93 clinical fraud investigator jobs found

Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Hybrid Workplace Strategy: 1-2 days in office per week The Clinical Fraud Investigator II is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. How You Will Make An Impact Conducts data mining activities using available tools and internal data warehouse. Performs comprehensive analysis and clinical evaluation of the collected data. Performs in-depth investigations on identified providers as warranted. Examines claims for compliance with relevant billing and processing guidelines and to identify opportunities for fraud and abuse prevention and control. Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare related questions as necessary to aid in investigations. Collaborates with the...

Anticipated End Date 2024-09-17 Position Title Clinical Fraud Investigator II Job Description Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Hybrid Workplace Strategy: 1-2 days in office per week The Clinical Fraud Investigator II is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. How You Will Make An Impact Conducts data mining activities using available tools and internal data warehouse. Performs comprehensive analysis and clinical evaluation of the collected data. Performs in-depth investigations on identified providers as warranted. Examines claims for compliance with relevant billing and processing guidelines and to identify opportunities for fraud and abuse prevention and control. Review and conducts analysis of claims and medical records prior to payment....

Anticipated End Date 2024-09-17 Position Title Clinical Fraud Investigator II Job Description Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Hybrid Workplace Strategy: 1-2 days in office per week The Clinical Fraud Investigator II is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. How You Will Make An Impact Conducts data mining activities using available tools and internal data warehouse. Performs comprehensive analysis and clinical evaluation of the collected data. Performs in-depth investigations on identified providers as warranted. Examines claims for compliance with relevant billing and processing guidelines and to identify opportunities for fraud and abuse prevention and control. Review and conducts analysis of claims and medical records prior to payment....

Anticipated End Date 2024-09-17 Position Title Clinical Fraud Investigator II Job Description Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Hybrid Workplace Strategy: 1-2 days in office per week The Clinical Fraud Investigator II is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. How You Will Make An Impact Conducts data mining activities using available tools and internal data warehouse. Performs comprehensive analysis and clinical evaluation of the collected data. Performs in-depth investigations on identified providers as warranted. Examines claims for compliance with relevant billing and processing guidelines and to identify opportunities for fraud and abuse prevention and control. Review and conducts analysis of claims and medical records prior to payment....

Anticipated End Date 2024-09-17 Position Title Clinical Fraud Investigator II Job Description Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Hybrid Workplace Strategy: 1-2 days in office per week The Clinical Fraud Investigator II is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. How You Will Make An Impact Conducts data mining activities using available tools and internal data warehouse. Performs comprehensive analysis and clinical evaluation of the collected data. Performs in-depth investigations on identified providers as warranted. Examines claims for compliance with relevant billing and processing guidelines and to identify opportunities for fraud and abuse prevention and control. Review and conducts analysis of claims and medical records prior to payment....

Anticipated End Date 2024-09-17 Position Title Clinical Fraud Investigator II Job Description Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Hybrid Workplace Strategy: 1-2 days in office per week The Clinical Fraud Investigator II is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. How You Will Make An Impact Conducts data mining activities using available tools and internal data warehouse. Performs comprehensive analysis and clinical evaluation of the collected data. Performs in-depth investigations on identified providers as warranted. Examines claims for compliance with relevant billing and processing guidelines and to identify opportunities for fraud and abuse prevention and control. Review and conducts analysis of claims and medical records prior to payment....

Anticipated End Date 2024-09-17 Position Title Clinical Fraud Investigator II Job Description Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Hybrid Workplace Strategy: 1-2 days in office per week The Clinical Fraud Investigator II is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. How You Will Make An Impact Conducts data mining activities using available tools and internal data warehouse. Performs comprehensive analysis and clinical evaluation of the collected data. Performs in-depth investigations on identified providers as warranted. Examines claims for compliance with relevant billing and processing guidelines and to identify opportunities for fraud and abuse prevention and control. Review and conducts analysis of claims and medical records prior to payment....

Anticipated End Date 2024-09-17 Position Title Clinical Fraud Investigator II Job Description Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Hybrid Workplace Strategy: 1-2 days in office per week The Clinical Fraud Investigator II is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. How You Will Make An Impact Conducts data mining activities using available tools and internal data warehouse. Performs comprehensive analysis and clinical evaluation of the collected data. Performs in-depth investigations on identified providers as warranted. Examines claims for compliance with relevant billing and processing guidelines and to identify opportunities for fraud and abuse prevention and control. Review and conducts analysis of claims and medical records prior to payment....

Anticipated End Date 2024-09-17 Position Title Clinical Fraud Investigator II Job Description Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Hybrid Workplace Strategy: 1-2 days in office per week The Clinical Fraud Investigator II is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. How You Will Make An Impact Conducts data mining activities using available tools and internal data warehouse. Performs comprehensive analysis and clinical evaluation of the collected data. Performs in-depth investigations on identified providers as warranted. Examines claims for compliance with relevant billing and processing guidelines and to identify opportunities for fraud and abuse prevention and control. Review and conducts analysis of claims and medical records prior to payment....

