Top 29 Fraud investigator remote Jobs in New Jersey

SIU Investigator
Centene —New Jersey
- $56,200 - $101,000 a year
- Full-time
- Remote
- 5 years
- Fair chance
- Senior level
- Paid holidays
- Health insurance
Director, Global Clinical Physician (Director)
BMS —Princeton, NJ
- $275,630 - $333,998 a year
- Email
- Hybrid work
- Medicine
- 5 years
- Analysis skills
- Paid holidays
- Disability insurance
Associate Director, Product Management - Contracting (CTFS) (Remote)
IQVIA —New Providence, NJ
- $98,500 - $274,400 a year
- Full-time
- Remote
- Computer science
- 7 years
- Computer Science
Director, Global Medical Evidence Generation Lead, Oncology
Bristol-Myers Squibb —Princeton, NJ
- $207,490 - $251,433 a year
- Email
- Hybrid work
- Medicine
- Management
- Doctor of Philosophy
- Paid holidays
- Disability insurance
Director, Global Medical Oncology, Solid Tumor Medical Lead, Women’s Cancers & Specialty Tumors
Bristol-Myers Squibb —Princeton, NJ
- $207,490 - $251,433 a year
- Email
- Hybrid work
- Medicine
- 5 years
- Analysis skills
- Paid holidays
- Disability insurance
Associate Director, Professional Societies (Global Medical Oncology)
Bristol-Myers Squibb —Princeton, NJ
- $166,350 - $201,571 a year
- Email
- Hybrid work
- Medicine
- 5 years
- Office
- Paid holidays
- Disability insurance
14d
Senior Director, Mavacamten Medical Product Lead
Bristol-Myers Squibb —Princeton, NJ
- $229,380 - $277,956 a year
- Email
- Hybrid work
- Medicine
- Office
- 8 years
- Paid holidays
- Disability insurance
Director, WW Autoimmune Cell Therapy Medical Affairs
Bristol-Myers Squibb —Princeton, NJ
- $207,490 - $251,433 a year
- Email
- Hybrid work
- Medicine
- 5 years
- Office
- Paid holidays
- Disability insurance
Director, Patient Safety Scientist
Bristol-Myers Squibb —Princeton, NJ
- $217,520 - $263,577 a year
- Email
- Hybrid work
- Medicine
- Bachelor of Science
- 8 years
- Paid holidays
- Disability insurance
Director, Global Medical Evidence Generation Lead, Hematology
Bristol-Myers Squibb —Princeton, NJ
- $207,490 - $251,433 a year
- Email
- Hybrid work
- Medicine
- Management
- Doctor of Philosophy
- Paid holidays
- Disability insurance
5d
Associate Director, Clinical Data Management
Bristol-Myers Squibb —Princeton, NJ
- $170,800 - $206,968 a year
- Email
- Hybrid work
- 7 years
- Analysis skills
- Bachelor's degree
- Paid holidays
- Disability insurance
Executive Director, Medical Safety Assessment Therapeutic Lead, Neuroscience
Bristol-Myers Squibb —Princeton, NJ
- $334,860 - $405,769 a year
- Email
- Hybrid work
- Medicine
- Analysis skills
- Travel
- Paid holidays
- Disability insurance
Director, Medical Safety Assessment Physician, Neuroscience
Bristol-Myers Squibb —Princeton, NJ
- $255,860 - $347,244 a year
- Email
- Hybrid work
- Medicine
- Office
- 3 years
- Paid holidays
- Disability insurance
Environmental Advisor - Due Diligence Project Manager
EFI Global, Inc. —New Jersey
- $66,113 - $92,250 a year
- Full-time
- Hybrid work
- Clean driving record
- 6 years
- Ability to walk for extended periods
- Health savings account
- Disability insurance
Executive Director, Worldwide Cell Therapy Medical Communications Lead
Bristol-Myers Squibb —Madison, NJ
- $255,480 - $309,587 a year
- Email
- Hybrid work
- Management
- Travel
- Fair chance
- Paid holidays
- Disability insurance
Director, MEG Lead Immunology, Medical Evidence Generation
Bristol-Myers Squibb —Madison, NJ
- $207,490 - $251,433 a year
- Email
- Hybrid work
- Medicine
- Management
- Doctor of Philosophy
- Paid holidays
- Disability insurance
Director, MEG Lead Neuroscience, Medical Evidence Generation
Bristol-Myers Squibb —Princeton, NJ
- $207,490 - $251,433 a year
- Email
- Hybrid work
- Medicine
- Management
- Doctor of Philosophy
- Paid holidays
- Disability insurance
Director, Global Medical Cardiovascular, Mavacamten
Bristol-Myers Squibb —Princeton, NJ
- $207,490 - $251,433 a year
- Email
- Hybrid work
- Medicine
- 5 years
- Doctor of Philosophy
- Paid holidays
- Disability insurance
Senior Director, Global Clinical Development (GI Oncology)
Bristol-Myers Squibb —Princeton, NJ
- $244,560 - $331,907 a year
- Email
- Hybrid work
- Medicine
- 8 years
- Doctor of Philosophy
- Paid holidays
- Disability insurance
Senior Manager, Global Medical Affairs, Oncology Strategic Alliances
Bristol-Myers Squibb —Princeton, NJ
- $131,330 - $159,135 a year
- Email
- Hybrid work
- 5 years
- Office
- Doctor of Philosophy
- Paid holidays
- Disability insurance

