Healthcare FWA Investigator - Program Integrity
Centene Corporation
Centene Corporation seeks an experienced investigator to conduct fraud, waste, and abuse (FWA) investigations, reviewing referrals, claims data, and medical records to identify misconduct and support case resolution. The role requires collaboration with internal teams and external agencies, ensuring adherence to laws, regulations, and contractual obligations while maintaining thorough investigative documentation. #J-18808-Ljbffr Centene Corporation
- ...Jersey is seeking an experienced Fraud, Waste, and Abuse (FWA) Investigator to review referrals, claims data, medical records, and provider... ...overpayment recoveries while monitoring for emerging schemes to mitigate healthcare program risks. #J-18808-Ljbffr Centene CorporationSuggested
$46.99k - $112.2k
...Position Summary The Senior Investigator, Aetna Special Investigations... ...known or suspected acts of healthcare fraud and abuse. This position... .... Investigate matters of program integrity to prevent payment of aberrant... ...clearly a high level of FWA knowledge and understanding...SuggestedHourly payFull timeTemporary workWork at officeLocal area$56.2k - $101k
...Purpose Conduct fraud, waste, and abuse (FWA) investigations by reviewing referrals, claims data,... ...external stakeholders, and support program integrity efforts while ensuring compliance... ...trends that may present risks to healthcare programs and recommend appropriate actions...SuggestedFull timePart timeH1bWork at officeRemote workFlexible hours- ...care centers, post-acute care/long-term care, rehabilitation programs, Home Care, and Correctional Health Services. Our diverse workforce... ...a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through...SuggestedFull timeWork at officeWork from homeShift work
- ...professional to develop and maintain the organization’s anti-fraud program, conduct investigations into fraud, waste, and abuse, and coordinate with law... .... The ideal candidate will have at least 3 years in healthcare fraud investigations, strong data-mining capability, and...Suggested
$85k - $105k
...Mid-Level Department: Litigation Support CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project... ...Responsibilities Review, sort, and analyze data using computer software programs such as Microsoft Excel Review financial records, complex...Full timeWork experience placementWork at officeLocal area- ...Comprehensive Children's Psychiatric Emergency Program; and Cancer Services. At NYC Health +... ...that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect,... ...Position: Under direct supervision, conducts investigations in a health care setting to determine...Full timeWork at officeShift workWeekend work
- ...approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect,... ..., supervisions a unit conducting investigations in hospitals to determine eligibility of... ...Collectively bargained contracts Loan Forgiveness Programs for eligible employees College tuition...Monday to Friday
$75.35k - $98.89k
...a Senior Analyst, Special Investigations Unit Clinical Investigator... ...clinical expertise to protect the integrity of healthcare spend. You will perform... ...Oscar's unlimited vacation program and annual performance... ...clinical audits into suspected FWA with high autonomy Document...Full timeWork at officeRemote workWork from homeFlexible hours3 days per week- To support healthcare fraud investigations, the full-time Minnesota Licensed SIU Investigator will conduct thorough investigations, analyze trends,... ...(AHFI) 5+ years of experience in fraud investigations or FWA/SIU roles 2+ years of experience in the health insurance claims...Full timeRemote work
- A leading company in healthcare fraud prevention is seeking a talented Coder or Clinical Coder/Fraud Investigator. This full-time role involves analyzing patient medical records... ...healthcare fraud and ensuring payment integrity. #J-18808-Ljbffr Healthcare Fraud ShieldRemote jobFull time
- ...acute care/long-term care, rehabilitation programs, Home Care, and Correctional Health... ...approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect,... ...Director or a Supervisory Confidential Investigator, with some latitude for independent...Full timeWork at officeWork from homeShift work
- Memorial Sloan Kettering Cancer Center (MSK) is seeking a full-time Assistant Attending for the Integrative Medicine & Wellness Service (IMWS) to deliver clinical care and lead translational research within cancer care. The role emphasizes a combination of patient-centered...Full time
- ...Clinical Certified Coder to support fraud detection and investigations in the Special Investigations Unit. The successful... ...role emphasizes strong analytical skills, communication, and integrity in handling sensitive healthcare information. #J-18808-Ljbffr MetroPlusHealth
- ...Criminal Investigator Position The primary purpose of this Criminal Investigator position is to serve as a Special Agent (SA)... ...misconduct matters and providing related services to the TSA in an effort to ensure the integrity of programs operated or funded by the agency....
