Remote Senior Healthcare Compliance Investigator
Centene Corporation
- Remote job
Centene Corporation is seeking a clinical compliance investigations professional to lead enterprise-wide investigations for all business units and health plans. You will manage case intake, interviews, fact-finding, and reporting, ensuring adherence to policies and regulatory standards. You will collaborate with Legal, People Relations, SIU, Privacy, Finance, and Operations to drive timely remediation and maintain regulatory defensibility. Strong analytical and documentation skills are essential. #J-18808-Ljbffr Centene Corporation
- ...Leading complex fraud investigations in healthcare billing, coding, and claims, the full-time remote Senior Fraud Investigator will analyze large data sets to identify patterns... ...are a plus Familiarity with HIPAA, OIG guidelines, and healthcare compliance frameworks...Remote workSeniorFull time
- Centene Corporation seeks a seasoned Compliance Investigations leader to guide an enterprise-wide program for investigations across business units, health plans, and corporate functions. You will oversee investigations, prepare reports, and collaborate with Legal, People...Remote jobSenior
- The Texas Health and Human Services Commission (HHSC) is seeking an Investigator V to join the Major Case Unit within the Office of Inspector General. You will lead high-level investigations into fraud, waste, and abuse across health and human services in Texas, with extensive...Remote jobSeniorWork at office
$107.7k - $199.3k
...York seeks a highly skilled individual to lead and manage complex internal investigations. This role requires exceptional judgment and the ability to guide senior management while ensuring compliance with federal and state regulations. The ideal candidate will have 7+...Remote jobSenior- The Arizona Supreme Court is seeking an experienced investigator to manage the investigation of complaints against certified professionals and unlicensed individuals or entities. You will oversee cases from initial inquiry through final disposition, prepare charging documents...Remote jobSenior
- Centene Corporation is seeking a skilled Investigator to lead complex internal investigations and ensure compliance with laws and regulations. This role involves evaluating allegations, conducting interviews, and managing investigation strategies. The ideal candidate will...Remote jobSeniorFlexible hours
- Centene Corporation seeks an experienced investigator to lead complex internal investigations. The role involves ensuring compliance with regulations and providing strategic advice to senior leadership. Applicants should have a Bachelor's Degree in a relevant field, substantial...Remote jobSeniorFlexible hours
- Washington State Department of Health is seeking a Health Care Investigator 3 to perform remote and travel-based investigations of licensed healthcare professionals. The role involves planning, data collection, on-site interviews, and preparation of formal reports for disciplinary...Remote jobSenior
- ...in Kentucky is looking for a skilled professional to lead complex internal investigations. The ideal candidate needs 7+ years of experience in investigations, proficiency in regulatory compliance, and a bachelor’s degree in a related field. Knowledge of Federal and...Remote jobSeniorFlexible hours
- ...Section 1: Position Summary The Senior Fraud Investigator is a senior individual contributor responsible... ...Partner with operations, compliance, legal, technology, and other stakeholders... ...preferred For all virtual remote positions, in order to ensure associates...Remote workSeniorSecond jobLocal area
$107.7k - $199.3k
...Corporate Ethics & Compliance Investigator Work Setting: Flexible – Remote, Hybrid, Field or Office schedules may be available... ...Type: Full-time Industry: Healthcare / Managed Care Function: Corporate... ...to work effectively with senior leadership, legal counsel, compliance...Remote workFull timeWork at officeFlexible hours- ...Highmark Health in Montgomery, AL, seeks an Anti-fraud Investigator to develop and maintain an anti-fraud program, conduct investigations... ...will oversee annual fraud plans, fraud training, and compliance with state regulations, while mentoring other investigators and...Senior
- ...Compliance Investigator At Fresenius Medical Care, we are the global leader... ...and care across the entire healthcare journey. Guided by our vision... ...with both junior and senior-level employees, preparing... ...the essential functions. Remote with travel as needed (up to...Remote workWork experience placementLocal areaWorldwideFlexible hours
- ...Medica is seeking an experienced SIU Investigator IV to lead complex fraud, waste, and abuse investigations involving members, providers... ..., and guiding investigative processes to strengthen compliance. The position requires a Bachelor’s degree or equivalent experience...SeniorWork at office
