Remote Healthcare Fraud & Compliance Investigator
Humana Inc
- Remote job
Humana Inc. is seeking an experienced Healthcare Investigator to join its Special Investigations Unit. The role involves researching allegations of fraud, waste, and abuse in healthcare, collaborating with members, providers, and industry partners, and conducting investigations with independent judgment. The position is remote with occasional travel to Humana offices for training or meetings. A Bachelor's degree and healthcare fraud auditing experience are required, with strong data-analysis and #J-18808-Ljbffr Humana Inc
$65k - $88.6k
...caring community The Fraud and Waste Professional 2 conducts investigations of allegations of... ...Home. While this is a remote position, occasional travel... ...degree • 2 years of healthcare fraud investigations and... ...affirmative action, in compliance with Section 503 of the...Remote workFull timeTemporary workFor contractorsApprenticeshipWork at officeWork from homeHome officeMonday to Friday- ...Centene Corporation seeks an Investigator to conduct fraud, waste, and abuse investigations across healthcare programs. You will review referrals, claims data, and medical... ...while ensuring regulatory and contractual compliance. Responsibilities include preparing reports,...Remote work
- ..., a national leader in diversified healthcare, seeks a seasoned investigator to guide team members, investigate fraud, waste and abuse, and mentor staff. This remote role covers the continental United States and emphasizes compliance with CMS guidelines, federal and state...Remote job
$65k - $88.6k
...our caring community The Fraud and Waste Professional 2 conducts investigations of allegations of... ...external entities including compliance, internal business... ...are fortunate to offer a remote opportunity for this job... ...years of experience in healthcare fraud investigations Knowledge...Remote workBi-weekly payFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday$85k - $105k
...Healthcare Fraud Investigator CGS is seeking a Healthcare Fraud Investigator to provide legal support for a large government project in Nashville... ...: Relevant Healthcare Fraud experience including compliance, auditing duties, and other duties in Section 3. Relevant...Remote jobWork experience placementWork at officeLocal area$85k - $105k
...Healthcare Fraud Investigator Employment Type: Full-Time, Mid-Level CGS is seeking a Healthcare Fraud Investigator to provide legal support... ...: Relevant healthcare fraud experience including compliance, auditing duties, and other duties in Section 3. Relevant...Full timeWork experience placementWork at officeLocal area- ...9-08 Position Title: Clinical Fraud Investigator II Job Description: Clinical Fraud... ...warranted. Examines claims for compliance with relevant billing and processing... ...prior to payment. Researches new healthcare related questions as necessary to aid...Temporary workWork at officeLocal areaDay shift2 days per week1 day per week
- ...hope. Overview Responsible for complex fraud and abuse investigations and data analysis to identify trends... ...audits, data mining, perform compliance audits of medical claims, fee screens... ...multiple perpetrators or intricate healthcare fraud schemes. Investigate fraud and...Local area
- ...Fraud Investigator IIUnder the general direction of the Associate Director, or designee, the Fraud... ...of federal and state regulations and healthcare industry standards.Conduct independent... ...records and claims data to ensure compliance with applicable regulations, contracts...Work at office
- ...Highmark Inc. is seeking a qualified investigator to develop and maintain an anti-fraud program, conduct investigations... ...work, and audits to ensure compliance with internal and regulatory requirements... ...’s degree and 3 years of healthcare fraud experience. The position...
- ...A healthcare organization is looking for a Special Investigations Unit Investigator II to investigate fraud and abuse in the healthcare environment. This role conducts thorough investigations... ...leveraging data analytics, ensuring compliance with regulations, and supports the FWA...
