Senior FWA Investigator, Healthcare Claims Analytics
Hispanic Alliance for Career Enhancement
The Hispanic Alliance for Career Enhancement is seeking a Sr. Analyst, Fraud, Waste, and Abuse in Massachusetts. The role involves analyzing claims data to identify and investigate fraud. Responsibilities include collaborating with various stakeholders to ensure compliance with regulatory standards. Qualified candidates should possess a high school diploma, work experience of 3-5 years, and relevant coding certifications. This full-time position offers competitive compensation and a range of benefits including health and wellness programs. #J-18808-Ljbffr Hispanic Alliance for Career Enhancement
$46.99k - $122.4k
The Hispanic Alliance for Career Enhancement is seeking a Health Care Fraud Investigator to manage complex cases and aid in preventing fraudulent claims. The role demands 3 years of experience in health care fraud investigations, familiarity with comprehensive coding standards...SeniorClaimsFull time$46.99k - $122.4k
...groups in a prepayment environment Investigates to prevent payment of fraudulent claims committed by insured's,... ...investigation and prosecution of healthcare fraud and abuse matters. Demonstrates... ...Health fraud cases. Strong analytical and research skills using health...SeniorClaimsHourly payFull timeTemporary workLocal area$43.89k - $76.5k
...Summary The Special Investigations Unit (SIU)... ...allegations of Medicaid healthcare fraud, waste or abuse... .... Use data analytics and software tools... ...Partner with the Senior Investigator, as needed, to support FWA case activities and... ...payer billing and claims guidelines. Communicate...ClaimsHourly payFull timeTemporary workLocal area$91.4k - $187k
...Oracle Health is transforming healthcare through intelligent,... ...seeking a highly motivated Senior Product Manager to lead product... .... ~ Experience using data, analytics, customer insights, and KPIs... ...Experience with prior authorization, claims management, eligibility...SeniorClaimsTemporary workWorldwideFlexible hours$115.2k - $144k
Clarivate Analytics is seeking a Senior Consultant in Healthcare Consulting specializing in Epidemiology. This role involves providing analytical insight and leadership for client engagements, developing work plans, and delivering actionable recommendations. The ideal...Senior- ...interests. Director, Clinical Data Analytics & Performance Job Number : 20... ...encounter data, Medicaid claims data, supplemental clinical... ...requirements Leadership Serve as a senior leader of the Office of... ...and/or quality measurement, healthcare data and analytics, and/or clinical...ClaimsFull timePart timeWork experience placementWork at officeShift work
- ...mitigation solutions. We specialize in workers' compensation investigations , surveillance, and claims support for clients across multiple industries. About... ...Skilled in video surveillance techniques Strong analytical and report writing abilities Ability to work...ClaimsPart timeWork from homeHome office
$78.47k
...Senior Medical Audit Specialist Agency: 807 HEALTH CARE AUTHORITY... ...the integrity of healthcare services by providing clinical... ...expertise in conducting audits and investigations to combat fraud, waste, and... ...billed services including claims and documentation to ensure...SeniorClaimsPermanent employmentWork at officeMonday to FridayFlexible hours$80.9k - $110.3k
...Provider Hospital Reimbursement Analyst (Senior Business Systems Analysis Professional)... ..., the pricing software vendor, CIS BSS, claims operations, and other business teams involved... ...encourage personal wellness and smart healthcare decisions for you and your family while...SeniorClaimsBi-weekly payFull timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome office$46.99k - $112.2k
...Fraud, Waste, and Abuse (FWA) will assist in detecting, investigating, remediating and... ...transportation, and other healthcare services. The Sr. Analyst... ...correct coding, review claims, and billing data from all... ...Responsibilities Leverage analytical skills to review claims...SeniorClaimsHourly payFull timeTemporary workWork experience placementLocal area$67.9k - $199.14k
...Oklahoma City seeks a strategic workforce management leader to optimize Claims operations. The ideal candidate will have over 7 years of experience in workforce management or operational analytics, focusing on forecasting, capacity planning, and staffing models. This role...SeniorClaims- ...billing standards while managing a team of medical billers. The ideal candidate has significant experience in medical billing and claims processing, with strong technical and leadership skills. We offer a competitive benefits package that includes insurance and paid time...SeniorClaims
- Job Summary Ensures the integrity and accuracy of claims processes and protocols. Collects data for audits/investigations into claims, utilizing a combination of analytical skills and attention to detail, reviewing documentation, interviewing involved parties, and communicating...ClaimsWork experience placement
