Fraud Investigator - Health Plan Compliance & Audits
Highmark Health
Highmark Inc. seeks an experienced anti-fraud professional to develop and maintain a comprehensive fraud program, conduct investigations, and coordinate regulatory interactions. You will train staff, file annual fraud plans and reports, and ensure compliance with HIPAA and policy requirements. The role requires ability to testify in court, coordinate externally with agencies, and lead recovery efforts for misappropriated funds, with field investigations and audits as core duties. #J-18808-Ljbffr Highmark Health
$70k - $105k
...banking has a distinct fraud profile. Minor cardholders... ...suspicious activity investigation, reporting directly to the Head of Compliance. This is a hands-on role... ...reporting; maintain audit-ready case records.... ...based on experience Health, dental, and vision coverage...Health InsuranceH1bRemote workVisa sponsorshipWork visaFlexible hours$3,672.84 per month
...the workstation, as it is crucial for conducting on‑site audits and investigations. This travel component is integral to the role's responsibilities... ...supervision, audits employer payroll records to assure compliance with KY UI tax laws and regulations and to determine...SuggestedPermanent employmentFull timeWork at officeRemote workNight shift- ...on home address. It is a federally funded FFTL assignment with benefits comparable to permanent roles. The successful candidate will audit payroll records, apply regulatory standards, and assist in enforcing unemployment insurance requirements across #J-18808-Ljbffr...SuggestedRemote jobPermanent employmentWork at office
- ...of MS&AD Insurance Group, is seeking a Lead, Governance, Risk & Compliance (GRC) to mature security governance, risk management, and... ...This role focuses on hands-on execution, regulatory compliance, audits, and policy governance while offering growth into leadership responsibilities...Suggested
- ...Inc. is seeking a detail-oriented anti-fraud investigator to develop and maintain an organization... ...coordinating with law enforcement, and performing audits to meet regulatory standards. The... ...funds, and stay current with changes in #J-18808-Ljbffr Highmark HealthSuggested
- ...Our client is seeking an experienced Governance, Risk & Compliance (GRC) professional with 5–8 years of experience to support information... ...compliance gaps. Perform SOX, SOC 1/SOC 2, ITGC/ITAC, internal audit, and privacy control testing. Assess control effectiveness...Fixed term contract
- ...patient-centered care through data collection, physical assessment, health teaching, health counseling and provision of supportive care to... ...Ensures optimal utilization of resources, service delivery and compliance with NYC Health + Hospitals, health care settings, and all...Full timeWork at office
- ...support for Agency policy, regulation, compliance programs, research, and outbreak investigations related to seafood safety. The... ...FDA, state, and local public health laboratories. The PT Laboratory conducts... ...students. PPO/HMO Health Plan (includes medical, dental, and vision...Health InsuranceFull timeLocal area
- ...Compliance Auditor The Compliance Auditor will foster an environment... ...8 requirements, etc., through audits. The Compliance Auditor is responsible... ...in preparing an annual audit plan. Responsibilities include:... ...degree in business, finance, health care operations, or a clinical...Health InsuranceLocal area
$180k - $250k
...Mentor teams and foster innovation.Ensure regulatory compliance and audit readiness.Support investment planning and prioritization.What do you need to succeed?... ...01(k) program with company-matching contributions, health, dental, vision, life, and disability insurance, and...Full timeWork at officeFlexible hours$55k - $85k
...airport security systems in Inwood and ensure compliance with federal regulations. Inspectors conduct audits and assessments to maintain safety... ...Benefits include paid leave and holidays, health coverage, retirement plans, and career growth opportunities. #J-18808...Health InsuranceHourly pay$77.9k - $117.05k
...shortage, mitigate theft and fraud, and maintain safe and... ...to develop action plans to address/minimize... ...Loss Prevention shortage audits are conducted... ...Aggressively identify, investigate, and resolve all internal... ...Prevention safety audits for compliance of all accident and...Work experience placementLocal areaRemote workFlexible hours$152.4k - $219.6k
...by the team, including investigation, coverage, reserves,... ...professional development plans for each direct report... ....Conduct monthly self-audits using Best Practices... ...accident and supplemental health insurance, reinsurance... ...opportunity and compliance with all laws and regulations...Health InsuranceFor contractorsLocal area- ...compensation, including base pay and annual incentiveComprehensive health and life insurance and well-being benefits, based on... ...functions.• Partner across Risk, Technology, Operations, Compliance, Internal Audit, Legal, Finance, and other control functions to build strategic...Health InsuranceRemote workFlexible hours
$210k - $250k
...innovation. The role serves as an active member of the Legal, Compliance, Audit, Risk and Sustainability (LCARS) Leadership Team,... ...for all employees that includes the following: Health Insurance, a Retirement Plan, Disability benefits, and a Paid Time Off program. We...Health InsuranceTemporary work$110k - $220k
...strategy, risk-based testing plan, evidence standards,... ...across Operations, Compliance, Product, Engineering, Finance, Legal, and Audit while preserving maker... ...into control health, recurring issues, and... ...process improvement, fraud investigation, and IT general controls...Health InsuranceFull timeTemporary workPart timeFor contractors- State of Oklahoma is seeking a Plans Reviewer/APO to perform technical reviews of fire and life safety plans and assist with field inspections to ensure compliance with IFC, IBC, IEBC and NFPA standards. Post-secondary education in fire protection or related fields or...
