Remote Fraud Investigator - Medical Claims & Investigations
Peraton
SafeGuard Services (SGS), a subsidiary of Peraton, is seeking a Fraud Investigator to perform high‑level investigations of medical professional service providers. The role involves developing cases for actions such as referrals to law enforcement, education, and overpayment recovery. You will work with internal teams and external agencies and may travel monthly. Telework is available from Florida (preferred) and Georgia, with occasional court testimony and data requests. #J-18808-Ljbffr
- ...Centene Corp. is hiring a SIU Investigator to conduct fraud, waste, and abuse investigations remotely in Texas. You will review referrals, claims data, medical records, and provider information to identify misconduct and support case resolution. Prepare investigative reports...Remote workMedicalClaims
- ...Peraton in the United States is seeking a Senior Associate for Fraud Investigation to conduct high‑level investigations of medical providers and prepare cases for action. You will analyze claims, interview witnesses, review records, and coordinate with internal teams and...Remote workMedicalClaims
- ...Assurant, Inc. seeks a Senior Special Investigator to protect assets by preventing fraudulent claims and leading complex investigations. The role analyzes medical, financial, and public records to... ...environment, based in Florida or remote within the state. #J-18808-...Remote workMedicalClaims
- ...Fwa InvestigatorLevels (Investigator, Sr. Investigator, etc... ...of healthcare fraud, waste and abuse (FWA)... ...including any findings from medical record reviewsKnowledgeable... ...2 years of healthcare claims investigation... ...independently within a remote team, under minimal supervisionBenefits...Remote workMedicalClaims
- ...Peraton seeks a Nurse Reviewer to join SafeGuard Services. The role involves conducting medical record reviews, applying clinical judgment to claim payments, and supporting fraud investigations with diverse data sources. The position emphasizes regulatory research,...Remote workMedicalClaims
- ...Nurse Reviewer to join our team. You will conduct medical record reviews, apply clinical judgment to claim payments, and help identify fraud, waste, and abuse in the Medicare program. This role supports investigations, may involve court testimony, and requires independent...Remote workMedicalClaims
$72.61k - $109.99k
...Health Plan is currently hiring a Fraud and Abuse Investigator/Certified Professional Coder (CPC) Remote! Status: Full-time,... ...relating to health insurance claims processing and ensures adherence... ...statistical sampling of complex medical claims. Assists in drafting...Remote workMedicalClaimsPermanent employmentFull timeTemporary workLive inCurrently hiringShift work$65k - $88.6k
...caring community The Fraud and Waste Professional... ...conducting comprehensive investigations of reported, alleged... ...areas to evaluate medical necessity, appropriateness... .... Review claims, provider billing patterns... ...Work Style Fully remote in South Carolina, with...Remote workMedicalClaimsFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday- ...leader in national security solutions, seeks a Medical Review Nurse for Medicare fraud detection and medical claim evaluation. You will analyze medical records... ...violations, with the opportunity to support investigations remotely from anywhere in the United States. The...Remote workMedicalClaims
- ...do. This position is remote within our NC, SC, VA... ...this role matters Fraud can have a lasting impact... ...and trust. As a Fraud Investigator II at Truliant Federal... ...evidence, validate member claims, and document clear,... ...~ No‑cost employee Medical, dental, vision coverage...Remote workMedicalClaimsTemporary workLocal areaFlexible hours
- ...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...Remote workMedicalClaims
- ...Hartford is seeking a Sr. Representative Claims to plan, investigate, and settle workers’ compensation claims. You will analyze medical and financial data, coordinate with doctors... ...and timely decision-making in a hybrid or remote work setting. Start Date is January 19, 20...Remote workMedicalClaimsMonday to Friday
- ...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 jobMedicalClaimsWork at office
$76.84k - $126.79k
...Field Claims Investigator #6089 Remote, California, United States Position Locations Remote, California, United States Area of Interests... .... For your health and well-being Health Benefits: Medical, Dental, Vision. Health Savings Account (HSA) with employer...Remote workMedicalClaimsFull timeTemporary workPart timeFlexible hours- ...organization looking for Insurance Fraud Investigator (SIU) to join our team.... ...underwriting, and strategic claims handling. Our ongoing... ...state where we conduct business.Remote position, and must be located... ...fraud rings, and questionable medical treatment. You will provide...Remote workMedicalClaimsWork experience placementWork at officeFlexible hours