- ...Services, Inc is looking for a temporary Workers' Compensation Claims Adjuster to work from anywhere in the continental United States... ...claims in Kentucky and Pennsylvania. Strong communication and analytical skills are essential for managing claims effectively and negotiating...SeniorClaimsRemote jobTemporary work
- OU Health in Oklahoma City is seeking a Professional Coding Specialist III responsible for complex coding portfolios while mentoring and training junior staff. The role requires expertise in coding standards and payer policies, with an emphasis on resolving disputes and...SeniorClaimsRemote job
- CVS Health is seeking a Senior Coordinator for the Minute Clinic Accounts Receivable Department, responsible for managing medical claims and optimizing reimbursement processes. The role requires a minimum of 2 years of medical billing experience and a solid understanding...SeniorClaimsFull time
- Ll Oefentherapie in Oklahoma City is seeking a Senior Principal Applied Scientist to join the Oracle Cloud Infrastructure (OCI) team. This role focuses on advancing Generative AI and Analytics technologies, leading research initiatives, and delivering high-quality models...Senior
$69.92k - $133.62k
...defined guidelines and framework, investigate, evaluate, negotiate, and... ...complex property insurance claims. You will confirm/analyze coverage... .... Proven investigatory, analytical, prioritizing, multi‑tasking,... ...Associate in Claims), or SCLA (Senior Claims Law Associate) or...SeniorClaimsH1bLocal areaRelocationAfternoon shift$23.16 per hour
...Stop Loss (Excess Risk and Reinsurance) claims in accordance with established... ...claim submissions and involves the Special Investigation Unit as necessary. Identifies issues which... ...independently. Problem Solving and analytical skills. ? Language (Other than English...SeniorClaimsFor contractorsWork at officeLocal area- ...Senior Assistant Customer Support (Remote) Oklahoma City, OK, United States Principal... ...of the policy; for example, status of claims, policy provisions, values, basic... ...process improvements. ~ Strong math and analytical skills. ~ HS Diploma required Work...SeniorClaimsRemote job
- ...Senior Vice President, Benefits About the Company Global risk management firm helping clients navigate complex risks with... ...program solutions specialty wholesale strategic risk analytics claims advocacy bermuda market access intermediaries group...SeniorClaims
$79.4k - $175.3k
...interpret documents such as plans of benefits, bid specifications, claim reports, and procedural manuals. Knowledge of principles,... ...diplomacy. Strong critical thinking, negotiating, organizational, and analytical skills. Proficiency in Microsoft Office (Excel, PowerPoint,...SeniorClaimsWork at officeLocal area$54k - $66k
...Senior Subrogation Claims Specialist LHH is looking for a Senior Subrogation Claims Specialist... ...high-value and total loss cases Investigate accidents, liability, and damages to... ...complex cases Excellent negotiation, analytical, and problem-solving skills...SeniorClaimsFull timeLocal area- ...territory. Partner closely with underwriting, product management, claims, and risk control to identify opportunities, resolve issues,... ...interpersonal relationship skills and problem solving. Advanced analytical thinking, business analytics and business development skills....SeniorClaimsWork experience placementNight shift
- Join Arch Insurance Group Inc. as an Executive General Adjuster, responsible for managing complex first-party property claims within our Claims Division. The role demands rigorous compliance with quality standards and state regulations while ensuring optimal claim resolutions...SeniorClaims
$81.7k - $135k
...Tax - Sales and Use Lookback Review COE - Senior Will you shape the future or will the... ...Prepare and defend sales and use tax refund claims Participation on a motivated team of... ...look for We seek top performers who are analytical, adaptable, and proactive individuals who...SeniorClaimsSummer holidayImmediate startFlexible hours$69.92k - $133.62k
AlphaStaffHCM seeks a Field Property Adjuster Specialist in Oklahoma City, OK, responsible for managing property insurance claims from investigation to settlement. This role requires a strong knowledge of residential construction and estimating losses with Xactimate....SeniorClaims$46.99k - $122.4k
Position Summary The Senior Business Analyst supports execution and... ...follow‑up needs Data & Analytical Expectations Maintain working... ...operations, compliance operations, or healthcare operations Strong Excel,... ...with medical and/or pharmacy claims data Education Bachelor's...SeniorClaimsRemote jobFull timeLocal area$21 - $25 per hour
Company Overview Advance Your Career in Insurance Claims with Allied Universal® Compliance and Investigation Services. Allied Universal® Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader,...ClaimsFull timePart timeWork at officeLocal area- ...Workplaces in Financial Services & Insurance Senior Backend Developer Job... ...enterprise environments preferred. · Strong analytical and troubleshooting skills with the ability... ...is the world’s leading risk and claims administration partner, which helps clients...SeniorClaimsContract work
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