Please note: This recruitment may be used to fill multiple vacancies at the location below. This position has a residency waiver and will be accepting applications from residents and non-residents of Colorado. This announcement is open to potential candidates who are legal residents of the United States. All legal residents of the United States are eligible to apply and compete. If appointed to a position, applicants from outside of Colorado will be required to relocate to Colorado prior to their start date, at their own expense Most State of Colorado employees are eligible for a great benefit package! Please see the Supplemental Information section below for details! About the Division of Youth Services:   The Division of Youth Services (DYS) provides a continuum of residential and non-residential services that encompass juvenile detention, commitment, and parole. DYS is the agency statutorily mandated to provide for the care and...

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Department Information Please note: This recruitment may be used to fill multiple vacancies at the location below. This position has a residency waiver and will be accepting applications from residents and non-residents of Colorado. This announcement is open to potential candidates who are legal residents of the United States. All legal residents of the United States are eligible to apply and compete. If appointed to a position, applicants from outside of Colorado will be required to relocate to Colorado prior to their start date, at their own expense Most State of Colorado employees are eligible for a great benefit package! Please see the Supplemental Information section below for details! About the Division of Youth Services: The Division of Youth Services (DYS) provides a continuum of residential and non-residential services that encompass juvenile detention, commitment, and parole. DYS is the agency statutorily mandated to provide for the care and...

The Central Investigations team is dedicated to keeping users of the Meta technologies safe. We pride ourselves in helping prevent harm by applying deep subject matter expertise to identify and mitigate potential safety-related threats to keep Meta and its users more secure. Our team is seeking a highly motivated and experienced investigator who will have the opportunity to work on some of the most challenging, high-visibility risks the company faces and the opportunity to have a substantial impact.We are seeking an investigator with experience in understanding and mitigating issues around fraud, scams, and deceptive practices. In addition to having a strong investigative and analytical background, we are seeking an investigator who has experience with open source investigations and who is passionate about protecting people from fraud and scams. The successful candidate will be able to assess and analyze large amounts of data in order to identify sources of potential threats and...

The Central Investigations team is dedicated to keeping users of the Meta technologies safe. We pride ourselves in helping prevent harm by applying deep subject matter expertise to identify and mitigate potential safety-related threats to keep Meta and its users more secure. Our team is seeking a highly motivated and experienced investigator who will have the opportunity to work on some of the most challenging, high-visibility risks the company faces and the opportunity to have a substantial impact.We are seeking an investigator with experience in understanding and mitigating issues around fraud, scams, and deceptive practices. In addition to having a strong investigative and analytical background, we are seeking an investigator who has experience with open source investigations and who is passionate about protecting people from fraud and scams. The successful candidate will be able to assess and analyze large amounts of data in order to identify sources of potential threats and...

The Central Investigations team is dedicated to keeping users of the Meta technologies safe. We pride ourselves in helping prevent harm by applying deep subject matter expertise to identify and mitigate potential safety-related threats to keep Meta and its users more secure. Our team is seeking a highly motivated and experienced investigator who will have the opportunity to work on some of the most challenging, high-visibility risks the company faces and the opportunity to have a substantial impact.We are seeking an investigator with experience in understanding and mitigating issues around fraud, scams, and deceptive practices. In addition to having a strong investigative and analytical background, we are seeking an investigator who has experience with open source investigations and who is passionate about protecting people from fraud and scams. The successful candidate will be able to assess and analyze large amounts of data in order to identify sources of potential threats and...

Full job description Recognizing and valuing diversity strengthens our ability to attract, retain and engage associates and reinforces our relationship within our communities. Our associates are the most valuable asset we have. The collective sum of the individual differences, life experiences, knowledge and talent that our associates invest in their work represents a significant part of not only our culture, but our reputation and company’s achievement as well. A Centier Associate is someone who embodies a servant heart, is unaccepting of anything less than remarkable service, and is self-motivated and driven to deliver exceptional results. What are our values? Our Corporate values are Caring, Loyalty, Integrity, Friendship, Fun....who wouldn't want to work for an AWARD-WINNING company that's built on these pillars? What about the perks? Access to our Marathon Health Clinics which provide FREE visits & prescriptions, Generous Paid Time Off...

This position is open to Alaskan Residents only. Please check our residency definition   to determine if you qualify. WHAT YOU WILL BE DOING: The Alaska Bureau of Investigation (ABI) is responsible for coordinating and conducting major criminal investigations within Alaska State Troopers jurisdiction to include homicides, sexual assaults, polygraph examinations, fraud, forgery, computer and internet crimes, surveillance, missing...

Requisition No: 837415 Agency: Financial Services Working Title: FINANCIAL CRIME INVESTIGATOR I - 43061887 Pay Plan: Career Service Position Number: 43061887 Salary: $40,000.08 (Plus $1,248.00 CAD) Posting Closing Date: 09/26/2024 Total Compensation Estimator Tool *****OPEN COMPETITIVE EMPLOYMENT OPPORTUNITY***** DIVISION: CRIMINAL INVESTIGATIONS DIVISION BUREAU: PUBLIC ASSISTANCE FRAUD CITY: MIAMI COUNTY: MIAMI – DADE The Criminal Investigations Division encompasses all law enforcement and forensic components residing within the Department of Financial Services. With this broad responsibility, the division investigates a wide range of fraudulent and criminal acts including: Insurance Fraud Investigations Workers’ Compensation Fraud Investigations Fire, Arson, and Explosives Investigations Theft/Misuse of State Funds Fire and Explosives Sample Analysis Public Assistance Fraud Mission Statement Serving and...

