Senior FWA Investigator - Healthcare Claims & Compliance
$46.99k - $112.2kHispanic Alliance for Career Enhancement
The Hispanic Alliance for Career Enhancement is seeking a Sr. Analyst for Fraud, Waste, and Abuse (FWA) to join their team in New Jersey. This full-time role involves detecting FWA incidents in healthcare services, reviewing claims data, and collaborating with regulatory agencies. The ideal candidate will have 3-5 years of experience, coding certification, and strong analytical skills. The position offers a competitive pay range of $46,988 to $112,200, along with comprehensive benefits focusing on the well-being of colleagues and their families. #J-18808-Ljbffr Hispanic Alliance for Career Enhancement
$46.99k - $112.2k
...seeking a Sr. Analyst, Fraud, Waste, and Abuse to detect and investigate incidents related to FWA in healthcare services. The role requires strong analytical skills to review claims data and ensure compliance with federal and state regulations. Applicants should have 3-...SeniorClaims- ...analysis. This role demands proficiency in data review and the ability to investigate FWA complaints while ensuring compliance with applicable standards. Ideal candidates should bring 3-5 years of healthcare experience, alongside CPC certification and a strong grasp of coding...SeniorClaims
- CVS Health is seeking a Sr. Analyst, Fraud, Waste, and Abuse to help detect and investigate incidents of FWA. This role will involve extensive analysis of claims data, preparing detailed investigative reports, and collaborating across departments. The ideal candidate will...SeniorClaimsFull time
$70k - $90k
Senior Investigator - Pre-Pay (Healthcare FWA) Job Location: US-Remote Overview As a Senior Investigator, you will... .... Utilizes data analytics, claims review, and industry intelligence... ...potential fraud, waste, abuse, or non-compliance. Leverages claims data, dashboards...SeniorClaimsWork experience placementWork at officeRemote workWork from home$60.2k - $107.4k
A leading health care organization is looking for a Senior Investigator Pharmacy to tackle healthcare fraud, waste, and abuse. The role includes investigating... ...with relevant experience, and knowledge of pharmacy claims processing is preferred. The position requires up to...SeniorClaims$66.33k - $145.86k
...contributor role supports complex investigations and contributes to organizational compliance with federal and state... ...investigations related to healthcare fraud, waste, and abuse (FWA), with a focus on... ...providers submitting non-NSA claims to CIDRE. Prioritizes and manages...ClaimsHourly payFull timeTemporary workLocal area$70k - $90k
A leading healthcare analytics firm is seeking a Senior Investigator to investigate incidents of healthcare fraud, waste, and abuse through data analysis. This remote... ...'s degree, 5-8 years of experience in healthcare FWA investigations, and advanced Excel skills....SeniorRemote job$68.04k - $118.8k
...Summary of Job Conduct complex, in-depth investigations of reported fraud involving the full range of healthcare products. Develop and maintain relationships with... ...sources to review for suspect activity. Review claim files and develop action plans for the...SeniorClaimsWork experience placementRemote work- ...Health in Pennsylvania is seeking a skilled professional to manage complex cases involving health care fraud. The candidate will investigate claims, collaborate with law enforcement, and ensure adherence to health care regulations. Interested individuals must hold a degree...SeniorClaimsFull timeWork at office
- Centene Management Company LLC is seeking a skilled investigator to handle allegations of healthcare fraud and abuse in New York. In this role, you'll plan, organize, and execute claims investigations, utilizing your expertise in data mining and report creation. The ideal...SeniorClaimsRemote jobFlexible hours
$60.2k - $107.4k
Senior Investigator Pharmacy At UnitedHealthcare, we're simplifying... ...and prevention of healthcare fraud, waste and... ...investigator will use claims data, applicable guidelines... ...referrals Ensure compliance with applicable... ...fraud, waste and abuse (FWA) 2+ years of experience...SeniorClaimsFull timeTemporary workWork experience placementLocal areaRemote work$120k - $150k
...Recruitment is actively seeking two Actuarial Analysts to support a healthcare client in New York. These analysts will play a crucial role in... ...of relevant actuarial experience, particularly with Medicare claims data and Value Based Care. The ideal applicants will also...SeniorClaims$216.42k - $324.63k
Lyric, an AI-first healthcare technology company, is seeking a Clinical Ambassador. This full-time role involves engaging with payer clients... ...success is shared. Candidates should have an understanding of claims operations and payment integrity programs. #J-18808-Ljbffr...SeniorClaimsFull time- ...platform for consumers and customers. As a Senior Fraud and Abuse Operations Analyst ,... ...responding to fraud and abuse events, investigating claims, and triaging incidents. We also... ...communicate effectively with internal Legal, Compliance, Comms and other risk management teams...SeniorClaimsWork experience placementLocal area
$120k - $150k