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SIU Investigator

Centene -
New Jersey

Apply Now

Job Details

Full-time
$56,200 - $101,000 a year

Benefits

Paid holidays
Health insurance
401(k)
Tuition reimbursement
Paid time off

Qualifications

Healthcare financial misconduct investigations
Data mining
Health data analysis
5 years
Bachelor's degree in business
Forensic audits
Suspicious activity investigations
Data summary reports
Criminal Justice
Investigative data analysis
Insurance investigation report preparation
Outlier detection
Healthcare billing investigations
Case referral
Insurance claims auditing
Senior level
Business
Healthcare claims compliance audits
Bachelor's degree in criminal justice
Law enforcement

Full Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Please note: this is a remote role with high preference on candidates residing within New York.

Position Purpose: Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse.

Conduct investigations of potential waste, abuse, and fraud
Document activity on each case and refer issues to the appropriate party
Perform data mining and analysis to detect aberrancies and outliers in claims
Develop new queries and reports to detect potential waste, abuse, and fraud
Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions
Assist with complex allegations of healthcare fraud
Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies
Complete various special projects and audits
Performs other duties as assigned.
Complies with all policies and standards

Education/Experience: Bachelor's Degree Business, Criminal Justice, Healthcare, or related field, or equivalent experience required. 1+ years Medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation required. Minimum of five (5) years in healthcare field working in fraud, waste and abuse investigations and audits, (or) five years of insurance claims investigation experience or professional investigation experience with law enforcement agencies, (or) seven years of professional investigation experience involving economic or insurance related matters.

Pay Range: $56,200.00 - $101,000.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Apply Now

Refine Your Search

fraud investigator remote jobs in new jersey

SIU Investigator

Director, Global Clinical Physician (Director)

Associate Director, Product Management - Contracting (CTFS) (Remote)

Director, Global Medical Evidence Generation Lead, Oncology

Director, Global Medical Oncology, Solid Tumor Medical Lead, Women’s Cancers & Specialty Tumors

Associate Director, Professional Societies (Global Medical Oncology)

Senior Director, Mavacamten Medical Product Lead

Director, WW Autoimmune Cell Therapy Medical Affairs

Director, Patient Safety Scientist

Director, Global Medical Evidence Generation Lead, Hematology

Associate Director, Clinical Data Management

Executive Director, Medical Safety Assessment Therapeutic Lead, Neuroscience

Director, Medical Safety Assessment Physician, Neuroscience

Environmental Advisor - Due Diligence Project Manager

Executive Director, Worldwide Cell Therapy Medical Communications Lead

Director, MEG Lead Immunology, Medical Evidence Generation

Director, MEG Lead Neuroscience, Medical Evidence Generation

Director, Global Medical Cardiovascular, Mavacamten

Senior Director, Global Clinical Development (GI Oncology)

Senior Manager, Global Medical Affairs, Oncology Strategic Alliances

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