Cloud CDN Engineer Frisco, TX FullTime Onsite Work Job Description This is an exciting opportunity to work in a large scale, Web Platform Operations project. Where you will work directly with Akamai's SMEs, direct product and professional services teams, you are involved in every facet of Akamai's services engineering & operations. You can contribute to the Web Platform Operations success while being part of a very important team. Monitoring, troubleshooting and resolving platform, app, server and network problems. Working with various internal/external stakeholders to narrow down problems and achieve resolution. Ensuring SLAs are achieved, and Web Platform Operations work quality expectations are met. Ensuring the accuracy of the Web Platform Operations procedures/documents. o Collaborate with application owners, infrastructure owners, architects, and developers to integrate CDN, WAF, security tools such as web application firewalls and bot mitigation...

Strength in Trust OneTrust unlocks the full potential of data and AI, securely and responsibly. Our platform enforces the secure handling of company data, empowering organizations to drive innovation responsibly while mitigating risks. With a comprehensive suite of solutions spanning data and AI security, privacy, governance, risk, ethics, and compliance, OneTrust enables seamless collaboration between data teams and risk teams to enable rapid and trusted innovation. Recognized as the market leader in trust, OneTrust boasts over 300 patents and serves more than 14,000 customers globally, ranging from industry giants to small businesses. The Challenge We are looking for a dynamic Associate Security Engineer to design, build, and maintain critical security infrastructure and controls in the One Trust environment. Contributions will be key in the successful delivery of enterprise corporate services and customer facing solutions Your Mission This role will design, build, and...

Full job description Requisition No: 837227 Agency: Financial Services Working Title: CRIME INTELLIGENCE ANALYST I (PENDING RECLASSIFICATION) - 43001452 Pay Plan: Career Service Position Number: 43001452 Salary: $36,000.00 (Plus $1,268.76 CAD) Posting Closing Date: 09/27/2024 Total Compensation Estimator Tool *****OPEN COMPETITIVE EMPLOYMENT OPPORTUNITY***** DIVISION: CRIMINAL INVESTIGATIONS DIVISION BUREAU: OFFICE OF CRIME INTELLIGENCE AND ANALYTICAL SUPPORT CITY: MIAMI COUNTY: MIAMI DADE The Criminal Investigations Division encompasses all law enforcement and forensic components residing within the Department of Financial Services. With this broad responsibility, the division investigates a wide range of fraudulent and criminal acts including: Insurance Fraud Investigations Workers’ Compensation Fraud Investigations Fire, Arson, and Explosives Investigations Theft/Misuse of State Funds Fire and Explosives...

Introduction Indulge your passion for problem-solving and embrace the thrill of addressing risk head-on at Gallagher's global brokerage team. Join a family of diverse minds, united by a relentless pursuit of excellence. As part of our team, you'll be the architect of protection, safeguarding businesses and empowering their ambitions. Together, we'll build a legacy of trust and triumph in the dynamic world of risk management. We believe that every candidate brings something special to the table, including you! So, even if you feel that you’re close but not an exact match, we encourage you to apply. Overview Gallagher is a global leader in Insurance broking, risk management and consulting, with over 52,000 employees worldwide in over 130 countries. We have a global reach with a local presence and pride ourselves on being a socially responsible and an ethical organisation expressed through our Shared Values, The Gallagher Way. We are proud to have been awarded one of...

  This position is only open to Colorado state residents.   This position will be required to work shift work. This position is housed at Crowley County Correctional Facility located in Crowley County, CO. This posting may be used to fill future vacancies at this location. If your goal is to build a career that makes a difference and builds greater public confidence in good government, consider joining the dedicated people of the State of Colorado. Our professionals strive to support state government and the citizens of Colorado. Customer service is a key component for every position in state government as is the focus on ideas and ways to redesign the delivery of services in making state government more effective and efficient. In addition to a great agency and rewarding, meaningful work, we offer:  Distinctive career advancement opportunities throughout the state system;     Strong, secure,...

Full job description Job Description: The Role Fidelity’s Financial Intelligence Unit (FIU) is seeking a motivated Squad Leader/Product Owner with a passion for building business critical Fraud Prevention capability, using a range of data science, machine learning, software and data management technologies and tools. This is an individual contributor role. The Team FIU strives to protect Fidelity businesses, clients, customers, and reputation by providing fraud management services, optimally balancing risk and customer experience. The Fraud Prevention organization within FIU deploys advanced AI/ML products inline in customer journeys to combat fraud for enterprise-wide financial products and services, working closely with business unit partners, vendors, fraud detection, investigation, surveillance and technology teams. Responsibilities Fraud prevention squad leader will lead the development of Customer Fraud Risk (CFR)...