- ...of Inspector General (OIG), Office of Investigations (OI). OI's mission is to conduct criminal... ...to U.S. Department of Labor (DOL) programs, operations, and personnel to prevent and... ...share intelligence, and enhance program integrity. Represents OI on working groups, task...Permanent employmentWork at officeLocal areaRemote workRelocation package
$90k - $105k
...Managing Investigator At Mintz Group, we specialize in uncovering the truth. For over 3... ...development through advanced training programs and by taking on challenging cases.... ...case outcomes. Champion initiatives to integrate new tools or processes that improve research...Work experience placementLive inLocal areaWorldwideFlexible hoursShift work- ...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...
$220k - $250k
...Metabolism at NYU Langone Health invites applications for a Clinician-Investigator with demonstrated expertise in clinical trials focused on... ...of innovative trials and translational research programs. Key Responsibilities Design, lead, and implement clinical trials...Full time- 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
$20 - $24 per hour
...Hospital Care Investigator / Medical Biller A large healthcare organization in New York City is seeking a Hospital Care Investigator / Medical Biller to support Patient Financial Services and revenue cycle operations. This position is responsible for backend medical...Hourly payFull time$25 - $30 per hour
Description Command Investigations, LLC is looking for Surveillance Investigators to become part... ...experience who demonstrate integrity, independence, and a drive to succeed in... ...Insurance 401(k) Plan Employee Referral Program Paid Travel Time Daily Vehicle Allowance...Hourly pay16 hoursFull timeWork at officeRemote workFlexible hoursShift workNight shiftWeekend work$60.2k - $107.4k
Sr Data Investigator At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers... ..., a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are...Minimum wageFull timeWork experience placementLocal areaRemote work- Organizational context: This position is within the Investigations Division (ID) of the Office of Internal... ...will contribute to upholding the integrity and efficiency of the Organization by... ..., business analytics, or data science programs is an advantage. Work experience: A...Work experience placementWork at officeRemote work
- The Senior Ethics and Compliance (E&C) Investigator conducts investigations into ethics and... ...Assessment. Support the Ethics & Compliance Program; promote partnership, prevention, and... ...on marketing/sales. High ethics/integrity; respect and Novo Nordisk Way principles...Flexible hoursNight shift
$65k - $69k
...learning, support, collaboration and career growth. SUMMARY Under general supervision, the Investigator supports the integrity and safety of ADAPT Community Network’s programs by conducting thorough internal investigations, providing administrative oversight of...Weekend workAfternoon shift$71.97k - $82.77k
...City Department of Correction (DOC) is an integral part of the City’s evolving criminal... ...self-starter to serve as a Compliance Investigator within the Office of Policy and Compliance... ...eligible for federal loan forgiveness programs and state repayment assistance programs...Full timeWork at officeImmediate start$71.97k - $82.77k
...City Department of Correction (DOC) is an integral part of the City’s evolving criminal... ...Correction seeks to recruit Supervising Investigators for the Investigation Division. Under... ...eligible for federal loan forgiveness programs and state repayment assistance programs...Full time$125k - $170k
...environment that is friendly, fair, and flexible. Our work is improving healthcare outcomes, increasing national security, and advancing our... ...a competitive compensation plan, tuition reimbursement program, flexible working hours, six weeks paid time off, 401(k), health...Contract workTemporary workWorldwideFlexible hours$58.66k - $78k
...innovation as we work together to transform healthcare. We encourage all team members to... ...quality care to all who need it. Through the integration of its hospitals, labs, and schools,... ...9th percentile in research dollars per investigator according to the Association of...TraineeshipLocal area
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