Nurse Reviewer: Medical Claims Fraud Investigator (Remote)
Peraton
- Remote job
Peraton is seeking a Nurse Reviewer to join SafeGuard Services (SGS) and conduct medical record reviews, applying clinical judgment to claim payments. The role supports fraud investigations and referrals, with opportunities to develop cases for law enforcement and recovery actions. The position requires RN or clinical background, regulatory knowledge, and strong investigative skills; telework is available nationwide in the United States. #J-18808-Ljbffr Peraton
- SafeGuard Services (SGS), a Peraton subsidiary, seeks a Nurse Reviewer to join a team of professionals. The role involves medical record reviews, applying clinical judgment to claim payments, and developing fraud investigations. Telework is available from anywhere in the...Remote jobMedicalFraud
- ...through SafeGuard Services (SGS), is seeking a Nurse Reviewer to conduct medical record reviews and determine claim payments with sound clinical judgment. The... ..., identifying billing issues, and supporting fraud investigations. Telework is available from anywhere in the United...Remote jobMedicalFraud
$51k - $82k
...Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter,... ...make referrals to recover fraud, waste, and abuse. We are looking to add a Nurse Reviewer to our SGS team of... ...sound clinical judgment to claim payment decisions. Responsibilities...Remote workMedicalFraudContract workTemporary workShift workNight shift- Peraton’s SafeGuard Services seeks a Nurse Reviewer to conduct medical record reviews, applying clinical judgment to claim payments and supporting fraud investigations. Telework is available from any state. The ideal candidate will hold a US nursing license, have 5+ years...Remote jobMedicalFraud
- Peraton is seeking a Nurse Reviewer to join the SafeGuard Services... ...team. The role involves medical record reviews, applying... ...decisions, and researching claims data to uncover fraud, waste, and abuse.... ...payments, develop cases for investigations, and collaborate with external...Remote jobMedicalFraud
- ...better care.? Requirements The Nurse Reviewer performs complex medical record reviews of Medicare Part A/B and DMEPOS claims that require clinical... ...potential for overpayment or fraud. Using established criteria... ...essential functions. This is a remote position. While performing...Remote workMedicalFraudContract workFor contractorsLocal area
$50 per hour
...Complaint Intake and Triage Nurse Reviewer - Remote (#25350) Location: Remote... ...RN with strong clinical and investigative skills who is passionate... ...providers physicians senior medical and administrative personnel... ...utilization review medical review fraud investigations surveillance...Remote workMedicalFraudHourly payFull timePrivate practiceWork at office$28 - $32 per hour
...Advance Your Career in Insurance Claims with Allied Universal® Compliance and Investigation Services. Allied Universal®... ...knowledge and understanding of anti-fraud laws, insurance regulations, and... ...Underwriter (CPCU) BENEFITS: Medical, dental, vision, basic life, AD&...MedicalFraudWork at officeLocal area- ## SIU Claims InvestigatorApply: GA-Atlanta: Full time... ...us as a **SIU Claims Investigator** to play your part in... ...to ensure that the fraud risk to AIG is minimized... ..., brokers, lawyers, medical providers, etc., to support... ...targeted claims reviews for all lines of business...MedicalFraudFull timeWork experience placementLocal area
$95k - $110k
...It takes great medical minds to create powerful solutions that solve... ...individual for a DRG Nurse Reviewer Appeals and Hearings to coordinate... ...perform reviews of multiple claim types to provide a flexible workforce... ...expect in this role Remote (Work from Home) Up to 25%...Remote workMedicalFull timeWork from homeRelocation packageFlexible hours$95k - $110k
...It takes great medical minds to create powerful solutions that solve... ...individual for a DRG Nurse Reviewer Appeals and Hearings to coordinate... ...perform reviews of multiple claim types to provide a flexible workforce... ...expect in this role Remote (Work from Home) Up to 25% Travel...Remote workMedicalFull timeWork from homeRelocation packageFlexible hours- ...Provide timely review and determination of medical claims, including prior authorization, appeals, and/or any other... ...State license as a Registered Nurse (RN),as required by contract(s). 1+... ...attendance is essential for this position Remote Compensation details: 67500-75000...Remote workMedicalContract workFor contractorsWork experience placementWork at officeLocal area
- ...Claims Investigator 12 months+ contract Oakland, CA-Remote ****Local candidates only**** Role is primarily remote... ...litigation, investigation lawsuits, and reviews tender cases involving... ...Knowledge and understanding of medical terminology ~ Demonstrated ability...Remote workMedicalContract workFor contractorsWork at officeLocal area
- # Claims InvestigatorField Investigations* Houston* Full time## About UsTJS Private Investigations... ...it up so an adjuster, a fraud bureau, or a court can... ...Premium fraud · Provider and medical billing fraud · Contents... ...team* Quality assurance reviews and constructive feedback...MedicalFraudFull timeWork at officeLocal areaImmediate start
