Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

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

Vacancy posted 4 days ago
Similar jobs that could be interesting for youBased on the Remote Nurse Reviewer Team Lead - Fraud & Medical Claims in Brooklyn, NY vacancy
  • $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 work
    Medical
    Claims
    Fraud
    Contract work
    Shift work
    Night shift

    Peraton

    United States
    4 hours ago
  •  ...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 work
    Medical
    Claims
    Fraud
    Full time
    Work at office
    Work from home
    Home office

    Tres Health

    New York, NY
    4 days ago
  • $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 work
    Medical
    Claims
    Full time
    Work from home
    Flexible hours

    Gainwell Technologies LLC

    United States
    3 days ago
  • $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 work
    Medical
    Claims
    Full time
    Work from home
    Relocation package
    Flexible hours

    Gainwell Technologies

    Tallahassee, FL
    1 day ago
  •  ...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 work
    Medical
    Claims
    Fraud
    Hourly pay
    Contract work
    Work experience placement
    Work at office
    Local area

    Molina Healthcare

    New York, NY
    20 hours ago
  • $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 work
    Medical
    Claims
    Full time
    Contract work
    Work from home
    Flexible hours
    Weekend work

    Gainwell Technologies LLC

    Ohio
    12 days ago
  •  ...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 work
    Medical
    Claims
    Fraud

    Centene Corporation

    United States
    3 days ago
  •  ...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 work
    Medical
    Claims
    Fraud
    Full time

    Virtual Vocations Inc

    United States
    1 day ago
  • 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 work
    Medical
    Claims
    Fraud
    Contract work
    Monday to Friday
    3 days per week

    Connect Search, LLC

    Chicago, IL
    2 days ago
  •  ...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 work
    Medical
    Claims
    Fraud
    Work at office
    Flexible hours

    GUARANTEE TRUST LIFE INS CO

    Glenview, IL
    2 days ago
  •  ...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 work
    Medical
    Claims
    Fraud
    Temporary work
    Work from home
    Home office

    ASSURED

    United States
    3 days ago
  •  ...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 work
    Medical
    Claims
    Fraud
    Work experience placement
    Work at office

    Military, Veterans and Diverse Job Seekers

    Los Angeles, CA
    1 day ago
  • $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 work
    Medical
    Claims
    Fraud
    Full time
    Work experience placement
    Work at office
    Immediate start

    National Indemnity Company

    Syracuse, NY
    1 day ago
  •  ...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 work
    Medical
    Claims
    Fraud
    Temporary work
    Work from home
    Home office

    ASSURED

    United States
    1 day ago
  • 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 job
    Medical
    Claims
    Work from home
    Flexible hours

    Gainwell Technologies LLC

    Columbus, OH
    5 days ago
  •  ...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 work
    Medical
    Claims
    Fraud
    Full time

    Virtual Vocations Inc

    United States
    4 days ago
  •  ...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 work
    Medical
    Claims
    Fraud
    Local area

    CMCI

    Fairfax, VA
    2 days ago
  •  ...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 work
    Medical
    Claims
    Fraud
    Full time
    Work at office

    Virtual Vocations Inc

    United States
    2 days ago
  •  ...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 work
    Medical
    Claims
    Fraud
    Temporary work
    Work from home
    Home office

    ASSURED

    United States
    1 day ago
  • $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 work
    Medical
    Claims
    Fraud
    Hourly pay
    Work at office
    Immediate start

    J29, Inc

    Remote
    2 hours ago
  •  ...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 work
    Medical
    Claims
    Fraud
    Full time

    Virtual Vocations Inc

    United States
    4 days ago
  •  ...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 work
    Medical
    Claims
    Fraud
    Temporary work
    Live in
    Immediate start
    Work from home
    Home office
    Shift work

    ASSURED

    United States
    4 days ago
  •  ...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 work
    Medical
    Claims
    Fraud
    Contract work
    For contractors
    Fixed term contract
    Work at office

    Jobgether

    Remote
    4 days ago
  • $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 work
    Medical
    Claims
    Fraud
    Full time
    Work from home
    Home office

    Oscar Health

    Georgia
    19 days ago
  • $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 work
    Medical
    Claims
    Fraud
    Full time
    Part time
    Work at office
    Flexible hours

    Metropolitan Jewish Health System

    United States
    3 days ago
  •  ...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 work
    Medical
    Claims
    Fraud
    Full time
    Temporary work
    Work at office
    Work from home

    The CKHobbie Group

    Harrisburg, PA
    3 days ago
  • $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 work
    Medical
    Claims
    Fraud
    Work at office
    Work from home
    Visa sponsorship
    Work visa
    Relocation package

    Allstate

    Nashville, TN
    1 day ago
  • $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 work
    Medical
    Claims
    Fraud
    Full time
    Monday to Friday

    Pinnacle Group

    Cupertino, CA
    4 days ago
  •  ...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 work
    Medical
    Claims
    Fraud
    Contract work
    Work from home
    Monday to Friday
    Flexible hours
    Rotating shift

    Equity Staffing Group

    Peoria, AZ
    4 days ago
  •  ...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 job
    Medical
    Claims
    Fraud

    WPS Health Solutions

    Columbus, OH
    5 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote Nurse Reviewer Team Lead - Fraud & Medical Claims. Be the first to apply!