With increasing independence, the Investigator II is assigned to multiple provider types and serves as a senior investigator in the Unit. The Investigator II will coach other investigators on developing techniques to find provider schemes based on federal and state regulations that govern Medicaid. ...
As a Fraud Investigator, you will investigate and research cases of identified fraud, fraud loss, or suspicious events to identify fraud rings and patterns, assist victims in resolving fraud events, and denying fraud claims identified as false through investigation. A primary responsibility of a fra...
As a Lead Investigator, you'll review claims, look for patterns of potential fraud, waste and/or abuse and interact with medical providers to complete investigations. Accredited Health Care Fraud Investigator (AHFI). ...
With increasing independence, the Investigator II is assigned to multiple provider types and serves as a senior investigator in the Unit. The Investigator II will coach other investigators on developing techniques to find provider schemes based on federal and state regulations that govern Medicaid. ...
Remote External Demand Investigations Team Investigator (EDIT). The EDIT Associate Investigator will be responsible for investigations, analysis, and preparation of reports and support of other defined functions of the External Demand Investigations Team (EDIT). ...
This position is a senior member of the corporate technical team and is a technical expert in one or more specific disciplines related to company's customer solutions.This position requires an individual capable of interfacing directly with customers as the project lead while also being the hands-on...
Based on contract requirements, may refer potential adverse decisions to the Lead Investigator/Manager/Medical Director or designee. Certification in an applicable program such as Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator Certification preferred. ...
Bring your heart to CVS Health.Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health.This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world.Anchored in our brand — with heart at its cente...
Worldwide Clinical Trials (Worldwide), a leading global contract research organization (CRO), works in partnership with biotechnology and pharmaceutical companies to create customized solutions that advance new medications – from discovery to reality.Anchored in our company’s scientific heritage, ou...
Investigator Contracts Analyst is responsible for direct site-facing contract and budget negotiations thought contract execution with assigned clinical investigator sites including initial agreements and amendments and oversight of other contracting professionals on assigned studies. Follow GPD proc...
The Clinical Investigator Consultant handles the retrospective review of paid claims and evaluation of claims data to identify provider fraud, waste, or abuse. The Clinical Investigator will conduct in-depth analysis of peers, trends, and statistical data to identify providers whose utilization patt...
Investigates complaints regarding alleged violations of the Nurse Practice Act and apply knowledge throughout the investigatory process to determine violations and risks to public safety. Extracts and analyzes information from statutes, legal documents, evaluations, healthcare and employment related...
As an Investigator, you can help put an end to it. ...
Qlarant has an immediate opening for a Healthcare Fraud Lead Investigator to provide supervision and mentoring to a team of Investigators. Supervises intake investigators and/or investigators and assigns work; regularly reviews team’s leads in screening and/or investigations and actions for qu...
This role will report to Head of Investigation, Claim in implementing field check with client’s family or neighbor to very information, checking document requirement, prepare pending letter/payment letter/declined letter and follow up progress of implementation.Check document requirement, prepare pe...
Credentialed Background InvestigatorJob Category: Service Contract ActTime Type: Full timeMinimum Clearance Required to Start: Top SecretEmployee Type: RegularPercentage of Travel Required: Up to 25%Type of Travel: Local* * *. Join CACI's Dynamic Team – Seeking Credentialed Background Investigators ...
Join our Special Investigations Unit as a Fraud Investigator, supporting our US Commercial Healthcare Business, r esponsible for conducting and supporting audits and investigations of potentially fraudulent claim activity by providers. May represent company as a witness in judicial proceedings when ...
You could be the one who changes everything for our 28 million members.Centene is transforming the health of our communities, one person at a time.As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.Investigate al...
Principal Investigator (Terrestrial Archaeology – Southwest). ...
To use a variety of undercover investigative methods to conduct field investigations in PETA's focus areas, including the use of animals for food, clothing, experimentation, and entertainment.Primary Responsibilities and Duties:.Travel to different states and temporarily stay on location for various...
As a Senior Investigator, you will investigate suspected incidents of healthcare fraud, waste, or abuse through. This is not a physical investigator role. Preferred certifications:Accredited Healthcare Fraud Investigator (AHFI),Certified Fraud Specialist (CFS),Certified Fraud Examiner (CFE),Certifie...
Certified Fire Investigator / Certified Fire & Explosion Investigator (CFI/CFEI) responsible for analyzing and interpreting fire and explosion scenes. Must meet all the requirements for qualification as a fire investigator per NFPA 1033. ...
The Investigator should demonstrate proficiency in the following areas: Must be motivated and possess a strong work ethic Must be customer service driven Able to format/type/edit full reports of background research findings Proficient with Microsoft Word and Microsoft Outlook Ability to take directi...
TMB - Investigator V (REMOTE)(00042167). Job Title:Field Investigator – Licensed LVN or RN. Ability to explain and interpret pertinent provisions of laws and regulations to other investigators, licensees, and complainants. Job Title:Field Investigator – Licensed LVN or RN. ...
Assist with mentoring and providing technical direction to other SIU Investigators. Provide training for SIU investigators as requested by the SIU manager. The SIU investigator is responsible for SIU investigations only. ...