Head of Healthcare Fraud Investigations & Pre-Payment Review
HCSC
HCSC is looking for a dynamic individual to join its Internal Investigations team! This role manages health care fraud and internal fraud investigations, mentors investigators, liaises with providers and law enforcement, and coordinates anti-fraud activities with Compliance, Legal, Audit, Provider Services, Clinical Operations, and regulators. The position is hybrid/flex with three days in-office visibility weekly and relocation/sponsorship not provided. #J-18808-Ljbffr HCSC
- ...Head of Payments About the Company A rapidly growing Vertical ERP software company with a collaborative, servant-leadership culture... ...driving payment economics, establishing and operationalizing risk, fraud, and compliance programs, and negotiating with various...Fraud
$92.7k - $167.5k
...individual to join its Internal Investigations team! This position is... ...responsible for managing health care fraud and internal fraud... ...with federal and state healthcare regulations. NOTE: this role... ...Experience in the implementation of pre-payment review process. Exceptional...FraudWork from homeRelocationFlexible hours3 days per week- ...Community Health Plan (PCHP) Special Investigations Unit is to implement an... ...investigation and pursuit of fraud, waste, and abuse violations.... ...Medicaid or Chip utilization review may be substituted for the 3... ...patterns to recommend payment based on medical records, claim...FraudWork at office
$116k - $165k
...leader in insuring Allied Healthcare Providers, including... ...for the overall investigation, management and resolution... ...policies and guidelines, review coverage, determine... ...litigation and authorizing payments within scope of... ...opportunities or potential fraud occurrences by...FraudWork experience placementWork at officeLocal areaFlexible hoursShift work$57.7k - $209.8k
...on-site position supporting investigational drug services in a fast-paced... ...Protocol Compliance: Review protocols, amendments, and study... ...services, commercial insights and healthcare intelligence to the life... ...tolerance policy for candidate fraud. All information and...FraudFull timePart timeImmediate startWorldwide$85k - $105k
...Healthcare Fraud Investigator Employment Type: Full-Time, Mid-Level CGS is seeking a Healthcare Fraud Investigator to provide legal support... ...learning opportunities. Responsibilities will include: Review, sort, and analyze data using computer software programs...FraudFull timeWork experience placementWork at officeLocal area- ...The Federal Bureau of Investigation (FBI) seeks a Special Agent whose work will protect national security by investigating cyber threats, terrorism, fraud, and violent crime. You will apply analytical skills, data analysis, and attention to detail to identify patterns...FraudWork at office
- ...ready to be at the forefront of digital payment innovation? Join our Payments... ...involve sanctions screening, payment investigations, funds control, exception processing... ...verification, performing basic research, reviewing sanctions, fraud, fund controls, and client...Fraud
- ...paychecks to employees Investigating and resolving... ...ongoing performance review and merit increase... ...spending account (Healthcare & Dependent care)... ...may be subject to pre-employment... ...employees for any form of payment or money transfer... ...enforcement agency and report fraud at...FraudTemporary workFor contractorsWork at officeLocal areaImmediate startFlexible hours
- ...Senior Risk Analyst responsible for monitoring and investigating credit card, debit card, and ACH transactions to identify potential fraud and compliance risks. This role is crucial in preventing unauthorized payments and maintaining transactional integrity. The ideal...Fraud
$63.59k - $121.53k
Life Special Investigations Unit Investigator I (Mid-Level)... ...- Medicare Supplement Fraud Waste & Abuse Join to... ...Investigator I (Mid-Level) to review, analyze, and... ...recommendation for claim payments. Represents USAA at... ...partner 5 or more years healthcare/insurance claim investigations...FraudFull timeContract workH1bWork at officeRelocation packageFlexible hours- UnitedHealth Group is seeking a Senior Investigator responsible for identifying and preventing healthcare fraud, waste, and abuse. This role offers telecommuting flexibility and requires investigating complex fraud cases, analyzing data trends, and collaborating with regulatory...FraudRemote job
- ...you will lead and contribute to complex multifamily mortgage fraud investigations by applying multifamily underwriting expertise, forensic... ...the following responsibilities: Perform forensic underwriting reviews of complex multifamily loan files to identify potential fraud...FraudWork at officeRemote work
$68.5k - $102k
