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Healthcare Fraud Investigator Intern Jobs

Healthcare Fraud Investigator Jobs
By Advize At United States

As Advize's work in the FWA world grows, so must our team. This position will be in our internal Special Investigations Unit (SIU) where you will conduct Medicaid fraud, waste, and abuse (FWA) ...

Healthcare Fraud Investigator-Work At Home
By The Cigna Group At United States
Minimum 3 years' experience in health insurance investigation/audit
Clear and concise verbal and written communication skills.
Strong computer skills are required - Excel, Access and Word
Accredited Health Care Fraud Investigator (AHFI) certification and Certified Fraud Examiner (CFE) preferred
Analyze information gathered by investigation/audit and report findings and prepare written summary/recommendations
Prepare evidence package for referral to third parties including contract holders, state insurance fraud bureaus and law enforcement agencies.
Healthcare Investigator Jobs
By Advize At United States

CFE and AFHI are preferred but not required.

Healthcare Fraud Intake Investigator - Entry Level - Hourly
By Qlarant At Los Alamitos, CA, United States
Refers all potential adverse decisions to the Lead Investigator/Manager.
Experience in healthcare programs or fraud investigation/detection;
Enters investigative information into the case tracking systems and will meet with Lead Investigators to assign investigations to the Investigative team.
Works with the team to prioritize complaints for investigations.
Places potential fraudulent providers on prepay review and monitor adjudication of claims.
Analyzes data for appropriateness of fraud, waste and abuse issues in accordance with pre-established criteria, requesting additional documentation if necessary.
Entry Level Healthcare Fraud Investigator - Hourly
By Qlarant At Dallas, TX, United States
Refers all potential adverse decisions to the Lead Investigator/Manager.
Experience in healthcare programs or fraud investigation/detection;
Enters investigative information into the case tracking systems and will meet with Lead Investigators to assign investigations to the Investigative team.
Works with the team to prioritize complaints for investigations.
Places potential fraudulent providers on prepay review and monitor adjudication of claims.
Analyzes data for appropriateness of fraud, waste and abuse issues in accordance with pre-established criteria, requesting additional documentation if necessary.
Jr. Healthcare Investigator (Full-Time, Remote)
By Integrity Management Services, Inc. At Alexandria, VA, United States
At least one year of experience investigating and identifying noncompliance activities in a healthcare setting
Knowledge of compliance laws, regulations, and healthcare industry practices
Bachelor’s degree and certification such as AAPC’s Certified Professional Compliance Officer (CPCO) or American Academy of Professional Coders’ (AAPC)
Work experience within health insurance is a plus
Ability to work independently as well as with a team
The ability to be flexible and adapt to new processes/systems
Investigative Analyst (Healthcare Fraud)
By US Defense Health Agency At , Wallops Island, Va $71,099 - $109,908 a year
Highly Qualified. Candidates in this category possess good skills and experience above the minimum requirements for the announced position.
If you are relying on your education to meet qualification requirements:
Qualified. Candidates in this category meet the minimum experience requirements for the announced position.
Professional certification as a Certified Fraud Examiner (CFE) within 36 months of employment.
Male applicants born after December 31, 1959 must complete a Pre-Employment Certification Statement for Selective Service Registration.
Your resume may be submitted in any format and must support the specialized experience described in this announcement.
Healthcare Fraud Investigator Lead - Medicare (Upic-West) - Remote Or Office Based
By Qlarant At United States
Based on contract requirements, may refer potential adverse decisions to the Manager, Medical Director, or designee
Supervises administrative remedies in accordance with major case coordination direction (e.g. payment suspensions, revocations, provider education) and reviews for quality assurance
Assists Program Integrity Manager and VP of Operations with information and reporting for contract deliverables
Analytical- Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data.
Problem Solving– Gathers and analyses information skillfully; Identifies and resolves problems.
Three years' experience fraud investigation/detection (preferred) or in healthcare programs.
Healthcare Fraud Investigator (Remote)
By RNa Partners At Ohio, United States
Creates detailed investigation report, including follow-up, remedial action, or recommendations, per department protocol and presents to department management.
Collaborates with FWA, Claims Manager and/or Data Analyst to identify audit sample, either random or based on another approved methodology.
Maintain current knowledge of industry standards including Medicare, Medicaid and OIG used in fraud prevention and detection
Attention to detail with excellent proof reading and editing skills
Organization and analytical skills necessary to aggregate potentially disparate information from multiple sources
Strong problem-solving skills, including with the ability to determine root causes and to define workable solutions
Healthcare Fraud Investigator Intern
By Qlarant At Dallas, TX, United States
Determines investigation or case appropriateness of fraud, waste and abuse issues in accordance with pre-established criteria.
Conducts interviews of witnesses, informants, and subject area experts and targets of investigations.
Identifies and collects information to support the an investigation
Drafts investigation reports and promotes effective and efficient investigations.
Works with data to understand healthcare claims
Prepares and presents a final report.