Nurse Investigator - Healthcare Fraud & Compliance Expert
Health Plan
Health Plan in Charleston, WV is seeking a Full Time Nurse Investigator to join the Special Investigations Unit. You will detect and investigate suspected fraud, waste, and abuse, review medical charts, coding, and billing to ensure program integrity, and support regulatory compliance. The role requires an RN license, coder certification or eligibility, coding knowledge, and experience with WV Medicaid or Medicare. #J-18808-Ljbffr Health Plan
- ...Charleston, WV, US The Nurse Investigator works as part of the... ...suspected fraud, waste, and abuse (FWA... ...SIU’s subject matter expert in terms of clinical... ...investigate, and resolve healthcare fraud, waste, and abuse... ...including Operations, Compliance, QI, Credentialing, and...FraudFull timeContract workWork at office
- CommunityCare, Inc. in Tulsa, OK, is seeking a Medical Review Examiner Nurse to audit provider and facility claims and contribute to quality... ...or health plan operations, with knowledge of coding and healthcare regulations. This is a full-time position in Medical Management...SuggestedFull time
- Staffing Solutions Organization LLC is seeking a Healthcare Investigator to safeguard Medicaid recipients across Ohio. This fully remote role... ...involved parties, and documents findings to ensure compliance with HCBS regulations. Ohio‑licensed professionals (RN/LISW...SuggestedRemote job
- ...Salisbury VA Medical Center in Salisbury, NC seeks a Senior Criminal Investigator to lead investigations of suspected major offenses against VA... ...the Chief of Police and focuses on high‑level cases including fraud, embezzlement, and other Title 18 offenses. Responsibilities...Fraud
- ...Analyst to review daily reports, identify suspicious activity, and research potential fraud, ensuring compliance with the Bank Secrecy Act and OFAC regulations. You will investigate alerts in BSA software, file CTRs and SARs, review new accounts for proper documentation...Fraud
- ...assess accounting systems across statewide facilities. The role supports audits of Circuit Clerk, MC, DRC, and COJ offices, ensuring compliance with federal and state policies and regulations. The position requires a Bachelor's degree in a related field, with at least one...FraudWork at office
- ...Community Financial System, Inc. (CFSI) is seeking a Fraud Investigator to conduct advanced investigations into suspicious account activity... ...analytical skills, independence, and collaboration with Operations, Compliance, and Security to protect customers and the bank. #J-18808-...Fraud
$107.7k - $199.3k
...high-impact internal investigations across the organization... ...advisor and subject matter expert on investigative best practices, regulatory compliance, and risk mitigation.... .../Criminology, Law, Healthcare Administration/Health... ...Certifications Certified Fraud Investigator preferred...FraudFull timePart timeWork at officeRemote workFlexible hours$43.89k - $69k
...Experienced AML Investigator - Financial Crimes (Hybrid)Skip to main contentThis website stores... ...financial activity, ensure regulatory compliance, and perform quality control. You will lead... ...money laundering, terrorist financing, fraud, and sanctions violations, escalating...FraudOngoing contractFull timeWork at officeLocal areaWork from homeMonday to Friday$89k - $100.81k
...Department Department of Administration Division Regulatory Compliance Salary $88,999.00 - $100,806.00 Job Profile JC-02641900-99 - Investigative Auditor (Non-Union Executive Branch) Scheduled Work Days & Work Hours Monday - Friday, 8:30am - 4:00pm 35 Hours - Non-Standard...FraudWork at officeLocal areaMonday to Friday$32 - $40 per hour
...Insurance Claims with Allied Universal® Compliance and Investigation Services. Allied Universal® Compliance... ...policies and the components of fraud to determine If claims warrant reporting... ...directed Produce professional and expert reports, memos, and letters that are clear...FraudWork at officeLocal area- ...professional to support attorneys with financial, healthcare, and forensic accounting analyses for civil fraud cases. The role includes reviewing records,... ...and preparing detailed reports and timelines for investigations and trials. Responsibilities also cover analyzing...FraudWork at office
$24.03 - $26.92 per hour
...for payment. Conducts research necessary to prevent and identify fraud occurrences with customer checks. ESSENTIAL DUTIES Identifies... ...against the Bank, assists in providing BSA, AML, OFAC and CIP compliance support; interacts with Bank personnel pertaining to such issues...FraudHourly payFull time$54k - $60k
...Deliver outstanding player support on Risk & Fraud matters, including account issues, verification,... ...identify suspicious or unusual player behaviour. Investigate escalations from Payments, KYC, Customer Support, Compliance, and VIP teams. Monitor daily reports to spot...Fraud- RELI Group is seeking an Investigator III to strengthen federal healthcare program integrity through rigorous investigations, compliance oversight, and risk assessment. You will review pharmacies, dispensers, and manufacturers, develop strategies, analyze data, and deliver...
