Senior Medicaid Fraud Investigator
NYC Department of Social Services
The Medicaid Provider Investigation Division (MPID) of the NYC Department of Social Services is recruiting for Fraud Investigator II to conduct investigations of Medicaid providers and clients suspected of fraud. Responsibilities include data review, interviewing subjects, and preparing detailed reports and closing memos. Candidates must meet NY civil service qualifications and be capable of fieldwork, collate evidence, and coordinate with law enforcement partners as needed. #J-18808-Ljbffr NYC Department of Social Services
- The City of New York seeks a Fraud Investigator II to join the Medicaid Provider Investigation Division (MPID) within the Department of Social Services in New York City. The role includes reviewing data from the Medicaid Data Warehouse, investigating suspected Medicaid...Senior
- ...MJHS Health System is seeking a SIU Fraud Investigator to identify, investigate, and resolve fraud, waste, and abuse across Elderplan’s product... ...lines in New York. This role requires deep knowledge of Medicaid/Medicare regulations and collaboration with compliance, legal...Senior
- ...A healthcare company in New York is seeking a Fraud Investigator to conduct in-depth investigations of reported fraud. Responsibilities include mentoring other investigators, investigating Medicaid fraud cases, and maintaining relationships with law enforcement. Candidates...Senior
- CVS Health is seeking a Senior Investigator to lead high level investigations of healthcare fraud and abuse, with a focus on Medicaid claims. You will handle sensitive cases, coordinate with providers and law enforcement, and train junior investigators. Strong Excel and...SeniorFull time
- The CenterWell Certified Healthcare Corp. is seeking a Fraud and Waste Professional to conduct comprehensive investigations of reported, alleged or suspected fraud within South Carolina's Medicaid program. Remote work option with SC residency required. You will coordinate...SuggestedRemote job
- Humana is seeking a Fraud and Waste Professional to conduct comprehensive investigations into fraud related to Medicaid programs. The role coordinates with law enforcement, assembles evidence, and performs on-site audits of provider records to ensure billing integrity....Remote job
- Humana, Inc. is seeking a Fraud and Waste Professional to conduct comprehensive investigations of alleged fraud related to Medicaid program activities in South Carolina. The role coordinates with law enforcement, assembles evidence, and conducts on-site audits of provider...Remote job
- ...CVS Health is seeking a Senior Investigator to conduct high-level investigations of known or suspected healthcare fraud and abuse. You will handle complex cases, often involving multiple perpetrators, and participate in presenting findings to clinical and legal partners...Senior
- ...Elderplan is seeking a SIU Fraud Investigator in New York, NY to identify, investigate, and resolve fraud, waste, and abuse involving providers, vendors, and members. Under the direction of the SIU Director and Manager, you will analyze claims, enrollment, medical records...Senior
- GEICO is seeking a Senior Field Security Investigator to join the SIU team in New York City and surrounding areas. You will conduct investigations of suspected fraud or other illegal activities against the Company, including interviewing witnesses, gathering statements...Senior
- Cotiviti is seeking a Senior Investigator who will analyze data and conduct interviews to identify potential healthcare fraud, waste, and abuse. This remote role emphasizes Excel expertise and the ability to work across a post-pay Fraud Waste & Abuse team. Responsibilities...SeniorRemote job
- ...remote-first fintech company delivering modern core platforms and cloud-based solutions to banks and financial institutions. The Fraud Investigator will lead complex investigations, analyze cross-channel data, and present findings to clients with actionable risk...SeniorRemote job
- micro1 is seeking a Senior Claims Investigation and Evidence Review Expert for a remote, contractor role (~10 hours per week). You will analyze digital... .... The role emphasizes expert-level domain knowledge in fraud detection, staged-loss, and forensic analysis, with...SeniorRemote jobFor contractors10 hours per weekFlexible hours
- EXL is seeking an Elite Premium Auditor to conduct remote premium insurance audits from home. The role involves interviewing, investigating, collecting, and recording information for written reports provided to the insurance carrier. Candidates must have 5+ years’ experience...SeniorRemote job
