Senior Healthcare Fraud Investigator - Remote
Centene Corporation
- Remote job
Centene Corporation, a national leader in diversified healthcare, seeks a seasoned investigator to guide team members, investigate fraud, waste and abuse, and mentor staff. This remote role covers the continental United States and emphasizes compliance with CMS guidelines, federal and state laws, and rigorous documentation of interviews and case plans. Responsibilities include supervising caseloads of moderate to high complexity, developing investigative plans, preparing clear reports, #J-18808-Ljbffr Centene Corporation
- ...Leading complex fraud investigations in healthcare billing, coding, and claims, the full-time remote Senior Fraud Investigator will analyze large data sets to identify patterns of fraud, prepare detailed reports, and collaborate with clients and internal teams while mentoring...Remote workSeniorFull time
- Company: Navanti Group, LLC Location: Remote Employment Type: Part-Time /... ...average, with workload varying based on investigative tasking. The position is anticipated... ...Overview Navanti Group is seeking a senior healthcare fraud investigator and Open-Source Intelligence...Remote workSeniorPart timeWork at officeMonday to Friday10 hours per week
- ...Highmark Inc. is seeking a qualified investigator to develop and maintain an anti-fraud program, conduct investigations into potential fraud, and coordinate... ...should have a bachelor’s degree and 3 years of healthcare fraud experience. The position entails collaborating...Senior
- ...Highmark Inc. is seeking an experienced anti-fraud professional to develop and maintain an enterprise fraud program, conduct investigations across providers, members, facilities, and staff, and prepare cases for law enforcement or regulatory review. The role includes...Senior
- ...Medica is seeking an experienced SIU Investigator IV to lead complex fraud, waste, and abuse investigations involving members, providers, and employees. The role also covers onsite audits, collaboration with legal and law enforcement, and guiding investigative processes...SeniorWork at office
- ...Medica is seeking an SIU Investigator III to join our Minnetonka, MN office. This onsite role conducts complex fraud, waste and abuse investigations, performs onsite audits and provider reviews, and collaborates with Legal, Regulatory, and law enforcement partners to advance...SeniorWork at office
- ...Conducting detailed investigations into potential fraud, waste, and abuse in healthcare claims, the full-time remote Special Investigator will review medical records and claims data, collaborate with internal teams, and prepare comprehensive reports for compliance and...Remote workFull time
$65k - $88.6k
...of our caring community The Fraud and Waste Professional 2 conducts investigations of allegations of fraudulent and... ...Work at Home. While this is a remote position, occasional travel to Humana... ...'s degree • 2 years of healthcare fraud investigations and auditing...Remote workFull timeTemporary workFor contractorsApprenticeshipWork at officeWork from homeHome officeMonday to Friday- ...humanity and inspire hope. Overview Responsible for complex fraud and abuse investigations and data analysis to identify trends, detect fraud and... ...groups or cases involving multiple perpetrators or intricate healthcare fraud schemes. Investigate fraud and abuse tips received...SeniorLocal area
- ...Humana Inc. is seeking a Fraud and Waste Professional 2 to coordinate investigations of fraudulent and abusive practices across internal and external entities,... ...audit reports in support of adjudication. This is a remote opportunity in the United States with occasional...Remote work
- Byline Bank in Chicago, IL is seeking a Fraud Analyst II to conduct complex fraud investigations, review transactions and customer accounts, and prepare SAIRs and SARs in line with regulatory requirements. This full-time role supports fraud loss recovery, collaborates...Remote jobSeniorFull timeWork at office
- ...Job Opportunity Council Capital is a healthcare-focused private equity firm based in... ...analytics with expert review to surface fraud, waste, and abuse across Medicare, Medicaid... ...but you will not manage anyone. Strong investigators here come from healthcare payer/vendor...Remote work
$100k - $150k
...today and tomorrow.Ascensus is seeking a Senior Fraud Strategy Analyst to join our Fraud Risk... ...experience in fraud strategy, fraud investigations, financial crimes, or financial services... ...directly through our website.SummaryLocation: Remote, Wisconsin; Remote, Nationwide;...Remote workSeniorFull time- ...Navanti Group, LLC is seeking a senior healthcare fraud investigator and OSINT analyst to support a sensitive federal law-enforcement customer. The... ...indicators of fraudulent activity. The position is fully remote, requires an active Top Secret clearance, and demands 5+...Remote work
