Title: Investigator Sr Job Responsibilities: The Investigator Sr is charged with the independent identification, investigation, and development of complex cases against individuals or entities involved in healthcare fraud, with the goal of recovering corporate and client funds that have been paid out...
The following jobs are no longer active but were real openings previously posted by employers. These listings provide valuable insight into employer hiring trends and frequently lead to job offers. In many cases, employers are still hiring or open to strong candidates even if no new job is posted. Applying to these listings often makes you the only applicant, increasing your chances of being hired.
VP Payment Models, Analytics and Reporting Duties: Responsible for leading the development of payment models to support migration from volume to value based contracting. Position has end-to-end financial and analytical accountability for the company’s value-based payment models (., shared savings/shared risk, bundle payment, pay for performance). As the healthcare industry continues to transform, moving away from traditional fee-for-service reimbursement, this rol... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
NGS Audit and Reimbursement II The candidate performs audit work scoped by the desk reviews and will be the in-charge auditor on small and less complex audits. Assists higher level auditor on field work and appeals as assigned. Responsible for completing interim rate reviews, tentative settlements and final settlements of providers as assigned. Performs special... audits of End Stage Renal Disease (ESRD) providers and provider exception requests... as assigned. Updates STAR, FISS... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
VP, Program Integrity / Investigations The candidate will provide leadership to the Commercial Special Investigations Unit, Provider Audit and Data Mining teams. Primary duties include: development and implementation of program strategies, goals, deliverables, and overall program execution. Develop and administer a strategy that continually reduces the inappropriate provider payments and optimizes opportunities to drive fraud, waste and abuse savings including identify... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
VP, Program Integrity / Investigations The candidate will provide leadership to the Commercial Special Investigations Unit, Provider Audit and Data Mining teams. Primary duties include: development and implementation of program strategies, goals, deliverables, and overall program execution. Develop and administer a strategy that continually reduces the inappropriate provider payments and optimizes opportunities to drive fraud, waste and abuse savings including identify... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
Director - Strategic Medicaid Partnerships The candidate will identify, design and implement strategic partnerships with a wide range of organizations to expand and enhance capabilities to support the Medicaid business and long-range Growth plan. Will apply knowledge about the unique needs of specialized service populations (including people with intellectual and developmental disabilities, children in foster care, people with serious mental illness or other disabili... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
Director - Strategic Medicaid Partnerships The candidate will identify, design and implement strategic partnerships with a wide range of organizations to expand and enhance capabilities to support the Medicaid business and long-range Growth plan. Will apply knowledge about the unique needs of specialized service populations (including people with intellectual and developmental disabilities, children in foster care, people with serious mental illness or other disabili... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
The candidate will report to an SIU Investigative Lead and work in the Medicare department. Will utilize appropriate resources from a variety of sources to investigate assigned cases within the Special Investigations Unit. Develop the strategy or theory of the case, by identifying key questions and elements needed to prove or disprove the allegation. Develop an investigative plan by identifying the information needed to prove or disprove the allegation, the reso... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
I, II, or Senior The candidate will be responsible for the independent identification, investigation and development of complex cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on fraudulent claims. Will claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims. Responsible for... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
Fraud and Waste Investigator The candidate coordinates investigation with law enforcement authorities. Assembles evidence and documentation to support successful adjudication, where appropriate. Conducts on-site audits of provider records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for proj... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
Integrity Lead The candidate will carry out the provisions of the compliance plan, including FWA policies and procedures. Investigate unusual incidents and implement corrective action plans. Assess records and independently refer suspected member fraud, provider fraud, and member abuse cases to the Louisiana Department of Health (LDH) and other duly authorized enforcement agencies. Coordinate across all departments to encourage sensible and culturally-competent busin... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here