Healthcare Investigations Analyst I - Fraud & Abuse
THPP Tufts Health Public Plans Inc
Point32Health is hiring an Investigator I for the Special Investigations Unit to lead provider investigations related to fraud, waste and abuse. You will apply laws, plan policies, review data and medical records, and prepare detailed reports. Minimum bachelor’s degree and 1–3 years in health insurance fraud investigations; CPC or CFE preferred. You’ll work from home as needed, with occasional on-site meetings and a collaborative, fast-paced team environment. #J-18808-Ljbffr THPP Tufts Health Public Plans Inc
- CES is seeking an Undercover Field Investigator to collect data for audits investigating fraud, waste, and abuse, reviewing documentation and interviewing involved parties to support resolution and closure. The role requires a Bachelor’s degree, Private Investigator license...FraudWork at office
- CVS Health in Providence, RI seeks a Senior Investigator to conduct high-level investigations of healthcare fraud and abuse. You will handle sensitive cases, identify fraudulent billing patterns, and collaborate with providers and law enforcement. The role requires 3+ years...Fraud
- Neighborhood Health Plan of Rhode Island is seeking an Investigative Auditor for the SIU to manage intake, triage, and investigation of FWA allegations. The role includes auditing, data analysis, and coordination with state and federal agencies to ensure compliance and...Fraud
- Point32Health is seeking an Investigator I for its Special Investigations Unit in Providence, RI. You will lead straightforward and moderately complex investigations related to fraud, waste, and abuse, review data, medical records, and interview members and providers....Fraud
- Job Description Summary CES is looking for an Undercover Field Investigator to collect data/information for audits/investigations concerning fraud, waste, and abuse allegations, utilizing a combination of analytical skills and attention to detail, reviewing documentation...FraudWork at office
$46.99k - $112.2k
...Dental Fraud InvestigatorWe're building a world of health around every... ...effectively pursue the prevention, investigation and prosecution of Fraud, Waste and Abuse.Collaboration with Dental... ...Required Qualifications3-5 years of healthcare fraud investigations experienceExperience...FraudHourly payFull timeTemporary workLocal area$65.6k - $98.4k
...Respond to reports of potential provider or member fraud and abuse cases. Conduct the investigation of fraudulent and abusive activities involving members... ...trends, patterns, outliers and emerging issues in healthcare fraud, waste, and abuse. Conduct audits and interviews...FraudContract workWork at officeLocal areaRemote workWork from homeFlexible hours2 days per week1 day per week- ...J T Becker & Co Inc is looking for skilled Field Investigators to join our team in the United States, Rhode Island. This role offers flexibility... ...claims, including workers' compensation and suspected fraud. The ideal candidate must possess a valid driver's license, current...FraudFlexible hours
$46.99k - $102k
...person, one family and one community at a time. Position Summary As a Senior Investigator you will conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high profile, those that...FraudHourly payFull timeTemporary workWork at officeLocal area- Blue Cross & Blue Shield of Rhode Island (BCBSRI) seeks a dedicated Fraud Investigator to respond to reports of potential fraud and conduct thorough investigations across members, providers, and accounts. You will analyze complex data patterns, apply regulations, and collaborate...FraudRemote job
$66.52k - $99.79k
...delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point... ...are at Point32Health .Job SummaryThe Investigator I is an essential team member of the... ...provider investigations related to fraud, waste, and abuse, and developing action plans to address...FraudContract workWork at officeWork from homeFlexible hours- ...Becker & Co Inc is looking for skilled and experienced Field Investigators in Rhode Island to join our team on an as-needed basis. This role... ...investigators while handling various insurance claims and fraud investigations, emphasizing high-quality results. The ideal candidate...FraudFlexible hours
- Insight Service Group (ISG) is seeking an experienced SIU Investigator to conduct comprehensive investigations into potential fraud and misconduct. You will perform scene recreations, collect statements, retrieve documents, and compile reports with time-stamped media. Requires...FraudFull timePart time
- AvonRisk is seeking motivated individuals for part-time, contract surveillance/investigative roles in Rhode Island. You will conduct fraud investigations using stationary and mobile surveillance and must be capable of independent work and rapid decision making. Candidates...FraudContract workPart time
