Remote RN/LPN Claims Examiner III - Fraud & Medical Audit
WPS—A health solutions company
- Remote job
WPS, a health solutions company, is seeking a Claims Examiner III LPN to protect the MVH program by identifying and preventing fraud, waste, and abuse. This role blends clinical expertise with data analysis to evaluate medical necessity, review claims, and ensure benefits are administered properly. Collaboration with leadership and external partners is key to compliant program operations. The position offers remote work options and a structured training schedule, with a typical 8:00–16:00 CT #J-18808-Ljbffr WPS—A health solutions company
- ...solutions company, seeks a Claims Examiner III LPN/RN to protect the MVH... ...by investigating fraud, waste, and abuse. You... ...analysis to evaluate medical necessity and detect... ...partners, contribute to audits, and support program... ...in a flexible, remote-capable environment across...Remote jobMedicalFraudFlexible hours
- ...Health Solutions seeks a Claims Examiner III LPN/RN to safeguard the MVH program by auditing claims, analyzing data... ...insights to support medical necessity decisions... ...focused on preventing fraud, improving audit quality... ...and external partners. Remote work options are...Remote jobMedicalFraudFlexible hours
- WPS Health Solutions seeks a Claims Examiner III LPN/RN to protect the MVH program... ..., and preventing potential fraud, waste, and abuse. You will... ...data analysis to evaluate medical necessity and detect unusual... .... The position offers remote work options within approved...Remote jobMedicalFraudContract work
$21.78 per hour
...restrictions. Our Claims Examiner III LPN protects the integrity... ...potential fraud, waste, and abuse.... ...analysis to evaluate medical necessity, detect... .... Contributing to audit activities and quality... ...We are open to remote work in the following... ...Registered Nurse (RN): Associate Degree...Remote workMedicalFraudContract workFor contractorsLocal areaImmediate startMonday to FridayFlexible hoursShift work- ...and DoD contractor, seeks a Claims Examiner III LPN to safeguard MVH program integrity... ...data analysis to assess medical necessity, detect unusual... ...compliant benefits administration. Remote work options are available... ...requires U.S. citizenship, RN or LPN licensure, and 3+...Remote jobMedicalFraudFor contractors
- ...Health Solutions is seeking a Claims Examiner III LPN to protect MVH program... ...investigating, and preventing potential fraud, waste, and abuse. This role... ...data analysis to evaluate medical necessity and detect unusual... ...and external partners. Remote work options are available...Remote jobMedicalFraud
- ...company, is seeking a Claims Examiner III LPN to protect MVH program... ...investigating, and preventing fraud, waste, and abuse. The... ...analysis to evaluate medical necessity and detect... ..., contributes to audits and quality initiatives, and offers remote work options in approved...Remote jobMedicalFraudFlexible hours
$21.78 per hour
WPS is seeking a Claims Examiner III LPN to protect the MVH program integrity by identifying and preventing fraud, waste, and abuse. This role blends... ...data analysis to evaluate medical necessity and detect unusual... ...program controls. Remote work is available in approved...Remote jobMedicalFraud$78k - $85k
Overview Medicaid Medical Review RN (Medical Reviewer III) - REMOTE The Medicaid Medical Review RN... ...records during the course of fraud investigations or other... ...contained in Standard Claims Processing System files... ...minimum experience auditing claims history or provider...Remote workMedicalFraudFor contractorsH1bH2bWork at officeLocal areaHome office- ...HEDIS Auditor RN/LPN Integrated Resources, Inc is a premier staffing... ...This request is for the 2018 HEDIS audit, Position is responsible for performing medical record reviews and data extraction... ...onsite meeting which candidate must attend and remote other days....Remote workMedicalContract workWork from home
$88k - $132k
...maintenance included). Claims inspections will include... ...Benefits Include: Medical, Dental, Vision, 401k with... ...program. #LI-JJ1 #LI-Remote Job Description... ...Subrogation to identify fraud and subrogation opportunities... ...for Claims Specialist III, Property Large Loss :...Remote workMedicalFraudFull timeTemporary workPart timeCasual workLive inWork at officeLocal areaWork from homeRelocation packageNight shift3 days per week$135k - $145k
...Role As our Enrollment RN Manager, you’ll be the clinical... ...documentation audit-ready, and serve as a go... ...laptop, charts, or small medical equipment), generally up... ...based on local markets; remote roles are aligned to national... .... Beware of Scams and Fraud Please beware of scams...Remote workMedicalFraudTemporary workPart timeWork at officeLocal areaMonday to FridayFlexible hours$4,942 - $6,920 per month
...Practical Nurse III - Float Clinic -... ...psychiatric and medical issues. The services... ...Nurse (RN): The purpose of... ...practical nurses (LPN) work in security... ...position implements audits and reviews... ...check Medicare Fraud Database TRAILS... ...training and more ~ Remote work...Remote workMedicalFraudFull timeContract workPart timeWork experience placementMonday to FridayFlexible hoursShift work$30k - $40k
...Position : Healthcare Claims Processor Location : Remote, Eastern Standard Time (EST)... ...claims, records, disputes, and audits. Established in 2017, J29... ..., or potential fraud, waste, or abuse through established... ...claims processing, medical billing, provider billing,...Remote workMedicalFraudFull timeImmediate start- Advent in Tampa, FL seeks Level III and Level IV Respite Care Providers to support individuals... ...daily living activities and more complex medical care within the local installation hours.... ...one qualification pathway (degrees, LPN or RN licenses, or equivalent experience) and...MedicalLocal area