- micro1 is seeking a Senior Claims Investigation and Evidence Review Expert for a remote, contractor role (~10 hours per week). You will analyze digital claim evidence... ...role emphasizes expert-level domain knowledge in fraud detection, staged-loss, and forensic analysis,...Remote jobFraudFor contractors10 hours per weekFlexible hours
- ...Florida is seeking a PIP Claims Adjuster to investigate and adjust moderate complexity... ...coverage questions, medically manage files, and pay medical... ...obtaining recorded statements; reviewing policy language and case... ...with SIU on potential fraud indicators #J-18808-Ljbffr...MedicalFraud
$110k - $140k
...an experienced Senior Claims Analyst with deep expertise... ...skills. This is a remote role. Key... ...Responsibilities Claims Analysis & Review ~ Perform detailed... ..., UB-04 claim forms, medical records, and remittance... ...Hospital/Surgical/ICU Nursing background (RN) and clinical...Remote workMedicalFull timeContract work- ...Delaware invites applications for an Investigator II to support the Paid Family and Medical Leave program under the Healthy... ...include investigating issues, reviewing eligibility, maintaining detailed... ...records, and identifying potential fraud. The role emphasizes customer...MedicalFraud
- Revecore is seeking team members to help hospitals recover earned revenue through proactive claim outreach and meticulous billing for medical claims. You will engage patients, insurers, and attorneys via outbound calls to collect information and push payments forward. The...Remote jobMedicalWork from home
- RAS Companies in Sioux Falls, SD is seeking a Claims Representative II to investigate workers’ compensation claims and apply state laws to determine coverage... ...will collaborate with injured workers, employers, and medical providers to move claims forward. The role is a work-...Remote jobMedicalWork from home
$25 - $32 per hour
...Your Career in Insurance Claims with Allied Universal® Compliance and Investigation Services. Allied... ...and the components of fraud to determine If claims... ...for investigations, file reviews, audits, training tasks... ...Underwriter (CPCU) BENEFITS: Medical, dental, vision, basic...MedicalFraud$76.84k - $126.79k
...This position performs field investigations on disability, life, and other insurance claims. This position conducts investigative... ...language. This role is fully remote (within California) and requires... ...and well-being: Health Benefits: Medical, Dental, Vision. Health Savings...Remote workMedicalTemporary workFlexible hours- ...Civil Service title of Claim Specialist. To be considered... ...City of New York. BLA investigates and, when in the best... ...this goal in its review, evaluation, and authorization... ..., rooting out fraud, and identifying trends... ...reviewing agency reports and medical records, analyzing liability...MedicalFraudPermanent employmentFull timeWork at office
- ...seeking a Customer-Focused Casualty Field Claims Representative to join their remote claims team in Virginia. The successful candidate will investigate claims, comply with company procedures... ...benefits package including medical, dental, and generous PTO. #J-18808-Ljbffr...Remote jobMedicalWork at office
- ...Centene Corporation is seeking an SIU Investigator in the United States to conduct fraud, waste, and abuse investigations using referrals, claims data, medical records, and interviews. You will prepare reports, coordinate with internal teams, and support program integrity...Remote workMedicalFraud
- ...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 workMedicalFraudFull time
- ...Centene Corporation is seeking an investigator to conduct fraud, waste, and abuse investigations across referrals, claims data, and medical records. You will document findings, prepare... ...investigations, with opportunities to work in a remote, hybrid, or onsite setting and benefit...Remote workMedicalFraud
- ...Job Opening: Claims Investigator – Property Damage & Claims Management Job... ...Work Arrangement: Primarily remote, with occasional in-person meetings... ...and third parties, reviewing insurance and incident records... ...evaluation. - Familiarity with medical terminology and bodily...Remote workMedicalContract workFor contractorsWork at office
$80k
Nurse Reviewer II-Case Management Job Location: US-MA-Westborough Position Type: Full-Time Min... ...long term care needs to determine medical necessity and clinical eligibility for Community... ...None Environmental Working Conditions: Remote/desk work with statewide travel required...Remote workMedicalFull timeWork experience placementWork at office$40.9 - $41.92 per hour
...Department of Health (NYSDOH) Nursing Home Centralized Complaint... ...Complaint Intake and Triage Nurse Reviewer performing clinical reviews... ..., physicians, senior medical and administrative personnel... ...utilization review, medical review, fraud investigations, surveillance or monitoring...MedicalFraudHourly payWork at officeRelocation package
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