- ...RoleLocation: Franklin, TN corporate office with remote work flexibilityTravel: Up to 25%The Compliance Investigator is responsible for conducting and overseeing... ...compliance, ethics, patient safety, privacy, and healthcare operations across one of the nation's leading...Remote workWork at office
- ...CA invites applications for the Special Investigations Investigator, Consultant role in our SIU. You will conduct investigations into healthcare fraud, waste, and abuse, report findings to the SIU manager, and ensure compliance with policies and laws. The position requires...SeniorWork at office2 days per week
- ...Highmark Health seeks a dedicated investigator to develop and maintain an anti-fraud program, conduct investigations into fraud, waste... ...and support recovery of misappropriated funds while ensuring compliance with internal audits and regulatory standards. #J-18808-Ljbffr...Senior
$105k
...Business Operations / Strategy; Compliance / Risk / Quality Assurance;... ...incident reporting and investigations, overseeing Electric Operations... ...hybrid, working from your remote office and assigned office based... ...consensus with multiple senior leaders to stay on schedule....Remote workSeniorWork experience placementWork at officeFlexible hours$115k - $165k
...University of California - Los Angeles Health is seeking a Senior Compliance Investigator to lead compliance investigations involving potential... ...relevant experience, strong analytical skills, and knowledge of healthcare regulations. Responsibilities include gathering and...Senior- ...Conducting detailed investigations into potential fraud, waste, and abuse in healthcare claims, the full-time remote Special Investigator will review medical records and claims... ..., and prepare comprehensive reports for compliance and recovery actions. Key responsibilities...Remote workFull time
$65k - $88.6k
...Healthcare Investigator Humana is looking for an experienced Healthcare Investigator to join its... ...a thorough investigation to maintain compliance with Humana and governmental requirements... .... Travel: While this is a remote position, occasional travel to Humana'...Remote workTemporary workWork at officeLocal areaWork from homeHome office$53.25k - $88.75k
...Sentara Health Plan is currently hiring a Senior Fraud and Abuse Investigator/CPC/CFI/CFS/CHC/CFE/AHFI - Remote! Status: Full-time, permanent position (40... ...Certified Professional Coder (CPC) or Certified in Healthcare Compliance (CHC) Certified Fraud Examiner (CFE) OR...Remote workSeniorPermanent employmentFull timeTemporary workCurrently hiringWork at officeShift work- ...Centene Corp. seeks an SIU Investigator to conduct fraud, waste and abuse investigations across... ...support case resolution and regulatory compliance. The role favors candidates residing in... ...visa sponsorship now or in the future. Remote options are available within the U.S....Remote workVisa sponsorship
- ...Centene Corporation seeks an Investigator to conduct fraud, waste, and abuse investigations across healthcare programs. You will review referrals, claims data, and medical... ...while ensuring regulatory and contractual compliance. Responsibilities include preparing reports,...Remote work
- Optum is seeking a seasoned investigator to support SIU/FWA efforts in Virginia. You will analyze data and evidence, interview members and providers, and prepare investigation summaries for clients, regulators, and stakeholders. This role requires 5+ years in FWA or fraud...Remote job
- Medica is seeking an SIU Investigator III to join our Minnetonka, MN office. This onsite role conducts complex fraud, waste and abuse investigations... ...partners to advance investigations and ensure regulatory compliance. The ideal candidate holds a Bachelor's degree in a related...SeniorWork at office
- ...immigrants in the U.S. in a hybrid role based in Miami. We seek a Senior Fraud Analyst for Consumer Lending to protect unit economics of... ...fraud typologies, own analytics, and work with Operations, Compliance, and Engineering to keep growth secure and profitable. #J-1880...Remote jobSenior
- ...today. About the Role As our Senior Fraud Analyst for Consumer... ...automated block and manual investigation policies. Advanced Risk Tooling... ...workflows. Regulatory & Compliance Liaison: Coordinate with the... ...Health, dental, and vision plans Remote work environment, although...Remote workSenior
- Centene Corporation is seeking an investigator to conduct fraud, waste, and abuse (FWA) investigations by reviewing referrals, claims data... ...investigations, preparing reports, and collaborating with compliance, legal, and external agencies to support corrective actions,...Remote job
$85k - $97.5k
...Senior Fraud AnalystThe Senior Fraud Analyst supports the Credit... ...program by monitoring, investigating, analyzing, and escalating fraud... ...banking, digital account opening, remote deposit capture, card-not-... ..., Cybersecurity, Payments, Compliance, and BSA/AML during fraud...Remote workSeniorFull timePart timeWork at office
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