- A leading health organization seeks an investigator for healthcare fraud allegations. Responsibilities include conducting investigations, analyzing... ...a minimum of 5 years in fraud investigations. This is a remote role with a strong preference for residents of New York....Remote work
- ...Centene Corporation seeks an Investigator to conduct fraud, waste, and abuse investigations across healthcare programs. You will review referrals, claims data, and medical records, document findings, and support case resolution while ensuring regulatory and contractual...Remote work
$65k - $88.6k
...part of our caring community The Fraud and Waste Professional 2 conducts investigations of allegations of fraudulent and... ...We are fortunate to offer a remote opportunity for this job. Our Fortune... ...2 years of experience in healthcare fraud investigations Knowledge of...Remote workBi-weekly payFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday- ...A healthcare company in New York is seeking a Fraud Investigator to conduct in-depth investigations of reported fraud. Responsibilities include mentoring other investigators, investigating Medicaid fraud cases, and maintaining relationships with law enforcement. Candidates...Senior
$85k - $105k
...Healthcare Fraud InvestigatorEmployment Type: Full-Time, Mid-Level Department: Litigation Support CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project in Nashville, TN. The candidate must take the initiative to ask questions...Remote workFull timeWork experience placementWork at officeLocal area- ...Medica in Minnetonka, MN is seeking an SIU Investigator IV to lead advanced fraud, waste, and abuse investigations involving members, providers, and employees. You will manage complex cases, review evidence from multiple sources, and guide actions that support legal or...Senior
- Premera Blue Cross is hiring an Investigator III in our Hybrid SIU team. You will lead medium to high complexity fraud cases from start to finish, analyze claims data, and coordinate... ...enforcement as needed. The role requires healthcare fraud investigation experience, strong...Senior
- ...profit health plan based in Mountlake Terrace, WA, is hiring an Investigator III for its Special Investigations Unit. Hybrid role, located... ...for Anchorage or Spokane. The investigator leads complex fraud cases, analyzes data, conducts interviews, delivers thorough case...Senior
$72.8k - $130k
...Caring. Connecting. Growing together.The Senior Fraud Analyst is a member of the Bank Fraud... ...will be responsible for reviewing and investigating potential cases of financial fraud on... ...SQL, VBA, Access, etc.) Experience in healthcare payments, particularly healthcare...Remote workSeniorMinimum wageFull timeWork experience placementBank staffWork at officeLocal area3 days per week- Medica in Minnetonka, MN is seeking an SIU Investigator III to lead complex investigations into fraud, waste, and abuse involving members, providers, and employees. You will work with legal teams and regulatory agencies, perform on-site audits, analyze evidence, and prepare...SeniorWork at office
- UnitedHealth Group is seeking a Coding Consultant to investigate and resolve healthcare fraud and provider abuse using CPT coding guidance. You will mentor investigators, review claims against medical records, and coordinate with internal and external stakeholders to ensure...Remote job
- ...To enhance fraud prevention efforts, the full-time Senior Fraud Analyst will evaluate trends and perform ongoing analytics remotely, leveraging advanced data science tools to develop recommendations for mitigating risks and presenting insights to senior management. Key...Remote workSeniorFull time
- ...Estágios e Treinamentos seeks a Medicaid Fraud Investigator to join its Special Investigations Unit. This role focuses on identifying healthcare fraud, conducting audits, data analysis... ...skills, and MS Office proficiency. Remote work from the Chicago area is preferred...Remote job
- Humana Inc. is seeking an experienced Healthcare Investigator to join its Special Investigations Unit... ...involves researching allegations of fraud, waste, and abuse in healthcare, collaborating... ...independent judgment. The position is remote with occasional travel to Humana...Remote job
- Centene Corp. in the United States seeks a Fraud, Waste, and Abuse (FWA) Investigator to review referrals, claims data, medical records, and provider information... ...Bachelor’s degree in a related field and 2+ years in healthcare investigations or related audits; preferred AHFI, CFE,...Remote job
- Praescient Analytics is searching for a Senior Investigative Analyst to enhance federal fraud detection and program integrity initiatives. The role encompasses analyzing various forms of data to uncover fraud indicators and producing high-quality intelligence for governmental...Remote jobSenior
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