- CDPHP (Albany, NY)
- …for investigating complex insurance cases to detect internal and external fraud and abuse. The Special Investigator will research and document cases ... (4) years of equivalent experience required. + Designation as an Accredited Health Care Fraud Investigator preferred. + Incumbent must meet one of the minimum… more
- IT Concepts (Woodlawn, MD)
- …driven and innovative individuals to join our team. IT Concepts is seeking a Fraud Analyst/ Investigator who will support several projects at a federal agency. ... as well as input from other sources to identify fraud + Communicates with internal and external ...identify fraud + Communicates with internal and external sources related to potentially fraudulent activity + Provides… more
- MUFG (Tempe, AZ)
- …details. Reporting to the Senior Fraud Prevention Manager (Vice President) of Fraud Operations. The Investigator will complete fraud investigations to ... experience and general level of supervision required by the Senior Fraud Prevention Manager. **Major Responsibilities:** + Analyze account transactions to determine… more
- M&T Bank (Amherst, NY)
- …or through the Bank by a customer or non-customer. Makes decisions about fraud regarding customer impact and future steps. Interacts with peers within and outside ... by gathering evidence, analyzing information and documenting findings. + Serve as primary fraud contact on all assigned cases. + Complete special projects in a… more
- BMO Financial Group (Omaha, NE)
- AML and Fraud are both exciting areas within the bank to be involved with. This is a high pace environment in a constantly shifting landscape. Our ideal candidate is ... the execution of strategic initiatives in collaboration with internal and external stakeholders. + Builds effective relationships with internal/ external … more
- Molina Healthcare (Albuquerque, NM)
- …ASSOCIATION** : + Health Care Anti- Fraud Associate (HCAFA). + Accredited Health Care Fraud Investigator (AHFI). + Certified Fraud Examiner (CFE). To all ... **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation,… more
- Premera Blue Cross (Spokane, WA)
- …(SIU), the ** Investigator III** will be responsible for investigating allegations of external fraud , waste, and abuse (FWA). The reports prepared by this ... Coder (CPC), Certified Fraud Examiner (CFE), or Accredited Health Care Fraud Investigator (AHFI) preferred. + (2) years of active experience in auditing and… more
- CVS Health (Baton Rouge, LA)
- …testimony during civil and criminal proceedings- Gives presentations to internal and external customers regarding healthcare fraud matters and Aetna's approach ... health care more personal, convenient and affordable. Position SummaryAs a Senior Investigator you will conduct high level, complex investigations of known or… more
- CVS Health (Springfield, IL)
- …testimony during civil and criminalproceedings *Gives presentations to internal and external customers regarding healthcare fraud matters and Aetna's approach ... care more personal, convenient and affordable. Position Summary: As a Senior Investigator you will conduct high level, complex investigations of known or suspected… more
- CVS Health (Hartford, CT)
- …to effectively pursue the prevention, detection, investigation and prosecution of healthcare fraud , waste, and abuse. Also reports suspected fraud , waste, and ... Fundamental Components: - Conducts investigations of known or suspected acts of healthcare fraud , waste, and abuse - Communicates with federal, state, and local law… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** **Position Summary:** The FWA Investigator Coder Sr. Associate is an integral part of the Fraud , Waste & Abuse (FWA) ... Special Investigation Unit (SIU). The position reports directly to the Sr. Director, Fraud , Waste & Abuse. This position utilizes a variety of FWA investigative… more
- Commerce Bank (Kansas City, MO)
- …the Bank and the Bank's stakeholders + Answer calls and emails routed to the investigator and the Duty Line and Resource mailbox + Conduct interviews of internal and ... external customers to obtain facts related to the investigation...Suspicious Activity Reports + Identify control weaknesses + Communicate fraud issues to various lines of business impacted by… more
- New York State Civil Service (Albany, NY)
- NY HELP No Agency State Inspector General, Office of Title Investigator - Albany, Syracuse, Long Island Occupational Category Enforcement or Protective Services ... its employees, and those who work with the State are free from corruption, fraud , criminal activity, conflicts of interest, or abuse; The Office of the New York… more
- Nordstrom (Daly City, CA)
- Job Description The External Market Investigator is responsible for overseeing investigations in Nordstrom key markets. This role will be responsible for ... and Experience and Brand to our customers. The role of a Market Investigator can provide you with the experience of building knowledge of criminal prosecution… more
- Golden Route Operations (Laughlin, NV)
- …NV Shift All Type of Shift Full Time Department Surveillance Surveillance Investigator Trainee Edgewater (Laughlin, NV) Description: General Summary It is the ... responsibility of the Surveillance Investigator - Trainee to maintain knowledge and have an...Food and Beverage operations, policies and procedures. + Occupational Fraud and Abuse Training. + Nevada GCB Regulations and… more
- CVS Health (Tallahassee, FL)
- …during civil and criminal proceedings. - Gives presentations to internal and external customers regarding healthcare fraud matters and Aetna's approach to ... pursue the prevention, investigation and prosecution of health care fraud and abuse, to recover lost funds, and to...case tracking system. - Makes referrals, both internal and external , in the required timeframe. - Facilitates the recovery… more
- CVS Health (Hartford, CT)
- …investigations to effectively pursue the prevention, investigation, and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with state ... regulations mandating fraud plans and practices. - Conducts investigations of known...company - Maintains open communication with constituents within and external to the company. - Uses available resources and… more
- CVS Health (Trenton, NJ)
- …investigations to effectively pursue the prevention, investigation, and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with state ... regulations mandating fraud plans and practices.- Conducts investigations of known or...the company- Maintains open communication with constituents within and external to the company.- Uses available resources and technology… more
- Universal Health Services (Reno, NV)
- …analytics or related field + The following certifications are preferred: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), and ... Unit is responsible for investigating and resolving high complexity healthcare fraud , waste and abuse (FWA) by medical professional, facilities, and members.… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Associate Investigator works with a growing team conducting and managing Health Care Fraud , Waste and Abuse ... interviews and data analysis to identify, evaluate and measure potential healthcare fraud and abuse to determine valid cases for appropriate action. + Document… more