Remote Nurse Reviewer Team Lead - Fraud & Medical Claims
Peraton
Peraton is seeking a Nurse Reviewer Team Lead for SafeGuard Services to oversee medical reviews, ensure quality, mentor staff, and coordinate with investigations for referrals to law enforcement. You will promote timely development and resolution of reviews, with the ability to present findings and support proactive fraud detection. The role requires an active nursing license, strong investigative and communication skills, and the flexibility to work remotely from anywhere in the United States. #J-18808-Ljbffr
$51k - $82k
...investigation, and medical review to detect, prevent,... ...referrals to recover fraud, waste, and abuse.... ...are looking to add a Nurse Reviewer to our SGS team of talented professionals... ...judgment to claim payment decisions. Responsibilities... .... As the world's leading mission capability...Remote workMedicalClaimsFraudContract workShift workNight shift- ...Supplemental Products Team Lead (Health Insurance)... ...as well as reviewing, analyzing, and auditing... ...insurance claims to ensure that claims... ...specific to supplemental medical plans and benefits... ...potential fraud or discrepancies.... .... Work Schedule & Remote Work Full-time, remote...Remote workMedicalClaimsFraudFull timeWork at officeWork from homeHome office
$90k - $99k
...Gainwell It takes great medical minds to create... ...Role in Our Mission Reviews provider appeals and redeterminations... ...reviews of multiple claim types to provide a... ...as defined by the Nurse Licensure Compact (NLC)... ...Expect in This Role Remote (Work from Home) Up...Remote workMedicalClaimsFull timeWork from homeFlexible hours$95k - $110k
...(in days) to receive an alert: DRG Nurse Reviewer Appeals and Hearings- Remote Date: Aug 30, 2026 Location: Any city... ...(Exception only) It takes great medical minds to create powerful solutions... ...trains to perform reviews of multiple claim types to provide a flexible...Remote workMedicalClaimsFull timeWork from homeRelocation packageFlexible hours- ...unit (SIU) activities specific to medical provider coding fraud, waste and abuse (FWA). Investigates... ...and medical records following review of post-payment claims. Essential Job Duties• Independently... ...multiple tasks. • Ability to work in a team setting. • Strong verbal/written...Remote workMedicalClaimsFraudHourly payContract workWork experience placementWork at officeLocal area
$78k - $88k
...It takes great medical minds to create powerful solutions that solve... ...a talented individual for a Nurse Reviewer who will be responsible for... ...perform reviews of multiple claim types to provide a flexible workforce... ...interactions with the team and other departments within...Remote workMedicalClaimsFull timeContract workWork from homeFlexible hoursWeekend work- ...Corporation is seeking an investigator to conduct fraud, waste, and abuse investigations across referrals, claims data, and medical records. You will document findings, prepare... ..., with opportunities to work in a remote, hybrid, or onsite setting and benefit from Centene...Remote workMedicalClaimsFraud
- ...Conducting fraud, waste, and abuse investigations, the full-time SIU Investigator will review referrals, claims data, and medical records to identify potential misconduct while collaborating with various stakeholders in a remote setting. Key responsibilities Conducts...Remote workMedicalClaimsFraudFull time
- Claims Adjuster II - California Workers' CompensationLocations... ..., including reserves, medical management, litigation... ...attorneys, physicians, nurse case managers, insureds... ...potential fraud and coordinate referrals... ...onsite and three days remote per week, with Wednesday...Remote workMedicalClaimsFraudContract workMonday to Friday3 days per week
- ...Glenview, IL is seeking a Life Claims Adjuster IV to adjudicate... ...claims. This role requires reviewing policy language, medical records, and state guidelines, and may involve fraud detection and complex eligibility... ...office, with 3 flexible remote days per month and half-day...Remote workMedicalClaimsFraudWork at officeFlexible hours
- ...modernize insurance. Claims processing, while... ...software to backend fraud detection, we're... ...opportunities. Lead the full product lifecycle... ..., and go-to-market teams to ensure smooth... ...Plan: Platinum medical, dental, and vision... ...& Offsites: We're remote, but we regularly get...Remote workMedicalClaimsFraudTemporary workWork from homeHome office
- ...desk investigations of insurance claims referred to and accepted for... ...will function as a remote investigator working from her/... ..., the Department of Insurance Fraud Division, NICB, and various law... ...related matters; or an authorized medical professional to evaluate medical...Remote workMedicalClaimsFraudWork experience placementWork at office
$85k - $95k
...that. A Brief Overview Claims Examiner will... ...Omaha, NE or eligible for remote work. This position is... ...independent adjusters and review of public and other records... ...and report potential fraud to Special Investigation... ...match up to 5%, Medical, Dental and Vision for...Remote workMedicalClaimsFraudFull timeWork experience placementWork at officeImmediate start- ...to modernize insurance. Claims processing, while often... ...software to backend fraud detection, we're the engine... ...with cross-functional teams. Top-notch... ...Healthcare Plan: Platinum medical, dental, and vision... ...events & Offsites: We're remote, but we regularly get together...Remote workMedicalClaimsFraudTemporary workWork from homeHome office
