Healthcare FWA Investigator | Fraud & Case Resolution
Centene Corporation
Centene Corporation is seeking a Fraud, Waste, and Abuse Investigator in the United States to conduct investigations by reviewing referrals, claims data, medical records, and provider information to support case resolution. The role requires 2+ years in healthcare investigations and a Bachelor's degree. You will prepare reports, collaborate with compliance and legal teams, and ensure compliance with applicable laws and Centene standards. #J-18808-Ljbffr Centene Corporation
- Centene Corporation seeks a Fraud, Waste and Abuse Investigator to conduct investigations using referrals, claims data, medical records, interviews, and analytics to identify misconduct and support case resolution. You will document findings, prepare investigative reports...Fraud
$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'...Fraud- Conduct complex, in-depth investigations of reported fraud involving the full range of healthcare products. Develop and maintain relationships... ...Investigate complex cases of reported fraud involving the... ...the SIU and follow through on resolution. Participate in meetings with...FraudRemote jobWork experience placement
- ...this mission, the BXDA seeks experienced and enthusiastic Cold Case Investigator. A dedicated Cold Case Investigator would be able to assist... ...preferred: homicides, robberies, grand larceny, financial crimes, fraud, and identity theft. As per NY Public Officers Law 2, 3-B, U....FraudWork at officeWeekend workAfternoon shift
$56.2k - $101k
...Position Purpose Conduct fraud, waste, and abuse (FWA) investigations by reviewing referrals, claims data, medical... ...potential misconduct and support case resolution. Document investigative... ...trends that may present risks to healthcare programs and recommend appropriate...FraudFull timePart timeH1bWork at officeRemote workFlexible hours- ...Conduct field-based investigations related to Medicaid fraud, abuse, or non-compliance, aligned with UPIC protocols and... ...state-specific Medicaid rules. Interview healthcare providers, beneficiaries, and witnesses to gather key case evidence. Analyze Medicaid claims,...FraudWork at office
- ...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...Fraud
- ...Healthcare Fraud Investigator Employment Type: Full-Time, Mid-Level Department: Litigation Support CGS is seeking a Healthcare Fraud Investigator... ...financial transactions (e.g., check spreads, etc.). Develop HCF case referrals including, but not limited to: Ensure that HCF...FraudFull timeWork experience placementWork at officeLocal area
- ...Corporation, a national leader in diversified healthcare, seeks a seasoned investigator to guide team members, investigate fraud, waste and abuse, and mentor staff. This... ...and rigorous documentation of interviews and case plans. Responsibilities include supervising caseloads...FraudRemote job
$60.2k - $107.4k
Senior Investigator Pharmacy At UnitedHealthcare, we're simplifying the... ...and prevention of healthcare fraud, waste and abuse. The investigator... ...Investigate medium to highly complex cases of fraud, waste and abuse... ..., fraud, waste and abuse (FWA) 2+ years of experience in...FraudFull timeTemporary workWork experience placementLocal areaRemote work- A government services contractor is seeking a Healthcare Fraud Investigator to provide legal support on a large Government project. You will analyze... ...and legal documents, and support the development of case referrals. Candidates should have a relevant degree and at...FraudFull timeFor contractorsWork at office
- ...senior leader to direct SIU analytics, detection, and investigative analytics across healthcare programs. You will work with SIU leadership and enterprise... .... The role requires 5+ years in healthcare analytics, fraud detection, SIU operations, and leadership of analytics...Fraud
$56.2k - $101k
...preferred. Position Purpose: Investigate allegations of potential healthcare fraud and abuse activity. Assist in... ...fraud Document activity on each case and refer issues to the appropriate... ...and further actions and/or resolutions Assist with complex allegations...FraudFull timePart timeWork at officeRemote workFlexible hours- ...Provides support for special investigation unit (SIU) activities... ...to medical provider coding fraud, waste and abuse (FWA). Essential Job Duties... ...participates in meetings related to cases. • Completes medical... ...findings. Molina Healthcare offers a competitive benefits...FraudContract workWork at officeLocal areaRemote 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...FraudRemote work
