Senior Healthcare Fraud Investigator
Virtual Vocations Inc
Leading healthcare fraud prevention initiatives, the remote Senior Healthcare Fraud Investigator will manage case development and documentation efforts to support oversight of federal healthcare programs serving Veterans. Key responsibilities Review and validate anomalies and provider risk indicators generated through advanced analytics Develop case documentation, referral packages, and supporting evidence for healthcare fraud investigations Prepare decision-ready case packages with findings, analysis, and recommendations for executive-level reporting Required qualifications 8+ years of experience in federal healthcare fraud investigations or program integrity Working knowledge of healthcare fraud regulations, including the False Claims Act and Anti-Kickback Statute Strong analytical and investigative skills with executive-level communication capabilities Bachelor's degree in a relevant field Ability to pass or currently hold a Tier 2 / Moderate Background Investigation (MBI)
Vacancy posted 3 hours ago
Similar jobs that could be interesting for youBased on the Senior Healthcare Fraud Investigator in United States vacancy
- ...Blue Shield of CA is seeking a Special Investigations Investigator, Consultant to join the SIU team in Oakland. You will conduct investigations into health care fraud, waste, and abuse, adhering to company policies, legal requirements, and applicable regulations. The role...Senior
Blue Shield of CA
Oakland, CA4 days ago - ...CVS Health is seeking a Senior Investigator in Ohio to conduct high‑level investigations of healthcare fraud and abuse, including Medicaid matters, handling sensitive, national cases and providing testimony when required. Requirements: 4+ years in healthcare fraud investigations...Senior
CVS Health
Columbus, OH3 days ago - ...CVS Health is seeking a Senior Investigator for the Aetna Special Investigations Unit to lead complex healthcare fraud investigations on a national scale. You will conduct proactive data mining, analyze claims in depth, and collaborate with Medical Directors to determine...Senior
CVS Health
Florida, NY1 day ago - ...Highmark Inc. seeks a seasoned investigator to develop and maintain an anti-fraud program, conduct field investigations, and coordinate with law enforcement... ...internal controls. The role requires 5+ years in healthcare fraud investigations, strong analytical skills, and...SeniorWork at office
Highmark Health
Austin, TX1 day ago - ...Blue Shield of CA invites applications for the Special Investigations Investigator, Consultant role in our SIU. You will conduct investigations into healthcare fraud, waste, and abuse, report findings to the SIU manager, and ensure compliance with policies and laws. The...SeniorWork at office2 days per week
Blue Shield of CA
Rancho Cordova, CA4 days ago - ...CVS Health is seeking a Senior Investigator for the Aetna Special Investigations Unit. The role focuses on complex national healthcare fraud investigations across multiple lines of business, including Medicaid-related matters. You will conduct research, perform data mining...Senior
CVS Health
New York, NY1 day ago - ...CVS Health is seeking a Senior Investigator for the Aetna Special Investigations Unit to lead high-level investigations into healthcare fraud and abuse. The role spans national scope with multi-line investigations and collaboration with medical directors and law enforcement...SeniorFull time
CVS Health
Lansing, MI1 day ago - ...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
EmblemHealth
New York, NY4 days ago - Responsibilities/Duties: Detail Review and Analysis of Case materials. This includes analyzing the case by identifying key facts, hot documents, witnesses and developing legal theories. Ability to review and analyze data and information from multiple sources and perform...SeniorPart timeLocal area
The Gilchrist Law Firm
Birmingham, AL3 days ago - ...products and expertise that help nearly 16 million people save for a better today and tomorrow.Section 1: Position SummaryThe Senior Fraud Investigator is a senior individual contributor responsible for leading complex or high-impact investigations, identifying emerging...SeniorFull timeSecond jobRemote work
Ascensus
Nashville, TN14 hours ago - ...Clinical Fraud Investigator II Locations: This role requires associates to be in-office 1-2 days per week, fostering collaboration and... ...claims and medical records prior to payment. Researches new healthcare related questions as necessary to aid in investigations....Temporary workWork at officeLocal area2 days per week1 day per week
Elevance Health
Tampa, FL3 days ago $77.1k
...Overview The challenges of affordable healthcare continue to create new opportunities.... ...Program (PSLF) Responsibilities The Investigator will be responsible for triaging,... ...~1 + years of experience in health care fraud, waste and abuse investigations. ~ Certified...Full timePart timeFlexible hoursMetropolitan Jewish Health System
New York, NY1 day ago- ...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
City of Groton
United States3 days ago - ...The State of Delaware seeks an Investigator II to perform the full range of investigations of alleged or probable violations of state or federal laws under general supervision. The role handles long‑term cases with substantial dollar amounts and complex issues. Responsibilities...Senior
DE Inc
Bellevue, WA4 days ago - ...JobAps seeks an experienced investigator to conduct investigations into alleged or probable violations of state or federal laws. This role works independently under general supervision and handles complex cases with substantial stakes. You will collect and analyze evidence...Senior
Jobaps
Wilmington, DE3 days ago - ...Healthcare Fraud Investigator Employment Type: Full-Time, Experienced Department: Litigation Support CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project in Oxford, MS. The candidate must take the initiative to ask questions...Full timeFor contractorsInterim roleLocal areaFlexible hours
Contact Government Services, LLC
Oxford, MS3 days ago - ...Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at... ...Functions-Responsible for conducting confidential investigations of suspected fraud, waste & abuse (FWA) involving medical providers, plan members...Full timeContract workWork at officeLocal areaMonday to FridayFlexible hours
Mass General Brigham Health Plan Holding Company, Inc.
