Lead Payment Integrity & Fraud Insights (Remote)
Centene Corp.
- Remote job
Centene Corp. is seeking a seasoned professional to develop, implement, and manage strategic fraud, waste and abuse activities across our managed care programs. You will monitor billing and claims payment integrity and lead analysts to ensure compliance with state and federal requirements. The role requires a bachelor’s degree and at least 4 years in medical claim investigation or compliance, with strong knowledge of medical terminology. #J-18808-Ljbffr Centene Corp.
- ...focusing on developing and managing fraud, waste and abuse programs for... ...and federal requirements and leading a team of analysts. The role... ...monitoring billing/claims integrity, conducting investigations,... ...in required settings. Remote/hybrid options and a comprehensive...Remote jobFraud
- ...partner for the Special Investigations Unit and Payment Integrity teams. You will deliver business intelligence, financial reporting, and operational insights, combining data analysis with stakeholder engagement to identify fraud, waste, abuse, and payment accuracy...Fraud
$112.7k - $193.2k
...UnitedHealth GroupOptum Insight is improving the flow... ...Growing together.The Payment Integrity Platform organization... ..., provider integrity, fraud detection, clinical review... ...healthcare costs.As a Lead Technical Product... ...the flexibility to work remotely * from anywhere within...Remote workFraudMinimum wageFull timeWork experience placementWork at officeLocal area$112.7k - $193.2k
...UnitedHealth GroupOptum Insight is improving the flow of... ...strategy for one of Optum Payment Integrity's Intelligent Fraud Detection products. This... ...the flexibility to work remotely * from anywhere within the... ...enabled platformsExperience leading or mentoring other...Remote workFraudMinimum wageFull timeWork experience placementWork at officeLocal areaShift work- Centene Management Company LLC is seeking a seasoned Fraud, Waste and Abuse (FWA) professional in Missouri to develop and manage strategic FWA activities across state and federal programs. You will lead analysts, monitor billing and claims processes, and ensure compliance...Remote jobFraud
$166k - $220k
...seeking an experienced EW Mission Integration Lead with prior training and... ...engineers.Conduct onsite and remote troubleshooting support with... ...scammers often attempt to extract payment or sensitive personal... ...links.What to Do If You Suspect Fraud: Should you encounter any questionable...Remote workFraudFull timeContract workWork experience placementImmediate start$98.2k - $163.6k
...Business Analytics Advisor, Payment Integrity - Cigna Healthcare - RemoteApplyremote... ..., with a strong ability to lead complex initiatives, reduce... ..., reduce waste, prevent fraud, and deliver measurable business... ...automation, AI-driven insights, and reusable data assets to...Remote jobFraudWork from home- Elevance Health is seeking a Carelon Payment Integrity Manager - Kansas to oversee accuracy of claims payments, prevent errors, and ensure compliance... .... The role collaborates with health plan leaders to monitor fraud, waste, and abuse programs and to enforce related policies....Fraud
- ...policy development, presenting findings to senior management, and leading Prepay Compliance Managers to reduce waste, abuse, and fraud. Responsibilities also include designing and implementing payment integrity edits, monitoring regulatory changes, and delivering training...Remote jobFraud
$112.8k - $257k
SOC Task & Integration LeadThe Opportunity:As a Security Operations Center (SOC) Task Lead, you’re in the middle of the action, responding... ...and protect against identity fraud. You are expected to be on camera... ...cameras on during meetings.Remote: If this position is listed...Remote workFraudFull timeContract workPart timeWork at officeLocal area- Centene Corporation seeks a senior leader to supervise the Coding & Clinical Review team within Payment Integrity, ensuring accurate DRG assignments and audit outcomes. This remote role drives quality, efficiency, and adherence to AHIMA standards while coordinating cross-...Remote job
- UMB Bank is seeking a Sr. Fraud BI Analyst to design and develop dashboards, reports, data... ...data analytics and presenting actionable insights to leadership. Applicants should have a... ...hybrid role supports Mon-Thu on-site and Fri remote work within the US. #J-18808-Ljbffr UMB...Remote workFraud
- A leading healthcare solutions firm seeks a Payment Integrity Supervisor to oversee daily operations of the payment integrity team. Responsibilities include managing... ...a focus on improving service delivery. This remote position requires strong experience in claims processing...Remote jobDaily paid
$99k - $225k
Palantir Mission Integration LeadThe Opportunity:As a Palantir Mission Integration Lead, you will lead full lifecycle software development... ...and protect against identity fraud. You are expected to be on... ...their cameras on during meetings.Remote: If this position is listed as...Remote workFraudFull timeContract workPart timeWork at officeLocal area$190k - $230k
