Top 33 Fraud Jobs in Jacksonville, Fl

Investigator, Special Investigative Unit
Molina Healthcare —Jacksonville, FL
- $21.82 - $42.55 an hour
- Full-time
- Anatomy knowledge
- Customer service
- Research
- Health insurance
Fraud Specialist
Citi —Jacksonville, FL
- From $20.05 an hour
- Full-time
- Hybrid work
- High school diploma or GED
- 1 year
- Communication skills
- Paid holidays
- Disability insurance
Fraud Operations Specialist
Citi —Jacksonville, FL
- $41,600 - $53,600 a year
- Full-time
- Hybrid work
- High school diploma or GED
- 1 year
- Communication skills
- Paid holidays
- Disability insurance
7d
Private Investigator
Summers Private Investigations, Inc —Jacksonville, FL
- $25 - $40 an hour
- Part-time
- Mid-level
- In-person
- 2 years
Quick Apply
Litigation Paralegal
Roig Lawyers —Florida
- Full-time
- Remote
- Writing skills
- High school diploma or GED
- Analysis skills
- Health savings account
- Disability insurance
Quick Apply
SIU Intelligence Analyst - Sr
Citizens Property Insurance Corporation —Jacksonville, FL
- Full-time
- Office
- 3 years
- High school diploma or GED
CRIME INTELLIGENCE ANALYST I - 43001501
The State of Florida —Jacksonville, FL
- $39,000 a year
- Overtime
- Bilingual
- Background check
- Microsoft Excel
- Paid holidays
- Health insurance
2d
Surveillance Investigator I - Entry Level
Command Investigations, LLC —Jacksonville, FL
- $20 - $25 an hour
- 8 hour shift
- Microsoft Word
- Background check
- Clean driving record
- Health insurance
- Dental insurance
Quick Apply
Head of Financial Crimes Compliance
FIS Global —Jacksonville, FL
- Full-time
- Pass drug screening
- Office
- Bachelor's degree
Fraud Prevention Analyst
FIS Global —Jacksonville, FL
- Full-time
- Spanish
- Writing skills
- Pass drug screening
2d
Vice President, BSA
We Florida Financial —Jacksonville, FL
- Urgently hiring
- 5 years
- Office
- Team management
Quick Apply
2d
SVP, Chief Compliance Officer
FIS Global —Jacksonville, FL
- Full-time
- Pass drug screening
- Office
- Mentoring
QC Credit Auditor
Intercontinental Exchange Holdings, Inc. —Jacksonville, FL
- 8 hour shift
- Finance
- Business Administration
- Senior level
Fraud .NET Developer, AVP
Information Technology Senior Management Forum —Jacksonville, FL
- $96,960 - $145,440 a year
- Full-time
- Office
- Continuous improvement
- JavaScript
- Paid holidays
- Disability insurance
Internal Audit Manager - Lead
Citizens Property Insurance Corporation —Jacksonville, FL
- Full-time
- CPA
- Writing skills
- 3 years
As Needed Field Investigator- Jacksonville, FL
J T Becker & Co Inc —Jacksonville, FL
- Writing skills
- Mid-level
- Driver's License
- Flexible schedule
Quick Apply
SIU Investigation Senior Adjuster - National General
National General —Jacksonville, FL
- $70,000 - $138,600 a year
- Online Application
- Remote
- Research
- Bachelor's degree
- US work authorization
5d
Fraud / Financial Crime Product Counsel
FIS Global —Jacksonville, FL
- Full-time
- Pass drug screening
- Continuous improvement
- Contracts
6d
Florida, Jacksonville Surveillance Investigator PT
Insight Service Group (ISG) —Jacksonville, FL
- $20 - $27 an hour
- Part-time
- Writing skills
- Mid-level
- Driver's License
Quick Apply
Licensed Covert Surveillance Investigator - Part Time - Jacksonville, FL
Meridian Investigative Group, Inc —Jacksonville, FL
- $20 - $30 an hour
- Extended hours
- Microsoft Word
- Computer literacy
- Writing skills

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Investigator, Special Investigative Unit

Molina Healthcare -
Jacksonville, FL

Apply Now

Job Details

Full-time
$21.82 - $42.55 an hour

Benefits

Health insurance

Qualifications

Healthcare financial misconduct investigations
Anatomy knowledge
Claim investigation
Investigations regulatory compliance
Medicare
Managed care
Customer service
Presentations for conferences or internal meetings
Forensic audits
Regulatory legal research
Investigative data analysis
Driver's License
Health insurance knowledge
Medicare regulations
Team training
Risk analysis
Medicaid regulations
Medicaid
Productivity software
Cross-functional collaboration
Medical terminology
Professional development training
Cross-functional communication

Full Job Description

JOB DESCRIPTION Job Summary

Provides investigative support for special investigation unit (SIU) activities. Responsible for supporting for the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse (FWA). Responsible for reviewing and analyzing information to draw conclusions on allegations of FWA and/or may determine appropriateness of care, and recognizing and adhering to national and local coding and billing guidelines in order to maintain coding accuracy and excellence.

