Position Summary
Responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving the full range of products for assigned Plan.
Ensures compliance with all requirements related to Special Investigation Units and fraud, waste and abuse investigations.
This position is fully remote.
Equal Opportunity Employer of Minorities / Females / Disabled / Veterans
LI-AK1
Qualifications : Required :
Required :
- Associate Degree in business, health care or related field.
- Three (3) years’ experience in progressively more responsible positions using analytical skills with at least two (2) years’ experience in compliance or related function.
Preferred :
- Bachelor’s Degree in business, health care or related field.
- Certification such as RHIT, RHIA, AHFI, CFE, CPMA or CPC.
- Two (2) years’ experience and knowledge of HMO, or PPO (e.g. accounting / finance, reinsurance, regulatory compliance, claims processing, membership / eligibility, and actuarial precepts).
- Course work or work experience in statistics.
Registered Nurse - Adult Surgical Trauma Critical Care Unit - Part Time Special Weekend Option - Rel
Are you an upcoming nurse graduate or recent nurse graduate? Please apply through our pipeline requisition here: Upcoming Grads & New Grads Registered Nurse (RN) in Indianapolis, Indiana, United States (iuhealth. Healthy Results - Participation in our team member wellness programs award points t...
Registered Nurse- OR Family Support Nurse PT- Previous RN experience in Periop required
Employee Assistance Program - Counseling at no cost to you* Healthy Results - Participation in our team member wellness programs award points that contribute toward a biweekly financial incentive in your paycheck. If you are seeking an organization where you can develop clinical expertise, explore d...
Registered Nurse Adult Neuro Trauma Unit - Special Weekend Option Full time Nights - Relocation Bonu
IU Methodist's A5North is a 23-bed inpatient neuro trauma surgical unit highly specialized in taking care of patients who experience significant brain and spinal cord trauma. At IU Health, you will develop in significant ways, advancing healthcare for all! Being an IU Health nurse means building a p...
Compliance Officer Medicaid, IN - Hybrid, Indiana Residency Required
One (1) year experience working as an independent auditor or accountant responsible for evaluating internal financial and operational records for the purpose of ensuring regulatory compliance. This is a hybrid position with requirements to come onsite in Indianapolis, IN, as determined by the leader...
LPN Care Coordinator - Remote in Daviess County, Indiana and Surrounding Areas
Develop and implement individualized, person-centered care plans inclusive of goals, opportunities and interventions aligned with a person’s readiness to change to support the best health and quality of life outcomes by meeting the member where they are . Provide referral and linkage as appropriate ...
Provider Services Representative, IN Residency Required - Remote
In-depth understanding of claims administration as it pertains to provider payments, including CPT-4 codes, revenue codes, HCPCS codes, DRGs, etc. Being an advocate for the Provider, supplying information and education, working with Provider Relations to handle issues. EDI, marketing, administration...
Early Career Sales Development Program 2025 - Carmel, IN Remote Indiana, Remote Ohio, Remote Kentucky
Participate in a 6-month product and industry training module on location at our Training Facility in Denver, CO. Attend all required factory training and additional outside product training to obtain a further understanding of the products. The Sales Development Program – Architectural Track is a 1...
RN Clinical Quality and Safety Manager - Remote in Indiana
OHS (20%): Integrates occupational health and safety standards with the organization’s mission, vision, values, while aligning all work efforts to the annually established objectives and key results (OKRs) Oversees, manages and implements the development, planning, and execution of continual process...
Indiana Remote Mental Health Therapist (LMHC, LCSW, LMFT, or HSPP REQUIRED)(Telehealth)
As a SonderMind counselor, you will have the opportunity to make a meaningful impact on the lives of individuals seeking therapy while enjoying the flexibility and support of our innovative platform. Our therapists are committed to delivering best-in-class care to all individuals by focusing on high...
Behavioral Health Advocate - Remote in Indiana
Coalesce Care Advocate role and relationships within context of established Care Advocacy Operating Model and customer/contractual requirements; collaborate early and frequently with other teams in the management of cases stratified as having intensive, complex, and high-risk needsParticipate jointl...