- Commercial and personal line insurance carriers rely on EXL as a key business partner through our Castle High Value and EXL Risk Control service offerings. We offer a variety of field inspections and risk control services to support our clients’ underwriting processes....For contractorsWork at officeLocal areaWork from home
$66.38k - $90k
...journal entries, ensuring compliance with accounting... ...for journal entries and investigate unusual transactions or... ...company policies and audit requirements. Support... ...k) retirement savings plan, tuition reimbursement... ...education programs Health & Wellness -...Health InsurancePermanent employmentWork at officeLocal area$62.87k - $79.97k
...EEO Investigator Department: Department of Design and Construction Location: Queens... ...investigations, employee requests, counseling and compliance. The selected candidate will conduct... ..., analyze data, conduct surveys and audits and perform quantitative analysis. The...Full time- ...Description Manage and create process documentation to ensure compliance. Apply all wire, ACH and check payments received in multiple currencies... ...monthly reconciliation of corporate GL’s and bank accounts. Audit customer payments for accuracy, completeness and conformance to...Health InsuranceWork at officeFlexible hours
- ...personnel to ensure consistent compliance with accounting standards and... ...consistent with HHM core values. Plan and organize the work of the... ...Oversee and ensure internal audit standards are met. Review... ...~ Medical, Dental and Vision Health Insurance ~ Paid Time Off...Health InsuranceFull timeWork at officeWeekend work
- A community development service provider is seeking a Master Plans Examiner to join their team. This remote role involves reviewing compliance for various projects, initiating preconstruction meetings, and providing technical direction. Ideal candidates must possess the...Remote jobLocal area
- ...Collections Field Officer to enforce state tax laws, perform field investigations, asset identification, and payment arrangements. You’ll... ...businesses, coordinate enforcement actions, and help ensure tax compliance across assigned regions. This full-time role requires...Full time
- The Oklahoma Tax Commission is seeking a Collections Field Officer to enforce state tax laws and secure compliance from delinquent taxpayers through field investigations, asset identification, payment arrangements, and enforcement actions. This full-time role requires...Full time
$27.02 - $48.55 per hour
...Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for... ...standards. Acts as a resource for the health plan peers on HEDIS measures,... ...of quality improvement interventions and audits in relation to plan providers. Position...Health InsuranceHourly payFull timePart timeWork at officeRemote workFlexible hours- MSIG USA is seeking a Lead Governance, Risk & Compliance (GRC) Analyst to mature security governance, risk management, and compliance activities... ...compliance posture. The role emphasizes regulatory alignment, audit support, and policy governance, with opportunities to grow into...
$50.4k - $72k
...to support quality assurance, auditing, and financial operations... ...identify discrepancies, ensure compliance, and support continuous improvement... ..., Medicare, managed care, health insurance, claims, or... ...a 401(k) retirement savings plan and additional employee wellness...Health InsuranceRemote jobFull timeWork at officeWork from homeFlexible hours$21 - $26 per hour
...innovative, streamlined compliance solutions. We’re growing... ...with any surplus lines audits, verifying transactions,... ...organization Independently investigate, research, and resolve... ...decisively Perks ~ Health, dental, and vision plans ~ Amazing work-life...Health InsuranceFull timeRemote work- AAA Auto Club Enterprises is seeking a Claims Service Representative III for the Special Investigations Unit to investigate potential fraud across product lines and serve as liaison with law enforcement and regulatory bodies. The role requires independent judgment, effective...
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