...looking to drive change in the marketplace. Healthcare client from the Northeast is in search... ..., including experience in Medicare claims data, Value Based Care &emerging ACO models... ...be able to speak confidently to clients &senior leaders and possess strong technical...SeniorClaims- ...to manage strategic fraud, waste, and abuse activities. This position requires knowledge in healthcare and compliance, with strong experience in medical claims and investigations. Candidates should have a Bachelor's degree and at least 4 years in relevant fields. The...SeniorClaimsRemote jobFlexible hours
- Responsibilities Conducts investigations into allegations of fraud, waste... ...analyzes medical records, claims data, enrollment data, and other... ...to evaluate potential FWA. Performs coding, billing, reimbursement... ...Coder (CPC), Accredited Healthcare Fraud Investigator (AFHI),...SeniorClaimsWork at office
- ...technology platform that helps healthcare providers get paid fairly in... ...dispute underpaid claims, reduce administrative burden... ...for a strategic, high-impact Senior HR Business Partner to play a... ...healthtech, or highly regulated/compliance-driven industries Prior people...SeniorClaimsRemote workFlexible hours
$77k - $202k
...Overview As a PwC Healthcare Consulting Actuary, you will be part of our exciting, growing team that provides strategic, analytic, and technical... ...Business and Industry Analysis: Analyzing clients’ medical claim data to understand historical trends and suggest opportunities...SeniorClaimsH1b$75k - $90k
...Description As a Healthcare Financial/Actuarial Senior Analyst you will contribute to a wide variety of complex analyses and projects involving the design... ...calculating reserves. Delivers accurate and reliable claim reporting and financial modeling to client teams to...SeniorClaimsTemporary workWork at officeLocal areaVisa sponsorshipWork visaFlexible hours- ...standard of care across the US healthcare system. We’ve built AI-... ...platform built to fix clinical and compliance risks before they impact... ...Ventures. About The Role As our Senior Technical Recruiter, you will... ...aware of fraudulent job offers claiming to be from Brellium. All...SeniorClaims
$190k - $260k
...standard of care across the US healthcare system. We’ve built AI-... ...platform built to fix clinical and compliance risks before they impact... ...Ventures. THE ROLE We're hiring a Senior Product Engineer to ship... ...aware of fraudulent job offers claiming to be from Brellium. All legitimate...SeniorClaims- ...financial and operational performance. Compiles claims, enrollment, revenue, and other... ...Monitors and translates key reimbursement, healthcare reform, and regulation policy issues... ...implement these changes and presents to senior management. Work is typically performed...SeniorClaimsWork experience placementWork at office
$108k - $132k
...insurance—we deliver the kind of healthcare that people deserve. The... ...and operational strategy. As a Senior Actuarial Analyst, You Will... ...and data pipelines. Support compliance under Sarbanes Oxley, including... ...and reliable analyses using claims and EDS data, and identify opportunities...SeniorClaimsWork experience placementWork at officeRemote workFlexible hours$87.65k - $98.6k
Senior Actuarial Data Analyst - Healthcare Salary: $87,647.11 - $98,603.00 Must reside in NY, NJ or CT Join VillageCare... ...monthly close process, conducting claim reserve analysis, and creating... ...financial statements, and ensure compliance with regulatory reporting...SeniorClaimsFull timeWork experience placementWork from home$230k - $300k
...standard of care across the US healthcare system. We've built AI-... ...platform built to fix clinical and compliance risks before they impact... ...THE ROLE We're hiring a Senior AI Engineer to own and evolve... ...aware of fraudulent job offers claiming to be from Brellium. All legitimate...SeniorClaims$215k - $235k
...”. We are looking for a Senior Counsel – Litigation & Employment... ..., medical malpractice claims, and employment matters... ..., multi‑jurisdictional healthcare business. This is a role... ...and manage internal investigations related to legal and compliance issues related to...SeniorClaimsLocal areaImmediate startFlexible hoursShift work$67.9k - $149.33k
...Program Solutions team, the Senior Manager, Health Services plays... ...business by leading clinical and claims-focused initiatives that... ...program effectiveness, regulatory compliance, and cost management across... ...Ensures compliance with healthcare regulations and policies for...SeniorClaimsHourly payFull timeTemporary workWork at officeLocal areaRemote work- ...seeks a Program Integrity Auditor who will review records for various healthcare providers, ensuring compliance with coding and documentation standards. Responsibilities include auditing Medicaid claims and providing education to providers on coding rules. The ideal...Claims
$122.44k
...oversee program performance, compliance, quality control, training,... ...proactive working relationship. Investigate and resolve action items... ...related field. 10+ years of healthcare program management, utilization... ...pricing large stop‑loss claims in coordination with clinical...SeniorClaimsFor contractorsWork at officeRemote workMonday to Friday
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