- ...Elite Premium Auditor in the United States to perform advanced remote and field audits. The role involves interviewing clients, investigating operations, collecting data, and delivering thorough written reports to carriers. The position offers hourly pay with production...SeniorRemote jobHourly pay
$60k - $90k
...Auditor to conduct remote and field audits across insureds. The role includes performing physical and remote audits, interviewing, investigating, collecting and recording information for audit reports to be provided to the insurance carrier. The position offers work-from-...SeniorRemote jobHourly payWork from home- ...Fortuna Health is seeking a Senior operations associate to drive end-to-end Medicaid eligibility, enrollment and renewal operations for thousands of people monthly. You will manage relationships with business clients and oversee key operational work behind the consumer...Senior
- ...Oregon Health & Science University (OHSU) CHSE seeks a seasoned Principal State Evaluation Manager to lead large-scale Medicaid policy evaluation contracts and drive cross-disciplinary research, stakeholder engagement, and center leadership. The role oversees research...Senior
- One Senior Care in Pennsylvania seeks a Medicaid Eligibility Specialist to manage Medicaid applications from intake through enrollment, renewals, and ongoing eligibility for PACE participants. You will ensure accuracy, follow established procedures, and provide reliable...Senior
- ...position in which the incumbent’s responsibilities include performing physical and remote audits of insured’s business. Interviews, investigates, collects, and records information to be used in a written report that is provided to the insurance carrier. Compensation: Pay...SeniorHourly payWork at officeRemote workWork from homeWorldwide
$90k - $125k
BerryDunn is looking for an Organizational Development Senior Consultant for its Medicaid Practice Group. This position involves facilitating group discussions, designing leadership development programs, and conducting organizational analyses. Ideal candidates should have...SeniorRemote job- ...new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how... ...Student Loan Forgiveness Program (PSLF) Responsibilities: The SIU Fraud Investigator is responsible for identifying, investigating, and resolving...Full timePart timeWork at officeFlexible hours
- ...CVS Health is seeking a Senior Manager to lead attribution governance, provider data integrity, and related operational controls supporting Medicaid operations. You will coordinate with provider relations, data management, IT, analytics, claims, and other departments...Senior
$65k - $88.6k
...Become a part of our caring community The Fraud and Waste Professional is responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving South Carolina's Medicaid Program. The Fraud and Waste Professional coordinates investigation...Full timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to Friday$56k - $67k
## Crop Insurance Senior Claims AuditorApply: Remote: Remote, Texas: Remote, Missouri: Remote, Oklahoma: Remote, New Mexico: Remote, Louisiana: Full time: Posted Yesterday: R4513## As one of the leading writers of Federal Crop Insurance, AgriSompo North America combines...SeniorFull timeWork at officeRemote workWorldwideFlexible hours- Humana is seeking a Senior Process Improvement Professional to analyze and measure the effectiveness of Medicaid enrollment and waiver modernization initiatives. You will partner across Enrollment, Clinical, Claims, Finance and Technology to design, implement, and sustain...SeniorRemote job
- Molina Healthcare is seeking a Senior Analyst, Claims Research (Medicaid Claims) for a fully remote role in the United States. The position emphasizes research on Medicaid claims, advanced Excel usage, and deep root-cause analysis to improve claim accuracy and regulatory...SeniorRemote job
- NYC Department of Social Services is seeking a Clerical Associate IV to function as the Senior Processor of Medicaid Pay-In payments within the Cashiers Unit. You will manage the cashier window, oversee CardConnect credit card transactions, and handle data entry for Medicaid...Senior
$51k - $82k
...world safe and secure. Program Overview Performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse in Medicare and Medicaid programs. About The Role SafeGuard Services (SGS), a...Contract workTemporary workFor contractorsRemote workFlexible hoursShift workNight shift- BerryDunn is seeking a Senior Consultant to join our Medicaid Practice Group. You will leverage Medicaid policy expertise and project management skills to help state Medicaid agencies improve health outcomes and implement waivers. You may be remotely based or located in...SeniorRemote jobWork at office
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