...Global Financial Crimes Compliance Investigator The Global Financial Crimes Compliance (GFCC... ...conducts complex investigations, including fraud committed by external parties,... ...Laundering Specialist (CAMS). Data Management, Review, and Analysis. FINRA Services Principal...FraudShift workDay shift- ...Global is a full-service engineering, fire investigation, environmental, health and safety, and... ...firm specializing in handling insurance fraud and arson cases and providing expert... ...developments that impact claims results. Reviews and makes recommendations on outcomes of...FraudFull timeWork at officeLocal areaRemote work
- ...protocols. Collects data for audits/investigations into claims, utilizing a... ...and attention to detail, reviewing documentation, interviewing involved... ...opportunities to target fraud, waste, and abuse or discrepancies... ...successful completion of pre-employment background and...FraudWork experience placement
- ...technologies, including GPS tracking and surveillance systems. Investigate incidents of theft, fraud, and cargo loss, documenting findings and implementing... ...and improving supply chain security. Audit freight payment data and shipment records to identify discrepancies or potential...FraudWork at office
- ...protecting the financial system and investigating suspicious activity? We're... ...part in monitoring Canadian payment activity, conducting complex... ..., and quality control reviews for both Canadian and U.S. compliance... ..., AML compliance, fraud investigations, or a related...FraudWork at office
- ...quality levels are met at pre-ship and at the final... ...via computer Reviews and approves solutions... ...preferred. BE AWARE OF FRAUD: When applying for a... ...does not request payments for interviews or at any... ...the Federal Bureau of Investigations internet crime hotline...FraudWork at officeLocal areaWorldwide
- ...population health, utilization review, managed care organization... ...national leader in fighting fraud, waste and abuse for large organizations... ...related to complaints and investigative leads of potential fraud... ...populated and updated per pre-established timeframes. Maintains...FraudFor contractorsWork experience placement
- ...to join the agency’s Healthcare Program Enforcement Division... ...Health Care Program Fraud Prevention Act. Our... ...Enforcement and related investigations. Analyzes factual and... ...activity. Reviews data and documentation... ...Conducting all aspects of pre‑trial litigation, including...FraudFull timeWork at officeRelocationNight shift
$90k - $115k
...is responsible for performing end-to-end investigations or investigations support functions of... ...routine to complex investigations, including fraud committed by external parties, money... ...adequately documented. Responsibilities Reviews, analyzes, and makes recommendations on...FraudWork at officeShift workDay shift- ...an Asset Protection Specialist to prevent financial loss from theft and fraud and to support safety and environmental program compliance in assigned stores. You will monitor security systems, review CCTV and exception reports, and help drive shrink-elimination...Fraud
- ...business customers and Intuit from financial losses, fraud, and compliance risk. As a Forensic Financial Investigations Senior Analyst, you'll own complex... ...exposure. Preferred Qualifications Experience in payment fraud or SMB lending/credit risk. Bachelor’s degree...Fraud3 days per week
- ...strategic, consultative selling approach to cultivate payments optimization strategies Prepare and deliver business reviews and analysis on strategic client relationship... ...or related field Certified Payments Fraud prevention professional (CPFPP) Technology related...FraudBank staff
- ...quality levels are met at pre-ship and at the final... ...via computer Reviews and approves solutions... ...preferred. Be aware of fraud: When applying for a... ...Jabil does not request payments for interviews or at any... ...the Federal Bureau of Investigations internet crime hotline...FraudWork at officeLocal areaWorldwide
$118.75k - $197k
...business problems, designing payment solutions, building the commercial... ...as a center of excellence for fraud prevention and helping grow... ...and technology - from CFOs and Heads of Product to engineers and... ...Client‑facing background spanning pre‑sales, solutions consulting,...Fraud$96.8k - $145.2k
...critical, higher education, sports, healthcare, grocery, restaurant, and... ...calculations, prepare and review design documents, coordinate... ...NOTICE TO CANDIDATES: RECRUITMENT FRAUD ALERT Henderson... ...and will never ask you for a payment of any sort nor offer one for...FraudCasual workWork at officeFlexible hours- Catalyst Brands is seeking a Central Investigations Technician in Dallas to support the Central Investigations... ...‑to‑day analytics and observation to detect fraud in stores and reduce shrink. You will generate clear reports, review POS and CCTV data, and assist with...Fraud
- ...be a part of the Global Corporate Banking Payments Sales team. In this role you'll play a... ....g., interchange, assessments), risk and fraud, chargebacks and disputes ~ Experience... ...position is contingent on JPMorganChase's review of criminal conviction history, including...Fraud
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