- ...to join a fast-paced eCommerce risk and fraud operations team. This position supports... ...skills will be heavily utilized to investigate cases, communicate with international sellers... ...seller history, and determining appropriate resolution paths. Monitor and manage case volume...FraudContract workFreelanceRemote work
- 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 tasks, perform detailed work consistently, accurately, and under pressure...Fraud
$75.35k - $98.89k
...Senior Analyst, Special Investigations Unit Clinical... ...protect the integrity of healthcare spend. You will perform... ...audits into suspected FWA with high autonomy Document... ...clinical experience. Case Management experience... ...(CPMA), Certified Fraud Examiner (CFE), Accredited...FraudFull timeWork at officeRemote workWork from homeFlexible hours3 days per week- ...Position: EEO Investigator Department: Equal Opportunity / Office... ...days remote; travel to NYC healthcare facilities as needed. Pay... ...discrimination and harassment cases. ~ Familiarity with... ...through the investigation and resolution of complaints involving unlawful...Work at officeLocal areaRemote workMonday to Friday
- ...help transform the future of healthcare , you’ll find your purpose... ...Employment Legal team, the Sr. Investigations and Employment Advisory... ...policy interpretation, conflict resolution, performance management... ...with a disciplined approach to case management and administration...Local areaWorldwideFlexible hours3 days per week
- 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...FraudRemote jobWork at office
$90k - $142k
...support engagements, providing expertise in financial fraud investigations, damage calculations, and dispute resolution. The role involves working closely with attorneys... ...with attorneys and clients to develop case strategies and provide financial insights. Assist...FraudFull time$75k - $120k
People Relations Specialist Own end-to-end workplace investigations and case closure for Palantir’s People Relations Location: New York Compensation... ...concern intake meetings, investigations, and conflict resolution. Experience in building out Employee Relations processes...Work experience placementWork at officeRemote workWork from homeRelocation package- ...Carolina seeks an analytics professional to act as a strategic partner to the SIU and Payment Integrity teams. You will translate healthcare data into insights, design dashboards, and support audits and savings initiatives. The role requires 3+ years in healthcare...Fraud
- ...Bank of America is seeking an Investigator to perform end-to-end investigations of external financial crimes, including fraud, money laundering, and terrorist financing across lines... ...with GFC and frontline units to resolve cases. Required experience includes at least five...Fraud
- ...Ellenco Estágios e Treinamentos is seeking a Fraud Analyst - Content & Reviews Abuse specialist contractor to evaluate AI outputs and... ...workflows and policy. You will review, grade, and document edge cases, flag policy gaps, and capture actionable next steps for model training...FraudFor contractorsRemote workFlexible hours
- ...Affirmative Civil Enforcement (ACE) Investigator Employment Type: Full-Time... ...investigative techniques and fraud detection to provide... ...involving fraud in areas such as healthcare, contracting, and grants, as... ..., or other aspects of a case. Examines books, ledgers,...FraudFull timeWork at officeLocal areaFlexible hours
$26 - $30 per hour
...Investigator - Network Services Immediate need for an undercover investigator... ...and intelligence about the case. Establish covert... ...technology, and expertise that help healthcare and government organizations... ...oversight, and address fraud, waste, abuse, and operational...FraudHourly payFull timeH1bH2bLocal areaImmediate startWorldwideFlexible hoursNight shift- ...Entry-Level Investigator Ethos Risk Services is a leading insurance claims investigation and... ...company, specializing in surveillance and fraud detection. We provide accurate data and... ...necessary! Key Responsibilities: Case Preparation: Conduct preliminary investigations...FraudFull timeLocal areaNight shiftWeekend work
- ...Protection Associate in New York to ensure store safety, detect theft and fraud, and support operational efficiency. The individual will perform investigative duties and assist with incident resolutions while meeting performance standards. The role requires previous retail...Fraud
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