Senior Healthcare Fraud Investigator
Highmark Health
Highmark Inc. is seeking a seasoned anti-fraud investigator to develop and maintain the organization’s fraud program, conduct investigations into potential fraud, and coordinate with law enforcement. This role may involve onsite interviews and fieldwork, with a focus on recovering funds and ensuring regulatory compliance. The ideal candidate has 3+ years in health insurance fraud investigations, strong data analysis skills, and knowledge of provider payment methods and claims systems. #J-18808-Ljbffr
- Highmark Inc. is seeking a seasoned anti-fraud investigator to develop and maintain the organization’s fraud program, conduct investigations into potential fraud, and coordinate with law enforcement. This role may involve onsite interviews and fieldwork, with a focus on...Senior
$80k - $100k
...Job Description The Fraud Risk Sr Analyst is accountable for monitoring and developing fraud risk strategies for Citizens Commercial Credit Card accounts with a focus on IT tools and systems to monitor and mitigate fraud. The Fraud Risk Sr Analyst will take the...SeniorWork experience placementWork at officeLocal areaMonday to FridayFlexible hours- ...your next big move starts here - DescriptionIGT is seeking a Fraud Analyst I to join our Payment Services Team. This role supports... ...on account reviews, transaction monitoring, and fraud investigation.This position reports to the Supervisor of Fraud and Risk Services...SuggestedDaily paidPermanent employmentFull timeWorldwide
- Job Responsibilities Experience in a healthcare environment. Easily adapt to change in an energetic environment. Comfortable with communicating at all levels in the organization. Motivated to establish, maintain, and manage working relationships with colleagues, external...SeniorWork at office
$23 - $30 per hour
...Job Type Part-time Description Command Investigations LLC is seeking an Insurance Claims Investigator with a minimum of one year of experience to become part of a dynamic team. This is a great opportunity for individuals with prior claims investigation...SuggestedHourly payPart timeSecond jobWork at officeRemote workFlexible hoursNight shift- A health services provider in Providence, RI, is seeking an Associate-level Health Care Provider for a full-time position. The role involves overseeing clerical activities and providing administrative support. Candidates should have a high school diploma and some college...SeniorFull time
$90k - $100k
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...Workday to our customers! The Workday Healthcare Consulting team is an industry focused... ...RoleThe Professional Services Healthcare Senior Payroll Consultant, Healthcare will be... ...a privacy right, or cooperating in an investigation in accordance with applicable law. Any...SeniorFull timeWork at officeRemote workHome officeFlexible hours- ...Senior Technical Project/Program Manager Anywhere Type: Contract Category: Program... ...-visibility initiatives within a large healthcare environment. The role will align business... ...fraudulent activity, please contact fraud@eliassen.com . About Eliassen Group...SeniorHourly payContract workLocal areaRemote work
$86.4k
...Company : Highmark Health Job Description : JOB SUMMARY This job promotes the understanding, integration, and use of healthcare data and information technology in support of scholarly research and addressing healthcare business challenges. Leveraging experience...SeniorFor contractorsWork at officeLocal area$79.3k
...insights which identify actionable opportunities and/or create analytics and reporting solutions aligned to the Quadruple Aim of Healthcare: lower per capita health care costs, improved outcomes from and quality of care received, and optimal member/patient and provider...SeniorFor contractorsWork at officeLocal areaShift work$130k - $160.6k
...application of risk based practices by defining scope, program, and review and exam procedures. Exercises judgment and influences senior business managers and peers. Drives completion of credit issues. Helps business partners balance their business strategy with appropriate...SeniorShift workDay shift$130k - $150k
...Description Job Description About TouchCare TouchCare is a healthcare concierge service dedicated to simplifying the complexities of... ...come in. Who You Are TouchCare is seeking experienced Senior Sales Consultants to join our team and help us accelerate our rapid...SeniorBase plus commissionWork at office$148.62k - $184.62k