...planning, design, delivery, systems integration, assurance, safety and... ...Systems Design Coordination Lead based in our San Francisco office... ...global profit share scheme (payments are dependent on the firm’s... ...Stay safe online. Recruitment fraud is on the rise, and Arup’s...Remote workFraudContract workFor contractorsWork at officeFlexible hours- ...-on, technically fluent Product Manager to build and scale our payments platform—the system that moves money from customer funding to settlement... ...cross‑functional collaboration with engineering, finance, fraud, and operations, plus a bias for action. #J-18808-Ljbffr FélixRemote jobFraud
- ...is seeking a Medical Review Manager to lead the Program Integrity medical reviews nationwide. You will... ...candidates possess deep Medicare knowledge, fraud-focused review experience and a master... ...or bachelor’s in nursing. This fully remote/office role collaborates with CMS and...Remote workFraudWork at office
- United States Digital Space LLC is seeking a Senior Payments Performance Analyst to lead data-driven optimisation discussions with existing and prospective... ...tools to reduce card network costs, improve acceptance, fraud controls, and cross-border flows, partnering with Sales...Remote jobFraud
- Félix is a payments platform leader moving money across borders for the Latino community in the United States. You will own the payments... ...ownership, data-driven decision making, and collaboration with fraud, finance, and business development to expand payment methods...Remote jobFraud
$160k - $180k
...represent our values of integrity, transparency,... ...Overview The Lead Product Manager will... ...locations. Fully remote work is not... ...quantitative and qualitative insights into opportunity... ...number of hiring fraud schemes across... ...requires advance payments of any kind for computer...Remote workFraudWork at officeLocal areaWork from home- CorVel Corporation seeks a Payment Integrity Analyst (Team Lead) to supervise the Policy and Payment Integrity (PPI) team while overseeing audits per... ...staff training, and timely completion of audits, with a remote work arrangement. Strong knowledge of CMS policies, ICD-...Remote job
$99k - $225k
Program Integrator, LeadThe Opportunity: As a Program Integrator, you know... ...for someone like you to lead a team of experienced professionals... ...and protect against identity fraud. You are expected to be on... ...their cameras on during meetings.Remote: If this position is listed as...Remote workFraudFull timeContract workPart timeWork at officeLocal area$107.7k - $199.3k
...ensure accurate and timely payments of coding and pricing... ...internal payment integrity edit and audit programs... ...accurate coding. Direct and lead Prepay Compliance... ...reduce waste, abuse, and fraud. Performs other duties... ...approach to work with remote, hybrid, field or office...Remote workFraudFull timePart timeWork at officeFlexible hours$112.2k - $151.8k
...Engineer (Experienced or Lead)Company:Build the... ..., analysis, integration, and test.On the Boeing... ...provide mission insight used by MDA and... ...onsite (no hybrid or remote options). The... ...student loan debt payments counted, along with... ...from recruitment fraud! The only way to apply...Remote workFraudFull timeWork experience placementCurrently hiringImmediate startRelocationVisa sponsorshipWork visaFlexible hoursShift work- Centene Corporation seeks an RN with coding credentials to lead Payment Integrity initiatives focused on preventing readmissions, cost recovery, and payment accuracy. You will guide a team, align with internal policies and regulatory requirements, and drive DRG-related...Remote job
- Head of Payments (Remote - Vertical ERP)Company OverviewWe are... ...Head of Payments to lead and scale the payments... ...across operations, risk, integrations and commercial... ...operationalize risk, fraud and compliance programs... ...CAC impact) and present insights to executive leadership...Remote workFraud
$87.7k - $157.8k
...implement and manage strategic fraud, waste and abuse activities by maintaining... ...processes and systems to assure integrity and compliance in billing and claims payment Lead teams of analysts to... ...flexible approach to work with remote, hybrid, field or office work schedules...Remote workFraudFull timeContract workPart timeWork at officeImmediate startFlexible hours$86.8k - $198k
...Job Number: R0238682 Integration Architect and API Lead The Opportunity: Are you looking for an opportunity... ...and protect against identity fraud. You are expected to be on camera during... ...cameras on during meetings. Remote : If this position is listed as remote...Remote workFraudFull timeContract workPart timeWork at officeLocal area- Elevance Health is seeking a Carelon Payment Integrity Manager in Kansas to oversee claims payment accuracy and fraud, waste, and abuse prevention. The role collaborates with health plan leaders and cross-functional teams to enforce compliance with state and federal rules...FraudWork at office
$120.8k - $169.1k
...Lead Merchant Risk Analyst Remote, USA Since 2018, Wisetack has been... ...leading VCs, including Insight Partners, Greylock,... ...to merchant fraud across the merchant... ...fraud, merchant risk, payments risk, or financial... ...data, or fraud vendor integrations ~ Experience...Remote workFraudFor contractors
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