- Gainwell Technologies LLC is seeking a Senior Nurse Reviewer to perform reviews of medical records, healthcare claims, itemized medical bills, and UB-04 forms to ensure... ...continental US, supporting a flexible, quality-driven team environment. #J-18808-Ljbffr Gainwell...Remote jobMedicalClaimsWork from homeFlexible hours
- ...Performing detailed reviews of healthcare claims and medical records, the full-time remote Healthcare Investigator will identify potential fraud, waste, and compliance issues while collaborating with internal teams to prepare comprehensive reports and support corrective...Remote workMedicalClaimsFraudFull time
- ...Medical Billing Specialist Position: Medical... ...Location: Remote / On-site Department... ...Specialist to oversee claims processing, revenue... ...Accurately process, review, and submit medical... ...guidelines to prevent fraud and billing errors.... ...engineering and data science teams to train AI models...Remote workMedicalClaimsFraudLocal area
- ...Working remotely on a full-time basis, the Medical Claims Specialist will manage medical claims processing... ...: Process and review medical claims, applying... ...medical claims processing and fraud detection Maintain performance... ...effectively with team members, providers, and clients...Remote workMedicalClaimsFraudFull timeWork at office
- ...modernize insurance. Claims processing (i.e.... ...software to backend fraud detection, we're the... ...growing finance team. In this role, you'... ...assets, and others. Review payroll entries... ...Healthcare Plan: Platinum medical, dental, and vision... ...& Offsites: We're remote, but we regularly...Remote workMedicalClaimsFraudTemporary workWork from homeHome office
$16.25 - $18.25 per hour
...management consulting company. Our team of 260 employees focuses on providing processing, review, and analysis of medical claims, records, data, and audits... ...any suspected instances of fraud and/or abuse and... ...or equivalent Location: Remote Salary: $16.25-18.25 per...Remote workMedicalClaimsFraudHourly payWork at officeImmediate start- ...identifying instances of fraud, waste, and abuse, the... ...Analyst will analyze medical billing data and collaborate... ...and data science teams to enhance anomaly detection algorithms in a remote work environment. Key responsibilities... ...coding guidelines, and claims adjudication processes...Remote workMedicalClaimsFraudFull time
- ...to modernize insurance. Claims processing (i.e. should... ...software to backend fraud detection, we're the engine... ...to join our Support team in Client Engagement.... ...Healthcare Plan: Platinum medical, dental, and vision... ...events & Offsites: We're remote, but we regularly get together...Remote workMedicalClaimsFraudTemporary workLive inImmediate startWork from homeHome officeShift work
- ...Officer, you will lead legal strategy... ...-functional teams, you will build... ...restrictions. Fraud and abuse... ...rules, and state medical board advertising... ...notifications and claims. Workforce... ...transactions. Remote work: The... ...application is reviewed quickly, objectively...Remote workMedicalClaimsFraudContract workFor contractorsFixed term contractWork at office
$72.04k - $94.55k
...Investigator to join our SIU team. Oscar is the first... ...behavior observed in claims and enrollment data.... ...process improvements for Fraud Waste and Abuse (FWA) recoupments... ...: This is a remote position, open to... ...for benefits including: medical, dental, and vision benefits...Remote workMedicalClaimsFraudFull timeWork from homeHome office$77.1k
...Affordable and comprehensive medical, dental and vision coverage for... ...The SIU Fraud Investigator is responsible for... ...policies. The investigator analyzes claims, encounter, enrollment, medical... ...CPT required. Knowledge of reviewing medical records/documentation...Remote workMedicalClaimsFraudFull timePart timeWork at officeFlexible hours- ...a registered nurse ready to take... ...mission-driven team dedicated to improving... ...setting to review and audit claims,... ...judgment to analyze medical records, documentation... ...'s leading Quality Improvement... ...populations Remote work - enjoy... ...identify potential fraud, waste, or...Remote workMedicalClaimsFraudFull timeTemporary workWork at officeWork from home
$1,000 per month
...facts of loss for Homeowners Claims. Determines coverage,... ...Adjuster to join our Claims team! This is a fully remote role, offering the flexibility... ...Responsibilities For claims involving fraud or subrogation, partners... ...decision, marital status, medical condition, military or...Remote workMedicalClaimsFraudWork at officeWork from homeVisa sponsorshipWork visaRelocation package$60 - $70 per hour
Position: Senior Fraud Operations SpecialistLocation... ..., candidate will lead initiatives aimed... ...cross-functional teams (including client’s... ..., Monday to Friday remote) 6 Infinite Loop... ...benefits including medical, dental, vision and... ...email, or phone call claiming to be from PTR...Remote workMedicalClaimsFraudFull timeMonday to Friday- ...Pharmacists for remote work nationwide.... ...Services Center team provides a variety... ...Adherence, Diabetes, Fraud Waste & Abuse, Medication Therapy... ...pharmacists, clinical nurses, certified pharmacy... ...comprehensive medication reviews, adherence... ...Utilize prescription claims data to generate...Remote workMedicalClaimsFraudContract workWork from homeMonday to FridayFlexible hoursRotating shift
- ...Health Solutions is seeking a Claims Examiner III LPN to protect MVH... ..., and preventing potential fraud, waste, and abuse. This role blends... ...data analysis to evaluate medical necessity and detect unusual utilization... ...and external partners. Remote work options are available for...Remote jobMedicalClaimsFraud
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