Remote Claims Examiner III - Fraud & Compliance (RN/LPN)

Wis Phys Svc Ins Corp

Remote job

Wisconsin Physicians Service (WPS) is seeking a Claims Examiner III LPN/RN to safeguard MVH program integrity by identifying, investigating, and preventing fraud, waste, and abuse. The role blends clinical expertise with data analysis to evaluate medical necessity and ensure proper benefit administration. The position supports audits and quality initiatives, collaborating with leadership and external partners to deliver well-documented recommendations. #J-18808-Ljbffr Wis Phys Svc Ins Corp

Apply

Vacancy posted 1 hour ago

Similar jobs that could be interesting for youBased on the Remote Claims Examiner III - Fraud & Compliance (RN/LPN) in Denver, CO vacancy

Claims Examiner III - LPN
$21.78 per hour
...Defense restrictions. Our Claims Examiner III LPN protects the... ...preventing potential fraud, waste, and abuse. They... ...role helps maintain compliance and strengthens trust... ...Location We are open to remote work in the following... ...Licensed Registered Nurse (RN): Associate Degree in...
Remote work
Fraud
Contract work
For contractors
Immediate start
Monday to Friday
Flexible hours
Shift work
WPS Health Solutions
Denver, CO
1 hour ago
Remote Medicaid Medical Review RN - Fraud & Compliance
...Integrity Systems is seeking a Medicaid Medical Review RN (Medical Reviewer III) to conduct clinical chart reviews for fraud investigations and program integrity initiatives... ...to determine payment coverage. This position is remote, with occasional on-site audits in OH if needed....
Remote job
Fraud
CoventBridge Integrity Systems
New York, NY
4 days ago
Commercial Property Claims Examiner III (Remote)
$95.99k - $106.66k
...The Commercial Property Examiner reviews, evaluates and... ...complex commercial insurance claims and makes... ...procedures. • Maintain compliance with the Department of... ...procedures. • Identify fraud or illegal activity indicators... ...Claims Examiner III role will focus on Claims...
Remote work
Fraud
Full time
Contract work
Work experience placement
California FAIR Plan Association
Remote
4 days ago
Travel Nurse RN - Intermediate Care in Burlington, NC
...Registered Nurse (RN) | Intermediate Care Location: Burlington... ...patients via telemetry with remote support from the Centralized... ...experience required Must pass a compliance EKG exam (2 attempts allowed)... ...on the Florida Diploma Fraud Audit list will not be accepted...
Remote work
Fraud
Weekly pay
Full time
Contract work
Temporary work
Immediate start
Night shift
Weekend work
TravelNurseSource
Burlington, NC
1 day ago
Medicaid Medical Review RN (Medical Reviewer III)
$78k - $85k
Overview Medicaid Medical Review RN (Medical Reviewer III) - REMOTE The Medicaid Medical Review RN (Medical Reviewer... ...medical records during the course of fraud investigations or other program... ...information contained in Standard Claims Processing System files (e.g., claims...
Remote work
Fraud
For contractors
H2b
H1b
Work at office
Local area
Home office
CoventBridge Integrity Systems
New York, NY
1 day ago
Licensed Practical Nurse III - Float Clinic - CMHHIP.
...Licensed Practical Nurse III - Float Clinic -... ...Registered Nurse (RN): The purpose of... ...practical nurses (LPN) work in security settings... ...HIPAA and JC compliance on an ongoing basis... ...Database check, Medicare Fraud Database, TRAILS... ...training and more Remote work arrangements...
Remote work
Fraud
Full time
Contract work
Temporary work
Part time
Work experience placement
Monday to Friday
Flexible hours
Shift work
State of Colorado
Pueblo, CO
57 minutes ago
Remote Utilization Management Nurse (RN/LPN)
...health services are delivered with quality, cost efficiency, and compliance. You will review treatment files, verify medical necessity,... ...multidisciplinary team to optimize patient outcomes. State licensure as an LPN or RN and a minimum of 2 years in Utilization Management are...
Remote job
Integrated HomeCare Services
Tallahassee, FL
1 day ago
Remote/Hybrid Registered Nurse (RN) - Advocacy & Program Integrity (Hospice Expert)
...program integrity through compliance management. Here, you'... ...to review and audit claims, supportprogram integrity... ...Registered Nurse (RN) license Strong clinical... ...vulnerable populations Remote work - enjoy the... ...and identify potential fraud, waste, or abuse related...
Remote work
Fraud
Full time
Temporary work
Work at office
The CKHobbie Group
Harrisburg, PA
5 days ago
Hospice RN Case Manager
$77k - $88k
...Hospice RN Case Manager Bring your nursing expertise to one of healthcare's most... ...Employer Match ~ Pet Insurance ~ ID and Fraud Protection ~ And more... Optimal... ...Care Partnership, and is performed in compliance with the Fair Credit Report Act. Reasonable...