...Source clinics. Additional travel may be required for training or company events. About Loyal Source Loyal Source provides healthcare and technology solutions designed to improve outcomes and support mission-critical operations. Guided by innovation and purpose,...For contractorsFor subcontractorWorldwideMonday to FridayWeekday work- ...including organizing workload, submitting examination findings, and corresponding with the Quality Assurance Team. Collaborate with Healthcare Professionals: Coordinate and collaborate with other healthcare professionals, specialists, and experts as needed to obtain...For contractorsFor subcontractorWorldwideMonday to Friday
$25.48 - $63.65 per hour
...Description The IC2 Consultant supports healthcare organizations in our CommunityWorks... ...escalates complex design decisions to a senior consultant or project lead. Responsibilities... ...charge or supply chain transactions. Investigate data and workflow issues, document...SeniorHourly payTemporary workFlexible hours$118.3k - $219.8k
...AnalyticsOur Company Elsevier is a global information analytics company that helps institutions and professionals progress science, advance healthcare and improve performance for the benefit of humanity. We serve the research, academic and clinical communities through the...Full timeLocal area$72.7k
...for developing and maintaining an anti-fraud program which includes development and... ...incumbent is responsible for conducting investigations of organizational or functional activities... ...the Health insurance industry and/or Healthcare fraud investigations ~1 year of...SeniorContract workFor contractorsWork at officeLocal area$80.5k - $166.1k
...Description Oracle Health Government Services is seeking a skilled Senior Consultant to join our VA Critical Support Team within a... ...Expert knowledge of Oracle Health (Cerner Millennium) solutions, healthcare workflows, system build, implementation, and workflow alignment...SeniorTemporary workFlexible hours$71.2k - $166.1k
...patients, and save lives. Our mission? To create a human-centric healthcare experience powered by unified global data. It’s a big... ...Oracle Health Government Services is seeking a skilled Federal Senior Engineer/Architect (Principal Consultant) to join our mission-driven...SeniorTemporary workFlexible hours$46.99k - $112.2k
...Dental Fraud Investigator We're building a world of health around every individual — shaping a more connected, convenient and compassionate... ...company. Required Qualifications ~3-5 years of healthcare fraud investigations experience ~ Experience with Microsoft...SeniorHourly payFull timeTemporary workLocal area$125.3k - $178.9k
...day legal contacts for business clients. Job Summary The Senior Legal Counsel serves as the primary legal partner to leaders of... ...Commercial/transactional experience required; knowledge of healthcare law preferred Excellent oral and written communication skills...SeniorFull timeContract workTemporary workLocal areaImmediate startFlexible hours$104k - $143k
...of our caring community This is a remote position. As a Senior Product Manager, you will lead cross-functional product initiatives... ...Preferred Qualifications ~ Master's degree in business or healthcare ~1-2 years supporting Medicare and/or Medicaid programs (Special...SeniorFull timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to FridayWeekend work$86.3k - $118.7k
...team within Marketing’s Creative and Content organization, the Senior Account Manager plays a pivotal role in advancing enterprise... ...benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life...SeniorFull timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome office- ...including organizing workload, submitting examination findings, and corresponding with the Quality Assurance Team. Collaborate with Healthcare Professionals: Coordinate and collaborate with other healthcare professionals, specialists, and experts as needed to obtain...For contractorsFor subcontractorWorldwideMonday to Friday
$71.1k - $97.8k
...Become a part of our caring community We're looking for a Senior workforce planning analyst to own and elevate our forecasting, budgeting... ...or capacity planning in a contact center, pharmacy, healthcare, or comparable operations environment ~ Demonstrated experience...SeniorFull timeTemporary workApprenticeshipSeasonal workWork at officeRemote workWork from homeHome office- BCBSRI is seeking a senior integration leader to drive end-to-end technical data exchanges across core administration, clinical systems, and external partners. You will lead FHIR-based integrations, API design, and data pipelines, ensuring secure, compliant interoperability...Senior
- Sr Payroll Specialist The Sr Payroll Specialist operates at an advanced level in the processing and monitoring of the payrolls, insuring adherence to hospital policies and procedures and collective bargaining agreements. Process payroll including data entry, proofing...Senior
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