Somerville, MA1 day ago - ...SafeGuard Services, a subsidiary of Peraton, is seeking a Fraud Investigator to perform high-level investigations of medical professional service providers. You will develop cases for future action, coordinate with state and federal partners, and prepare investigative...Remote work
Peraton
Brooklyn, NY3 days ago - ...Employment Type: Full‑Time, Experienced Department: Litigation Support Job Overview CGS is seeking a Healthcare Fraud Investigator to provide legal support for a large government project in Oxford, MS. The candidate must take the initiative to ask questions to successfully...Full timeFor contractorsInterim roleLocal areaFlexible hours
CGS Federal (Contact Government Services)
Oxford, MS4 days ago - ...Centene Corporation seeks an Investigator to conduct fraud, waste, and abuse investigations across healthcare programs. You will review referrals, claims data, and medical records, document findings, and support case resolution while ensuring regulatory and contractual...Remote work
Centene Corporation
Raleigh, NC1 day ago - ...Healthcare Fwa Investigator Levels (Investigator, Sr. Investigator, etc) will depend on experience and qualifications. Integrity Advantage... ...the detection, investigation and prevention of healthcare fraud, waste and abuse (FWA). We are growing and looking for dynamic...Remote work
Integrity Advantage
United States2 days ago - ...Ardelle Associates is seeking paralegals with experience in healthcare fraud and criminal and civil cases to support the U.S. Attorney's... ...using various databases and sources; identifies subjects to investigate and develops leads; conducts interviews; collects and processes...Full timeFor contractorsWork experience placementInterim roleWork at officeLocal areaMonday to Friday
Ardelle Associates
Cedar Rapids, IA2 days ago $85k - $105k
...Healthcare Fraud Investigator CGS is seeking a Healthcare Fraud Investigator to provide legal support for a large government project in Nashville, TN. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently...Work experience placementWork at officeLocal areaContact Government Services LLC
Arlington, VA21 hours ago- ...The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed... ...independent and living life on their own terms. The SIU Fraud Investigator is responsible for identifying, investigating, and resolving...
Metropolitan Jewish Health System
New York, NY1 day ago - ...Highmark Inc. seeks an experienced anti-fraud investigator to develop and maintain an enterprise fraud program, deliver training, and file fraud plans and reports. You will conduct investigations into fraud, waste and abuse across providers, members, facilities, pharmacies...
Highmark Health
Baton Rouge, LA4 hours ago - ...State of Colorado’s Department of Law seeks a Compliance Investigator II for the Medicaid Fraud Control Unit to lead complex civil and criminal investigations into healthcare fraud, abuse, and neglect. You will analyze financial, medical, and investigative data, develop...
State of Colorado
Denver, CO21 hours ago $56 - $64 per hour
...or GED or Bachelor’s degree 8 years of experience in fraud, waste & abuse (FWA) investigations or special investigations unit (SIU) including 1 yr experience... ...assigned by the Director of Controls and Compliance. Seniority level Mid-Senior level Employment type Contract Job...SeniorContract workFor subcontractorTruBlu HR Solutions
Bellaire, TX4 days ago- A leading health organization seeks an investigator for healthcare fraud allegations. Responsibilities include conducting investigations, analyzing claims data, and preparing reports. A bachelor's degree and 1+ years in medical claim analysis are essential. Preferred candidates...Remote work
Centene Corporation
New York, NY1 day ago - ...Highmark Inc. seeks a qualified anti-fraud professional to develop and maintain a proactive fraud program, conduct investigations, and coordinate with law enforcement. The role involves interviews with providers/members, fieldwork, and preparation for referrals to authorities...
Highmark Health
Tallahassee, FL2 days ago - ...Independently leading complex fraud, waste, and abuse investigations, the full-time Senior Fraud Investigator will utilize advanced investigative techniques and... ...Bachelor's Degree in Business, Criminal Justice, Healthcare Administration, Public Health, or a related field...SeniorFull timeRemote work
Virtual Vocations Inc
United States1 day ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Senior Healthcare Fraud Investigator. Be the first to apply!
Related searches
- fraud investigator United States
- entry level fraud investigator United States
- bank fraud investigator United States
- senior business controller United States
- senior service associate United States
- senior safety specialist United States
- civitas senior living United States
- senior learning manager United States
- senior merchandising manager United States
- senior vice president of business development United States