Essential Job Duties

Responsible for developing leads presented to the special investigation unit (SIU) to assess and determine whether potential fraud, waste, or abuse (FWA) is corroborated by evidence.
Conducts both preliminary assessments of FWA allegations, and end-to-end investigations, including but not limited to witness interviews, background checks, data analytics to identify outlier billing behavior, contract and program regulation research, provider and member education, findings identification and communications development, recommendations and preparation of overpayment identifications, and closure of investigative cases.
Completes investigations within the mandated period of time required by either state and/or federal contracts and/or regulations.
Conducts both on-site and desktop investigations.
Conducts low to medium, and extensive investigations, including reviews of medical records and data analysis, and makes determinations as to whether the investigation and/or audit identified potential FWA.
Performs accurate and reliable medical review audits that may also include coding and billing reviews.
Produces audit reports for internal and external review.
Coordinates with various internal customers (e.g., provider services, contracting and credentialing, healthcare services, member services, claims, etc.), to gather documentation pertinent to investigations.
Detects potential health care FWA through the identification of aberrant coding and/or billing patterns through utilization review.
Prepares appropriate FWA referrals to regulatory agencies and law enforcement.
Documents appropriately all case related information in the case management system in an accurate manner, including storage of case documentation following SIU related requirements.
Prepares detailed preliminary and extensive investigation referrals to state and/or federal regulatory and/or law enforcement agencies when FWA is identified as required by regulatory and/or contract requirements.
Renders provider education on appropriate practices (e.g., coding) as appropriate based on national or local guidelines, contractual, and/or regulatory requirements.
Interacts with regulatory and/or law enforcement agencies regarding case investigations.
Prepares audit results letters to providers when overpayments are identified.
Ensures compliance with applicable contractual requirements, and federal and state regulations.
Complies with SIU policies as and procedures as well as goals set by SIU leadership.
Supports SIU in arbitrations, legal procedures, and settlements.
Actively participates in Medicaid Fraud Control Unit (MFCU) meetings and roundtables on FWA case development and referrals.
May work with other internal departments, including compliance, corporate legal counsel, and medical affairs to achieve and maintain appropriate anti-fraud oversight.

Required Qualifications

At least 2 years of investigative experience in the health care industry, or equivalent combination of relevant education and experience.
Valid and unrestricted driver’s license.
Proven investigatory skills including ability to organize, analyze, and effectively determine risk with corresponding solutions, and remain objective and separate facts from opinions.
Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations.
Knowledge of managed care and Medicaid, Medicare, and Marketplace programs.
Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems.
Understanding of datamining and use of data analytics to detect FWA.
Ability to research and interpret regulatory requirements.
Effective interpersonal skills and customer service focus; ability to interact with individuals at all levels.
Strong presentation skills with ability to create and deliver training, informational and other types of programs.
Strong logical, analytical, critical-thinking and problem-solving skills.
Strong sense of initiative, excellent follow-through, and persistence in locating and securing needed information.
Fundamental understanding of audits and corrective actions.
Ability to multi-task and operate effectively across geographic and functional boundaries.
Detail-oriented, self-motivated, and able to meet tight deadlines.
Ability to develop realistic, motivating goals and objectives, track progress and adapt to changing priorities.
Energetic and forward-thinking with high ethical standards and a professional image.
Collaborative and team-oriented.
Effective verbal and written communication skills.
Microsoft Office suite and applicable software program(s) proficiency.

Preferred Qualifications

Experience in government programs (i.e., Medicare, Medicaid, Marketplace).
Experience in FWA or related work.
Accredited Health Care Fraud Investigator (AHFI) and/or Certified Fraud Examiner (CFE).

#PJCorp

#LI-AC1

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $21.82 - $42.55 / HOURLY

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Apply Now

Refine Your Search

fraud jobs in jacksonville, fl

Investigator, Special Investigative Unit

Fraud Specialist

Fraud Operations Specialist

Private Investigator

Litigation Paralegal

SIU Intelligence Analyst - Sr

CRIME INTELLIGENCE ANALYST I - 43001501

Surveillance Investigator I - Entry Level

Head of Financial Crimes Compliance

Fraud Prevention Analyst

Vice President, BSA

SVP, Chief Compliance Officer

QC Credit Auditor

Fraud .NET Developer, AVP

Internal Audit Manager - Lead

As Needed Field Investigator- Jacksonville, FL

SIU Investigation Senior Adjuster - National General

Fraud / Financial Crime Product Counsel

Florida, Jacksonville Surveillance Investigator PT

Licensed Covert Surveillance Investigator - Part Time - Jacksonville, FL

I want to receive the latest job alert for fraud in jacksonville, fl

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