- ...research suspicious or fraudulent activity. Ensures compliance with the Bank Secrecy Act (BSA) and the Office of Foreign... ...PRIMARY RESPONSIBILITIES AND ACCOUNTABLILIES: (90%) Investigate anti money laundering (AML) and fraud alerts in the BSA software and from a variety of...FraudWork at office
- ...Corporation is hiring for a Fraud Prevention Analyst. In this... ...operations. You’ll combine investigation, analytics, and risk management... ...Partner cross‑functionally (Compliance, data teams, vendors, and... ...services, benefits administration, healthcare, or another regulated...FraudWork at officeRemote workFlexible hours
$70k - $105k
...Till Financial Fraud AnalystTill is a banking platform built for families: debit cards, accounts, and tools... ...lifecycle transaction monitoring, and suspicious activity investigation, reporting directly to the Head of Compliance. This is a hands-on role with real ownership from...FraudH1bVisa sponsorshipWork visa- ...re seeking a Warranty Claims Investigator who’s ready to be part of a people... ...history. Subject matter expert for warranty services team.... ...work in the United States. In compliance with the ADA Amendments Act (... ...YOURSELF FROM RECRUITMENT FRAUD The only way to apply for a position...FraudFor contractorsLocal areaRemote workFlexible hours
- Bank of America is seeking a detail‑oriented Fraud Analyst to review complex transactions and help prevent fraud. You will research... ..., perform outbound client contact when needed, and document investigative steps in our systems. The role requires strong analytical skills...Fraud
$18 - $24.33 per hour
...Overview Fraud Agent I is responsible for reviewing Verafin alerts and analyzing potentially... ..., the role assigns cases to Fraud Investigators for further review and resolution while... ...activity observed in alerts. Compliance Ensure all actions taken are compliant...FraudFull timeWork at officeLocal areaImmediate startRemote workWeekend workAfternoon shift- Baystate Health in Massachusetts seeks an experienced Registered Nurse to provide high-quality patient care according to the... ...Model and state regulations. The RN will collaborate with the healthcare team to assess, plan, implement, and evaluate care plans for diverse...
- ...Molina Healthcare is seeking a compliance auditor to support auditing activities and evaluate adherence to regulatory requirements and internal policies... ...findings, and propose improvements to mitigate risks in fraud or abuse areas. The role emphasizes strong analytical...Fraud
$867 per month
...and maintain customer trust in their premium wellness brand. The Fraud Analyst will serve as the primary guardian against fraudulent... ...current fraud prevention measures Recommend process improvements Compliance Reporting Maintain detailed records of fraud cases Ensure...FraudRemote jobHourly payFreelanceWork from home- ...paced cath lab setting. You will circulate and scrub as needed, supporting CV procedures and ensuring sedation safety and regulatory compliance. The role requires 2+ years in cardiac cath or related fields, Texas RN licensure, BLS/ACLS, and strong teamwork and...
- ## Fraud Audit & Investigations AnalystApplyremote type: Remotelocations: US Remotetime... ...by states and managed healthcare organizations to better... ...relationship restrictions, and EVV compliance* Partner with the... ...Serve as a subject matter expert with working knowledge of...FraudLocal areaRemote work
$45 - $63 per hour
...professional delivery of all dialysis-related nursing services in an outpatient setting,... ...rewards package, which includes a 401k match, healthcare coverage and a broad range of other... ...this information. Beware of Recruitment Fraud DaVita will never ask for payment or...FraudMinimum wageStart working today- ...JOB SUMMARY: Responsible for assisting with fraud and security related initiatives by providing... ...oversight. ESSENTIAL DUTIES AND RESPONSIBILITIES: Investigate, review and analyze cases of fraud, examining data to ensure compliance with internal Policies and Procedures and...FraudFull timeBank staffWork at office
- ...role involves recommending follow-up actions such as education, recoupment or rebilling, and referring to regulators for suspected fraud, waste, or abuse. The auditor will work with audit teams across Medicaid and other lines of business, identify aberrant billing patterns...Fraud
$46 - $63 per hour
...competitive total rewards package, which includes a 401k match, healthcare coverage and a broad range of other benefits. Learn more at... ...redacting or removing this information. Beware of Recruitment Fraud DaVita will never ask for payment or personal financial information...FraudMinimum wageMonday to FridayFlexible hoursShift work
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