- ...duties such as completing medical forms, reports,... ...suspected incidents of fraud to the Administrator. Ensure... ...graduate of an approved LPN/L.VN program. Specific... ...license to practice as an RN or LPN/LVN in this... ...a medical and physical examination. Must be able to relate...MedicalFraudTraineeshipWork at officeLocal areaShift work
- ...Position Title: RN/LPN Job Location: Culbertson, MT, 59218 Remote/ Onsite: Onsite Job Type: Contract Duration: 13 Weeks Shift... ...acute care skills are needed for intermittent patient medical admissions for pneumonia, COPD exacerbations,...Remote workMedicalContract workShift workNight shift
$32.13 - $48.2 per hour
...Document accurately in the electronic medical record. Support autonomy and... ...: Registered Nurse (RN): Holds full accountability... ...individualized care plans. Supervises LPN and nursing assistant clinical... ...review as appropriate. Remote Type Salary Range: $32.13...Remote workMedicalDaily paidRelocation packageShift work- ...Wound Nurse (LPN/RN) - Philadelphia, Pennsylvania At Accela Rehab and Care Center at Somerton, we are committed to providing exceptional... ...and interpersonal skills ~ Familiarity with electronic medical records and wound care software How to Apply: If you...Remote workMedical
$36.53 - $38.46 per hour
...Job Description Workers’ Compensation Claims Examiner III (Contract) Please no 3rd party recruiters... ...is a core part of the role—remote or hybrid work is not available. What... ...Texas statutes Administer indemnity and medical benefits within assigned authority levels...Remote workMedicalHourly payFull timeContract workWork at officeLocal areaMonday to Friday$32.13 - $48.2 per hour
...Registered Nurse (RN) The Registered Nurse (RN) will utilize... ...appropriately in the electronic medical record 8. Identifies and seeks... ...etc) · Provides oversight of LPN assessments (as assigned) and co... ..., written and verbal Remote Type: On-site Salary Range:...Remote workMedicalFlexible hoursShift work$30 - $40 per hour
...to apply for the CMA/LPN role at FirstHealth of... .../Registered Medical Assistant In addition... ...manager. Recognizes how fraud and abuse interplay into... ...prepares patients for examination. Maintains patient health... ...States 1 month ago Remote Registered Nurse (RN) Case Manager North...Remote workMedicalFraudFull timeTemporary workWork at officeNight shift$85k - $95k
...just that. A Brief Overview Claims Examiner will investigate, evaluate,... ...in Omaha, NE or eligible for remote work. This position is not eligible... ...and report potential fraud to Special Investigation Unit... ...00% employer match up to 5%, Medical, Dental and Vision for regular...Remote workMedicalFraudFull timeWork experience placementWork at officeImmediate start- ...setting to review and audit claims, supportprogram integrity... ...judgment to analyze medical records, documentation,... ...unrestricted Registered Nurse (RN) license Strong... ...populations Remote work - enjoy the convenience... ...and identify potential fraud, waste, or abuse. Review...Remote workMedicalFraudFull timeTemporary workWork at officeWork from home
$5,250 per month
...services to include AVM, fraud, & Credit Supplements,... ...applicable Answers audit issues on purchases or... ...more than 5 years (UW III) of Underwriting experience... ...: ~ Hybrid and remote work opportunities ~4... ...employer match ~ Medical, dental, and vision with...Remote workMedicalFraudContract workSelf employmentWork at officeWork from home- Fully remote position supporting patients during Annual Wellness Visits. Requires strong... ...charts and review patient histories, medications, and screenings. Conduct face-to-face virtual... ...HIPAA. What We're Looking For: Active RN or LPN/LVN compact license and 3+ years of...Remote jobMedicalPart timeFlexible hours
- ...educating patients, and ensuring they have access to necessary resources such as transportation and medications. Applicants need at least 1 year of experience as an RN, LPN, or Social Worker, along with an active professional license. Dependability and a good driving...Remote jobMedicalWork from homeFlexible hours
- ...accommodation or an alternative application process. Precertification Nurse-LPN/RN (Remote in NJ/PA) Hamilton, NJ, US 2 days ago Requisition ID: 1459 Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our Medlogix® technology...Remote workMedicalFull timeWork at officeMonday to Friday
$19.86 - $38.85 per hour
...to the highest level of medical care. Here, you will join... ...Quality Assurance LPN/LVN, under the supervision of QA RN, audits clinical records for compliance... ...issues and potential fraud/waste/abuse Monitors and... ...with the Board of Nurse Examiners for the state of employment...MedicalFraudHourly payMinimum wageFull timeWork experience placementWork at officeLocal area- ...Looking for qualified Weekend Nurse (RN or LPN) to join our team! Location: Arden Ridge... ...hands-on nursing care, ensuring residents' medical needs are met in accordance with... ...adults. From telemedicine services and remote health monitoring to advanced diagnostic...Remote workMedicalFull timeLocal areaShift workNight shiftWeekend workDay shiftAfternoon shift
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote RN/LPN Claims Examiner III - Fraud & Medical Audit. Be the first to apply!
- public health registered nurse Kansas City, MO
- temporary rn Kansas City, MO
- cath-lab rn Kansas City, MO
- perioperative rn Kansas City, MO
- part time rn Kansas City, MO
- pacu rn Kansas City, MO
- travel registered nurse l&d Kansas City, MO
- nicu registered nurse Kansas City, MO
- telephonic rn Kansas City, MO
- rn urgent care Kansas City, MO