- AvonRisk is seeking part-time, contract investigators for surveillance and field work in Rhode Island. You will conduct fraud investigations, compile reports, and manage video documentation while adhering to privacy and legal standards. The role requires independence, reliability...FraudContract workPart time
- Description Becker & Company is seeking skilled and experienced Field Investigators to join our team on an "as needed" basis. This role is perfect... ...insurance claims including workers' compensation, suspected fraud, liability and aimed at mitigating expenses for our clients...FraudFlexible hours
- About Us:Insight Service Group (ISG) is a national investigative services firm specializing in cost containment and anti-fraud related services. We are dedicated to maintaining the highest standards of integrity and transparency within our operations. Our Special Investigations...FraudFor subcontractor
- The Investigative Auditor is responsible for the intake, triage, review, and documentation of Fraud, Waste, and Abuse (FWA) allegations referred to the Special Investigations Unit (SIU)... ...patterns, outliers and emerging issues in healthcare fraud, waste, and abuse with fraud...FraudContract workWork at officeLocal area
- ABOUT US: Ethos Risk Services is a leading insurance claims investigation and medical management company, specializing in surveillance and fraud detection. At the forefront, we provide accurate data and actionable insights that translate into better decision-making for...FraudLocal areaNight shiftWeekend work
- ...states. With nearly 700 professionals and brands including Contego Investigative Services, Intercare, InterMed, George Hills, and AS&G Claims... ...opportunities are open in Rhode Island Requirements Conduct fraud investigations to include video surveillance, recorded...FraudContract workPart timeImmediate startNight shift
- AAA Auto Club Enterprises in the United States is seeking a claims fraud investigator to oversee the investigation and disposition of potentially fraudulent claims across product lines. The role also serves as a liaison to industry bodies such as NICB and the Department...Fraud
- CharterCARE Health of Rhode Island, LLC seeks a Technician to handle systems installation, maintenance, support and application development. The role includes managing small projects within departments and coordinating changes to ensure smooth system functionality in a ...
- Brown University Health seeks a Help Desk Analyst to resolve system and application problems under supervision. You will log issues, troubleshoot, and escalate as required, acting as the single point of contact for staff across the organization. This role emphasizes compassionate...Weekday work
- A healthcare organization is looking for a Systems Analyst I to manage system installations and applications. This role involves coordinating and communicating changes within departments, providing user training, and working with external organizations for issue resolution...
- Job Summary This position's primary responsibility is the investigation and disposition of potentially fraudulent claims in any product line... ...and proceedings as required. Remain current on emerging fraud trends, investigations, and fraud identifying/combatting tools...FraudLocal area
- CharterCARE Health Partners is seeking a Financial Analyst to provide detailed financial and clinical analyses. This role requires a minimum of 6-8 years of experience in hospital or healthcare finance, a Bachelor’s degree in Accounting or Finance, and familiarity with...Work at office
- CVS Health is seeking a Senior Analyst, Compliance COE in the United States to execute selected compliance monitoring activities across... ...resolution and continuous improvement. A CPC and 2+ years of healthcare compliance experience are required. #J-18808-Ljbffr CVS...
$18.5 per hour
...areas.Job Responsibilities:Contribute to shortage reduction/ Investigations:• Work closely with the General Manager to ensure that all employees... ...newPosition Type:HourlyPosition Starting At:$18.50BE AWARE OF FRAUD! Please be aware of potentially fraudulent job postings or...FraudLocal areaNight shiftWeekend work- ...Kyc Analyst Splitwise is looking for a full-time KYC Analyst to expand our KYC team!... ...verifying customer identities, preventing fraud, and following Know Your Customer (KYC)... ...identifying and mitigating risk. Our analysts investigate cases, make decisions based on available...FraudFull timeRemote workVisa sponsorshipWork visaWeekday work
- ...data integrity across departments while aligning with organizational values. The role requires knowledge of accounting practices in healthcare finance, experience with budgeting tools, and collaboration with senior staff. Work hours are standard; location is Providence,...
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