$79.56k - $115.72k
...teams drive groundbreaking medical discoveries and invite all... ..., wasteful, or abusive claim submissions. In addition to... ...for conducting confidential investigations of suspected fraud, waste & abuse (FWA)... ...:30-5:00 PM Eastern Time Remote workspace requirements, including...Remote workMedicalClaimsFull timeContract workWork at officeLocal areaMonday to FridayFlexible hoursShift work- ...Automobile Insurance Company is seeking an Insurance Fraud Investigator (SIU) to conduct field and desk investigations of high- complexity auto claims. The role involves coordinating with NICB, law enforcement, and medical professionals to detect fraud while ensuring...Remote jobMedicalClaims
$66k - $106k
...Fraud Investigator - Medicare Job Locations US-GA-Home | US-SC-Home Responsibilities SafeGuard Services... ...data analysis, investigation, and medical review to detect, prevent, deter,... ...investigations. Experience in reviewing claims for technical requirements, performing...Remote workMedicalClaimsContract workFor contractorsFlexible hoursShift workNight shift- ...TERRITORY. ROLE IS PRIMARILY REMOTE WITH INFREQUENT HYBRID... ...LOOKING FOR: Property damage claim handling experience, excellent... ...Job Responsibilities - Investigate, negotiate, and settle third... ...Knowledge and understanding of medical terminology - Demonstrated...Remote workMedicalClaimsContract workFor contractorsWork at officeHome office
$25.58 - $28.78 per hour
...Portland, Oregon. The Dental Fraud and Abuse Investigator is responsible for... ...position. Benefits : ~ Medical, Dental, Vision, Pharmacy,... ...2 years of experience as a Claim Support or Customer Service... ...required to support remote or hybrid work. Must be comfortable...Remote workMedicalClaimsHourly payFull timeWork experience placementWork at officeAfternoon shift$30 - $35 per hour
...Job Opening: Claims Investigator – Property Damage & Claims Management Job ID:PCGJP00005279 Location... ...Work Arrangement: Primarily remote, with occasional in-person meetings... ...damage evaluation. - Familiarity with medical terminology and bodily injury documentation...Remote workMedicalClaimsContract workFor contractorsWork at office$71.14k - $95.68k
...Description Provider Fraud Investigator 3 This is a full-time permanent remote position. Employees may occasionally be... ...querying analyzing and mining complex claims data billing codes and encounter... ...staff to synthesize technical medical evidence. Root-Cause &...Remote workMedicalClaimsPermanent employmentFull timeContract workWork experience placementWork at officeMonday to FridayFlexible hoursShift work$30 - $35 per hour
...Job Description Job Description Claims Investigator Location: Oakland, CA Onsite Flexibility... ...Job Summary This role is primarily remote with infrequent hybrid necessity for meetings... ...law ~ Knowledge and understanding of medical terminology ~ Demonstrated ability to...Remote workMedicalClaimsContract workFor contractorsWork at officeHome officeWork visa$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&...MedicalClaimsWork at officeLocal area- ...Providing investigative support for special investigation unit activities, the full-time Healthcare Fraud Investigator will focus on the prevention... ...and abuse, while working remotely. Key responsibilities Conducts... ..., Medicaid, Medicare, and claim billing codes Proven...Remote workClaimsFull time
- ...Plans in the United States is hiring an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for a remote role. The position is full-time (40 hours)... ...investigations of fraud across provider, pharmacy, and claims, review coding quality, and help ensure...Remote workClaimsFull time
$65.97k - $124.99k
...services provider is seeking a Clinical Fraud Investigator II, requiring an Associate Degree in... ...analyzing clinical data, investigating claims for compliance, and collaborating with... ...fraud investigation. This role offers remote work flexibility within certain commuting...Remote workClaims- ...MJHS Health System is seeking a SIU Fraud Investigator to identify, investigate, and resolve fraud, waste, and abuse... ...enforcement. The successful candidate will review claims, encounter data, enrollment records, medical charts, and conduct interviews and audits as needed...MedicalClaims
- ...Sun Life U.S. is seeking a Senior Consultant, Claims Investigation Services to lead complex investigations into suspected fraud across Supplemental Health products,... ...strong analytical skills, experience reviewing medical records, and the ability to present findings...MedicalClaims
- ...CNA Insurance in California seeks an experienced investigator to lead suspected provider fraud investigations across medical and legal areas, with emphasis on California fraud schemes and regulations. This hybrid role works from one of CNA's CA offices (Walnut Creek, Los...MedicalClaims
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