82k
...subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent,... ..., reduce, and make referrals to recover fraud, waste, and abuse. We are looking to... ...~ Knowledge of Medicare and/or Medicaid programs and the rules, regulations, policies...Remote workContract workTemporary workFor contractorsFlexible hoursShift workNight shift$77.1k - $92.52k
...Status: Regular Full-Time Office: Remote Salary: $77,099.34 - $92,51... ...and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding... ...Responsibilities: The SIU Fraud Investigator is responsible for identifying, investigating...Remote workFull timePart timeWork at officeFlexible hours$62.4k - $71.76k
State of Florida, Office of the Attorney General, Medicaid Fraud Control Unit in Miami, seeks a Law Enforcement Investigator II to conduct investigations into Medicaid fraud and patient abuse. The role requires U.S. citizenship, a high school diploma, and successful completion...Work at office- The Oregon Department of Justice is seeking an experienced Investigator 3 to join the Medicaid Fraud Unit in the Civil Enforcement Division. This role conducts statewide investigations of Medicaid provider fraud, abuse, and financial exploitation in long-term care settings...
- The City of New York seeks a Fraud Investigator II to join the Medicaid Provider Investigation Division (MPID) within the Department of Social Services in New York City. The role includes reviewing data from the Medicaid Data Warehouse, investigating suspected Medicaid...
- The State of Georgia invites applications for the Investigator - Medicaid Fraud position within the Department of Law. The role focuses on health care fraud investigations, developing data analyses, and supporting prosecutors with evidence and testimony. Ideal candidates...Day shift
- The Office of the Attorney General, Department of Law Medicaid Fraud Division in Georgia seeks an Investigator to support health care fraud investigations and patient abuse inquiries. You will review records, interview witnesses, and assist in preparing reports and exhibits...Work at office
- The Office of the Attorney General in Florida's Medicaid Fraud Control Unit is seeking a Senior Investigator in Miami. The role involves independent investigations of Medicaid fraud and patient abuse, gathering evidence, interviewing witnesses, and preparing reports and...Work at office
- The Medicaid Provider Investigation Division (MPID) of the NYC Department of Social Services is recruiting for Fraud Investigator II to conduct investigations of Medicaid providers and clients suspected of fraud. Responsibilities include data review, interviewing subjects...
- The Oregon Department of Justice seeks an experienced Investigator 3 for the Medicaid Fraud Unit in the Civil Enforcement Division in Portland. You will conduct statewide investigations into provider fraud, abuse, neglect, and financial exploitation in long-term care settings...
$57.98k - $69k
...Division DOJ Legal Services Job Classification Title Financial Investigator I (NS) Position Number 60010403 Grade NC16 About Us The... ...to perform investigations in the area of criminal and civil Medicaid fraud schemes, patient abuse or neglect, and misappropriation of recipient...Local areaNight shift- ...Evaluation & Review Analyst to join our team in Orlando or Tampa. The role focuses on advanced audit techniques, Medicaid-related financial analysis, and investigative support to ensure program integrity. Ideal candidates bring a strong background in accounting or finance,...Work at office
- The Office of the Attorney General in Miami, FL seeks a Law Enforcement Investigator II to conduct Medicaid fraud investigations, collect evidence, interview witnesses, and prepare reports for potential criminal or civil proceedings. You will work within the Medicaid Fraud...Full timeWork at office
- ...Integrity Systems is seeking a Medicaid/Medicare Program Integrity... ...leads, complaints, and investigations, and to recommend administrative... ...onsite in Grove City, OH or remotely from a home office. Responsibilities... ...patterns, and developing fraud alerts for CMS and state...Remote jobHome office
- ...Inspector General (OIG) - Career Brochure To conduct investigations of fraud, waste or abuse by recipients, non-Medicaid providers and vendors of all MDHHS administered... ...be notified of the results. Position Location/Remote Office The physical location of this position is...Remote workFull timeWork at office
- ...Solutions Organization LLC (SSO) is seeking a Licensed Professional Counselor to join our remote Healthcare Investigator team in Ohio. The role conducts investigations into Medicaid incidents, analyzes documentation, interviews involved parties, and ensures compliance...Remote jobLocal areaWork from home
$68.97k
...York State Attorney General is seeking a forensic accountant/auditor for its Medicaid Fraud Control Unit in Albany. This role involves collaboration with attorneys and analysts to investigate complex healthcare fraud cases, ensuring the integrity of New York's Medicaid...Remote jobWork at office- Join a leading agency as a Forensic Accountant in New York City, supporting the Medicaid Fraud Control Unit in vital healthcare fraud investigations. The role involves collaboration with diverse professionals to ensure the integrity of New York's Medicaid program. Ideal...Remote jobWork at office
- North Carolina Department of Justice seeks a Financial Investigator I (NS) to lead investigations into criminal and civil Medicaid fraud schemes, patient abuse, and misappropriation of funds. The role involves financial analysis, reviewing documents, and preparing comprehensive...Local area
- A leading live shopping platform is seeking a Fraud Agent to investigate and develop solutions to mitigate fraud. This role requires identifying fraud patterns proactively and working collaboratively with the team to enhance user experience. Candidates should have experience...Remote workWork at officeWork from home
$120k - $150k
...Program. This role combines deep Medicaid policy and financing... ...hired for the position may work remotely within the United States (U.S... ...operations in roles such as principal investigator, project director, or task... ..., or program integrity and fraud oversight. Demonstrated...Remote workFull timeContract workFixed term contractH1bWork at officeLocal area- ...Centene Corporation is seeking an SIU Investigator in the United States to conduct fraud, waste, and abuse investigations using referrals, claims data, medical records, and interviews. You will prepare reports, coordinate with internal teams, and support program integrity...Remote work
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