Healthcare Fraud Investigator & Quality Reviewer
Itlearn360
CVS Health is seeking a skilled investigator to assess and enhance processes preventing fraudulent healthcare claims. The role involves case analysis, documentation, and collaboration with law enforcement to support prosecution of fraud and abuse, while presenting findings to stakeholders. The ideal candidate has at least 1 year in healthcare fraud areas, strong MS Office and research skills, and willingness to travel for legal proceedings and investigations. #J-18808-Ljbffr Itlearn360
$43.89k - $102.08k
...thoroughness and accuracy of investigations aimed at preventing payment... ...cases for clinical and legal review, ensuring all documentation... ...of company funds lost due to fraud by providing insights and... ...support the prosecution of healthcare fraud and abuse matters. Demonstrate...QualityHourly payFull timeTemporary workLocal areaFlexible hours$95 - $100 per hour
.... What You Will Be Doing: Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical... ...Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. Aids and acts as a resource to...QualityPart timeWork at officeImmediate start- The Hispanic Alliance for Career Enhancement is seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit. This role involves managing complex investigations into suspected healthcare fraud, waste, and abuse while enabling remote...SuggestedRemote jobWork at office
- CVS Health, Meritain Health’s SIU, seeks an Investigator to support the Network Cost Management team in pursuing fraud prevention and recovery across self-insured commercial... ...conduct investigations of known or suspected healthcare fraud and abuse, coordinate with law...Suggested
- ...QC Batch Reviewer Join Lonza's Quality Control team in Geleen and play a critical role in ensuring the quality, safety, and compliance of pharmaceutical... ...of QC batch records, analytical data, deviations, and investigations to ensure compliance with cGMP requirements and...QualityFull timeRemote work
$36.63 - $48.85 per hour
...all from Day One. Job Description Reviews appraisals and reports including desktop... ..., well supported and credible. Analyzes quality and statistical data for the assigned property... ...Our benefits include the following: ~ Healthcare (medical, dental, vision) ~ Basic term...QualityTemporary workWork at officeLocal area$70k - $95k
...Job Description Tax Senior/Reviewer Needed in Hartford, CT - Boutique Firm, Big Impact... ...s also a rising hub for tech startups, healthcare systems, nonprofits , and closely held... ...a firm culture built on collaboration, quality, and work-life balance. What You’ll...Quality$46.99k - $122.4k
...accountable and prioritize safety and quality in everything we do. Join us... ...health plans. The SIU Investigator will support Meritain Health... ...and prosecution of healthcare fraud and abuse, to recover lost funds... ...cases for clinical and legal review. Documents all appropriate...QualityHourly payFull timeTemporary workWork experience placementWork at officeLocal areaFlexible hours$20 per hour
A healthcare technology company is seeking a Risk Adjustment Analyst to enhance AI models through evaluating their logic and performance. The ideal candidate will have a deep understanding of healthcare, bolstered by a relevant degree. This role offers flexible hours and...QualityHourly payRemote workFlexible hours$20 per hour
...Connecticut is seeking an IV Room Technician. In this role, you will train AI models by providing complex healthcare-related problems, evaluating AI outputs, and ensuring the quality of model responses. Candidates should possess a degree in healthcare and be fluent in English....QualityRemote jobHourly payFlexible hours$20 per hour
A healthcare technology company in Connecticut is seeking a Certified Coding Specialist (CCS) to train AI models. The role involves providing... ..., evaluating AI outputs for accuracy, and ensuring the quality of model responses. Candidates must be fluent in English and possess...QualityHourly payRemote workFlexible hours- A healthcare-focused AI company in Connecticut is seeking an Infection Preventionist to train AI models. The role involves evaluating the... ...offering flexible hours and hourly pay starting at $50, with additional bonuses for quality work. #J-18808-Ljbffr DataAnnotationQualityRemote jobHourly payFor contractorsFlexible hours
- Infosys is seeking a qualified candidate to contribute to healthcare software testing and quality assurance. The role focuses on mainframe testing (Cobol, JCL, DB2), creating comprehensive test strategies, and participating in all SDLC phases to ensure robust software delivery...Quality
- A healthcare technology company based in Connecticut is seeking a Quality Systems Manager to improve AI models through evaluating and solving healthcare-related problems. The ideal candidate should have relevant healthcare degrees and fluency in English. The position offers...QualityRemote jobHourly payFlexible hours
$48.67k - $54.08k