- ...Medica is seeking an SIU Investigator III to join our Minnetonka, MN office. This onsite role conducts complex fraud, waste and abuse investigations, performs onsite audits... ...advance investigations and ensure regulatory compliance. The ideal candidate holds a Bachelor's...Work at office
$38.77k - $57.88k
...Fraud Investigator IThe Fraud Investigator I plays a key role in protecting the bank and its customers... ...fraud cases, maintain regulatory compliance, and identify emerging fraud trends... ...credit check.This is a full-time, non-remote position that requires schedule flexibility...Remote workFull timeWork at officeLocal areaWeekend workAfternoon shift$61k - $74k
...Fraud Investigator Richmond, VA; Arlington, VA; or Remote (U.S.). Associates near one of our office locations may work in-office, hybrid, or remotely. Remote... ...such as Sales, Operations, Fraud Analytics, and Compliance About You (Qualifications) ~2+ years of...Remote workWork at officeWork from homeFlexible hours- ...Job Opportunity Council Capital is a healthcare-focused private equity firm based in... ...analytics with expert review to surface fraud, waste, and abuse across Medicare, Medicaid... ...but you will not manage anyone. Strong investigators here come from healthcare payer/vendor...Remote work
- A leading health organization seeks an investigator for healthcare fraud allegations. Responsibilities include conducting investigations, analyzing... ...a minimum of 5 years in fraud investigations. This is a remote role with a strong preference for residents of New York....Remote work
- ...Location: REMOTE – MUST be based in the United States Type: Contract... ...-paced eCommerce risk and fraud operations team. This position... ...will be heavily utilized to investigate cases, communicate with international... .... Demonstrate and promote compliance with company policies,...Remote workContract workFreelance
$40.76 per hour
Healthcare Fraud InvestigatorMacon, GAOnsiteAre you a detail-oriented legal professional who enjoys investigative work, analyzing complex information, and helping attorneys build successful... ...of investigative, law enforcement, compliance, or related experience. Healthcare...Hourly payFull timeContract workWork at office$72.8k - $130k
...Growing together.The Senior Fraud Analyst is a member of the Bank... ...for reviewing and investigating potential cases of financial... ...collaborate with Operations, Compliance, and IT teams to resolve issues... ...Access, etc.) Experience in healthcare payments, particularly healthcare...Remote workMinimum wageFull timeWork experience placementBank staffWork at officeLocal area3 days per week- Contact Government Services seeks a Healthcare Fraud Investigator to provide litigation support for a major government project based in Nashville... ...documents, and help develop referrals while ensuring compliance with agency and USAO standards. U.S. #J-18808-Ljbffr Contact...Local area
- Medica is seeking an experienced SIU Investigator IV to lead complex fraud, waste, and abuse investigations involving members, providers, and employees... ..., and guiding investigative processes to strengthen compliance. The position requires a Bachelor’s degree or equivalent...Work at office
- Centene Management Company LLC is seeking a healthcare investigator to conduct fraud, waste, and abuse investigations across claims data, medical records... ...to support case resolution while ensuring regulatory compliance. The role requires 2+ years of relevant experience,...
- ...SIU Clinical Healthcare Fraud Investigator III Lead complex investigations into suspected healthcare fraud, waste, and abuse. Independently... ...Expertise in clinical documentation review and regulatory compliance. Strong understanding of coding and reimbursement structures...
- UnitedHealth Group is seeking a Coding Consultant to investigate and resolve healthcare fraud and provider abuse using CPT coding guidance. You will mentor investigators, review claims against medical records, and coordinate with internal and external stakeholders to ensure...Remote job
- Humana Inc. is seeking a Fraud and Waste Professional 2 to coordinate investigations of fraudulent and abusive practices across internal and external entities,... ...audit reports in support of adjudication. This is a remote opportunity in the United States with occasional...Remote job
- Wealthfront Corporation is seeking a Fraud Operations Specialist to monitor and investigate daily fraud activity in a fully remote role. You will work closely with Compliance, Engineering, and Product to optimize detection rules and controls, while maintaining adherence...Remote job
$29.37 - $41.12 per hour
Fraud Investigator II Salal Credit Union is seeking a Fraud Investigator II to play a vital role... ...controls to reduce risk. This is a remote position , offering flexibility to work... ...Understanding of various fraud typologies, compliance and regulations. Strong analytical...Remote workHourly payLocal areaWork from home- Wealthfront is hiring a fully remote Fraud Operations Specialist to monitor and investigate daily fraud activity. You will work with Compliance, Engineering, and product teams to strengthen controls and automation, while conducting complex investigations across multiple...Remote job
- ...Estágios e Treinamentos seeks a Medicaid Fraud Investigator to join its Special Investigations Unit. This role focuses on identifying healthcare fraud, conducting audits, data analysis... ...skills, and MS Office proficiency. Remote work from the Chicago area is preferred...Remote job
- Centene Corp. in the United States seeks a Fraud, Waste, and Abuse (FWA) Investigator to review referrals, claims data, medical records, and provider information... ...Bachelor’s degree in a related field and 2+ years in healthcare investigations or related audits; preferred AHFI, CFE,...Remote job
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