Remote work
Fraud
Daily paid
Full time
Temporary work
Part time
Work at office
Monday to Friday
Weekend work
OPTIMAL CARE INC
United States
4 days ago
Senior Compliance Oversight Specialist (RN)
...subcontractors' corporate ethics and compliance program, and ongoing... ...Key Details: This is a remote position. Previous experience... ...License/Certification: RN or LPN required. Certified in HealthCare... ...Auditor (CIA); or Certified Fraud Examiner (CFE) preferred. At Centene...
Remote work
Fraud
Full time
Part time
For subcontractor
Work at office
Flexible hours
Centene Corporation
Florida
11 days ago
Remote Clinical QA Coordinator (RN/LPN)
...Solutions is seeking a Clinical Quality Assurance Coordinator to review peer reports remotely and ensure accuracy, citations, and regulatory compliance. The role requires an active RN or LPN license and at least two years of clinical experience. You will verify client...
Remote job
Monday to Friday
MES Solutions
Norwood, MA
2 days ago
Patient Monitor & Care Liaison (LPN/RN)
...Patient Monitor to analyze and document remote patient data, monitor vital signs via RPM... ...needed. The position requires an Arkansas RN license, BLS, and clinic experience. It is... ...support teams to ensure quality patient outcomes and compliance with #J-18808-Ljbffr PTCOA
Remote work
Full time
PTCOA
Texarkana, TX
1 day ago
Litigation Administrative Assistant III - Remote Eligible
$1,000 - $2,999 per month
...Opportunities: Administrative Assistant III - Litigation (21502) Posting... ...employment decisions, tort claims, agency rules and policies,... ...prosecute cases of Medicaid fraud. The Administrative Assistant... ...Descriptions . ADA Accommodations: In compliance with the Americans with...
Remote job
Fraud
Full time
Contract work
Temporary work
Part time
Work at office
Shift work
Health & Human Services Comm
Austin, TX
4 days ago
Remote RN/LPN: Medical Director Assistant & Compliance
...to the Medical Director, requiring an active RN or LPN license and significant wound care knowledge. This full-time remote role involves supporting the Clinical Director... ...and clinical tasks, while also ensuring compliance with healthcare regulations. Ideal candidates...
Remote job
Full time
Integrated Wound Care
Greenville, NC
2 days ago
Remote RN Medical Reviewer: Claims & Compliance
Broadway Ventures LLC is seeking an experienced Registered Nurse to perform medical review of complex claims, pre-authorization requests, appeals, and fraud and abuse referrals. You will apply clinical expertise and established coverage guidelines to determine medical...
Remote job
Fraud
Broadway Ventures LLC
Salem, OR
2 days ago
Remote Medicaid Medical Review RN: Fraud & Claims Auditor
...Integrity Systems is seeking a Medicaid Medical Review RN (Medical Reviewer III) for remote work with potential on-site audits in Grove City, OH. The... ...role focuses on clinical reviews of medical records during fraud investigations and applies Medicare/Medicaid guidelines...
Remote job
Fraud
CoventBridge Integrity
Grove City, OH
3 days ago
Primary Care Nurse RN or LPN - Edmond I-35 South
...Find your calling at Mercy! Position Details: Primary Care Nurse RN or LPN Mercy Clinic Primary Care - Edmond I-35 South Monday-Friday, 40 hours per week *This is a hybrid remote position. The person hired for this role will complete at least 90 days of...
Remote work
Full time
Monday to Friday
2 days per week
3 days per week
Mercy
Edmond, OK
24 days ago
LICENSED PRACTICAL NURSE III - Rifle, CO
...behavior changes with RN oversight. Identifies... ...assessments. Regulatory Compliance Directs and implements... ...valid licensure as an LPN from the Colorado Board... ...Database check, Medicare Fraud Database, TRAILS... ...schedules, training and more Remote work arrangements for...
Remote work
Fraud
Full time
Temporary work
Part time
Work experience placement
Work at office
Flexible hours
State of Colorado
Rifle, CO
3 days ago
Project Manager III
...national leader in fighting fraud, waste and abuse for... .... The Project Manager III is responsible for... ...governance frameworks to ensure compliance with industry standards... ...), Registered Nurse (RN), Certified... ...and/or Certified Fraud Examiner (CFE) Qlarant is an Equal...
Remote work
Fraud
Work experience placement
Qlarant
United States
1 day ago
Business Banking Underwriter III
$70k - $140k
...Underwriter IIIThe Business Banking Underwriter III is responsible for underwriting Business... ...loans to determine credit worthiness and compliance with Bank lending policy.Duties &... ...strong community, and do their best work. Remote roles will also have the opportunity to come...