...members, have a high level of initiative and motivation to deliver quality results, have strong problem‑solving skills and a demonstrated... ...and produce logs, transmittals and other reports as required. Review and proofread documents for consistency of document format and...QualityH1b$72k - $78k
...data collaboration platform trusted for healthcare. Guided by our mission to make the world... ...healthcare. The Manager, Service Delivery - Quality & Training leads oversight of quality... ...packages for leadership and client reviews Identify systemic issues vs. site-specific...QualityLocal area$20 per hour
...join their team and train AI models by measuring their progress and evaluating performance. The role requires strong expertise in healthcare, with a focus on revenue cycle management, pharmacy operations, and clinical support. This is a flexible remote position paying $...QualityRemote jobHourly payFlexible hours- ...Limited is seeking a QA/Software Testing professional within its Healthcare unit to transform healthcare delivery through AI-driven... ...design discussions, coding support, and rigorous testing to ensure quality and reliability. The candidate will work on payer domain...Quality
$20 per hour
A healthcare technology company seeks a Value-Based Performance Reporting Analyst to enhance AI models by providing healthcare-related challenges and evaluating AI outputs. Ideal candidates will have fluency in English and either a degree or in-progress studies in healthcare...QualityRemote jobHourly payFor contractorsFlexible hours- ...Assistance, Residential Facility, Healthcare Center, and Cemetery and... ...on fostering these qualities as we honor Veteran patients... ...transcripts, diplomas, performance reviews, attendance records, supervisory... ..., a thorough background investigation of each candidate may be made...QualityTemporary workPart timeWork at officeImmediate startAll shiftsShift workAfternoon shift
$20 per hour
A healthcare technology company is seeking a Primary Care Practice Manager to evaluate and enhance AI chatbots focused on healthcare. The role requires an expert in healthcare with a relevant degree. Responsibilities include providing complex healthcare problems for AI...QualityRemote jobHourly payFlexible hours- Day Kimball Health is seeking a Quality Data Coordinator (RN) for the Day Shift in Putnam, CT. You will oversee data collection for... ...collaboration. Requires a Bachelor’s degree with 5+ years of healthcare experience and Connecticut RN licensure; a Master’s in a related...QualityDay shift
- ...Manufacturing, Retail, Energy & Utility, Healthcare, Technology and the Public-Sector. Our... ...Job Description Run baseline analysis, review wireframes and evaluate visual designs for... ...to meet deadlines without compromising quality Lead and Coordinate activities between Onsite...QualityFor contractors
- ...Company Overview At FUJIFILM Healthcare Americas Corporation, we’re on a mission to innovate... ...on software functional testing and quality assurance, and the fulfillment of relevant... ...with the automated testing team for reviewing implementation of new test cases. Create...QualityFor contractorsWork experience placementWork at officeLocal areaRemote workFlexible hours
- ...looking for experienced Board-Certified Physical Medicine & Rehabilitation (PM&R) physicians in Connecticut to join their independent reviewing panel. This fully remote position offers flexibility and the ability to customize your workload as a 1099 contractor. As a...Remote jobFor contractors
- ...Job Title This position oversees the quality teams at Saint Francis Hospital and Medical Center and Mount Sinai Rehabilitation Hospital... ...Registered Nurse (RN) required, Master's degree in Nursing, Healthcare Administration or Business preferred Three (3) years of...QualityFull timeLocal area
- Quality Data Coordinator (RN) - Day Kimball Health Day Kimball Health... ...the process of gathering healthcare system core measure and... ...Measure Committee. Perform chart reviews to ensure complete... ...QI/RM. Assist in follow‑up investigation of reported variances; prepare...QualityFull timeTemporary workLocal areaFlexible hoursDay shift
$32 - $42 per hour
...Datavant is the data collaboration platform trusted for healthcare. Guided by our mission to make the world's health data secure, accessible... ...facility. Experience with significant level of coding quality review feedback Experience in computerized encoding and...QualityHourly payReliefRemote workRelocation packageFlexible hours- Hartford HealthCare is seeking a Patient Access Services Registrar in Hartford, CT. The registrar will be the first point of contact for... ...be part of a team where every moment matters, facilitating quality healthcare for our community. #J-18808-Ljbffr Hartford HealthCareQuality
- ...Learn more about this outstanding opportunity to join Hartford HealthCare's Heart & Vascular Institute , a national leader in... ...embedded culture of inclusion, innovation, and focus on the highest quality of care. We are a collegial group of specialists, teachers, researchers...QualityFull time
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