Remote work
Work at office
Work from home
Flexible hours
Huntington
Birmingham, AL
5 days ago
Business Banking Underwriter III
$70k - $140k
...Summary The Business Banking Underwriter III is responsible for underwriting Business... ...loans to determine credit worthiness and compliance with Bank lending policy. Duties &... ...strong community, and do their best work. Remote roles will also have the opportunity to come...
Remote work
Work at office
Work from home
Flexible hours
Huntington Bancshares, Inc.
Dallas, TX
5 days ago
Operations Manager III
$60 - $70 per hour
Position: Senior Fraud Operations SpecialistLocation: Cupertino,... ...and risk initiatives, ensuring compliance with evolving industry... ...Thurs onsite, Monday to Friday remote) 6 Infinite Loop Cupertino, CA... ...message, email, or phone call claiming to be from PTR Global do not...
Remote work
Fraud
Full time
Monday to Friday
Pinnacle Group
Cupertino, CA
1 day ago
Auto Litigation Claims Specialist
$59.9k - $98.2k
...Auto Litigation Claims Specialist Zurich North America Claims... ...updating claims data/information in compliance with best practices for low... ...claim to subrogation and fraud teams by identifying potential... ..., Addison, Atlanta, Omaha Remote Working: Hybrid Schedule:...
Remote work
Fraud
Full time
Temporary work
Apprenticeship
Currently hiring
Work at office
Local area
Visa sponsorship
Zurich Insurance Group
Atlanta, GA
17 hours ago
Remote Life Insurance Claims Processor
$51.5k
Somebody Has to Be the Steady One A claim shows up. Behind it is a... ...life insurance claims remotely, and you're the reason the process... ...authenticity before you even open them. Compliance runs in the background -... ...not meant to. Some move into fraud detection, digging through...
Remote job
Fraud
Live in
Work from home
Home office
Flexible hours
Shift work
Naukri Mitra
New York, NY
1 hour ago
Cybersecurity Engineer III
$149.01k - $170.9k
...Health Inc. seeks Cybersecurity Engineer III at its facility located at 155 E 44th Street... ...participating in the documentation of compliance with safety standards. 100% Telecommuting... ...interviews (live or video), and screen for fraud or misrepresentation. Applicants who...
Remote work
Fraud
Full time
Part time
Visa sponsorship
Work visa
Flexible hours
Teladoc Health
Remote
16 days ago
Remote UM Nurse Coordinator (RN/LVN) | 6-Month Contract
$45 per hour
Utilization Management Nurse Coordinator(RN or LVN) needed for a temp 6+ month, remote contract opportunity with Yoh’smanaged care health plan client based... ...the right care at the right time while maintaining compliance with regulatory and health plan guidelines. Top...
Remote job
Contract work
Temporary work
Monday to Friday
Weekend work
Yoh
Columbus, OH
11 hours ago
RN or LPN - Long Term Care - Nights - 12 hours shift
$37.1 - $55.65 per hour
...Relocation reimbursement for qualifying positions RN ($37.10-$55.65 based on experience):... ...local regulatory or accrediting agencies. LPN ($25.22-$37.83 based on experience): A... ...within 6 months of hire. FTE: 0.3 Possible Remote/Hybrid Option: Shift Rotation: Night Rotation...
Remote work
Part time
Local area
Relocation
Flexible hours
Shift work
Night shift
Weekend work
Essentia Health
Fosston, MN
11 days ago
Medical Claims Recovery Specialist (Subrogation) - Hybrid EST / CST
Remote Summary HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare—... ...quality, and achieve regulatory compliance. We also help consumers... ...intake, maintenance, claims review and selection, asset...
Remote work
Fraud
Contract work
Work at office
Gainwell Technologies LLC
New York, NY
2 days ago
Wound Care Nurse (RN or LPN)
...Wound Care Nurse (RN or LPN)Location: Middleton Oaks Health and RehabilitationJob Type: Full... ...- Assist in the implementation and compliance of wound care policies, procedures, and... ...adults. From telemedicine services and remote health monitoring to advanced diagnostic...
Remote work
Full time
Local area
Shift work
Night shift
Day shift
Afternoon shift
Avardis Health
Winona, MS
2 days ago
Payment Policy Analyst - Clinical (LPN or RN required)
...team, helping ensure provider claims are paid accurately, efficiently... ..., with 2 days (Monday, Friday) remote option. Qualifications... ...Unrestricted Licensed Practical Nurse (LPN) in Iowa or South Dakota (... ...Unrestricted Registered Nurse (RN) license in Iowa or South Dakota...
Remote work
Permanent employment
Work experience placement
H1b
Work at office
Monday to Friday
Flexible hours
Wellmark, Inc.
Des Moines, IA
15 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote Claims Examiner III - Fraud & Compliance (RN/LPN). Be the first to apply!