Fraud and Abuse Investigator / CPC - Remote
Sentara Workforce Solutions, LLC —Osseo, MN
- $25.60 - $42.67 an hour
- Overtime
- Remote
- Mid-level
- Bachelor's degree
- 2 years
- 403(b) matching
- Paid parental leave
Quick Apply
4d
Special Investigator
Medica Services Company LLC —Minnetonka, MN
- $62,700 - $107,500 a year
- 5 years
- Research
- Office
- Paid holidays
- Health insurance
14d
Field Investigator (FT & PT) – Minneapolis- St. Paul, MN
Origin Investigations Inc —Minneapolis, MN
- $25 - $35 an hour
- Part-time
- Background check
- Military
- Computer literacy
Quick Apply
SIU Investigator III
Medica Services Company LLC —Minnetonka, MN
- $62,700 - $107,500 a year
- 5 years
- Research
- Office
- Paid holidays
- Health insurance
4d
SIU Investigator IV
Medica Services Company LLC —Minnetonka, MN
- $70,200 - $120,400 a year
- Anatomy knowledge
- 7 years
- Microsoft Excel
- Paid holidays
- Health insurance
4d
Investigator, Special Investigations Unit (Meritain Health)
CVS Health —Saint Paul, MN
- $46,988 - $122,400 a year
- Full-time
- Customer service
- Research
- Mid-level
- Health insurance
- Dental insurance
Senior Fraud Intelligence Analyst
Target —Brooklyn Park, MN
- $88,000 - $158,000 a year
- Full-time
- Office
- Analysis skills
- Continuous improvement
- Paid holidays
- Disability insurance
3d
Surveillance Investigator
Frasco Inc —Minneapolis, MN
- $20 - $26 an hour
- Part-time
- Clean driving record
- Military
- Writing skills
- Paid training
- Mileage reimbursement
Surveillance Investigator
Allied Universal® Compliance and Investigations —Saint Paul, MN
- $25 - $30 an hour
- Weekends as needed
- Microsoft Word
- Military
- Mid-level
- AD&D insurance
- Paid holidays
Quick Apply
3d
SIU Investigator - Minneapolis, MN
Delta Group —Minneapolis, MN
- $30 - $40 an hour
- Per diem
- Microsoft Outlook
- Organizational skills
- Senior level
Quick Apply
13d
Private Investigator - Minneapolis, MN
Delta Group —Minneapolis, MN
- $20 - $30 an hour
- Per diem
- Background check
- 18 years or older
- Clean driving record
- Disability insurance
- Health insurance
Quick Apply
Minnesota, Minneapolis Surveillance Investigator
Insight Service Group (ISG) —Minneapolis, MN
- $20 - $27 an hour
- Part-time
- Mid-level
- Analysis skills
- Driver's License
Quick Apply
Surveillance Investigator
Advantage Surveillance LLC —Minneapolis, MN
- $20 - $25 an hour
- Weekends as needed
- Clean driving record
- Pass drug screening
- Driving
- Travel reimbursement
- Paid parental leave
Quick Apply
Senior AML Analyst – Surveillance & Investigations
Royal Bank of Canada —Minneapolis, MN
- $70,000 - $130,000 a year
- Full-time
- 5 years
- Research
- Office
- Disability insurance
- Health insurance
Affirmative Civil Enforcement (ACE) Investigator/Analyst
SGI Global, LLC —Minneapolis, MN
- Full-time
- Microsoft Access
- Microsoft Outlook
- Computer literacy
Quick Apply
Minnesota, Minneapolis SIU Investigator PT
Insight Service Group (ISG) —Minneapolis, MN
- $20 - $27 an hour
- Part-time
- Mid-level
- Driver's License
- Travel
Quick Apply
SIU Investigator
Allied Universal® Compliance and Investigations —Minneapolis, MN
- $27 - $32 an hour
- Weekends as needed
- Military
- Computer literacy
- High school diploma or GED
- AD&D insurance
- Paid holidays
Quick Apply
4d
Claims Investigator - Part Time
Command Investigations, LLC —Minneapolis, MN
- $23 - $30 an hour
- Overtime
- Microsoft Excel
- Microsoft Outlook
- Customer service
Quick Apply
Part Time SIU Investigator
The Robison Group —Minneapolis, MN
- $30 - $35 an hour
- Part-time
- Background check
- 5 years
- Computer literacy
Quick Apply
Security Officer
Children's Minnesota —Saint Paul, MN
- $21.78 - $31.11 an hour
- Full-time
- Customer service
- Ability to walk for extended periods
- Writing skills
- Health insurance
- Dental insurance

I want to receive the latest job alert for fraud investigator in richfield mn

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

fraud investigator jobs near richfield mn

Surveillance Investigator jobs in Minneapolis, MN

Surveillance Investigator jobs in Saint Paul, MN

Siu Investigator jobs in Minneapolis, MN

Claims Investigator jobs in Minneapolis, MN

Field Investigator jobs in Minneapolis, MN

Health Unit Coordinator jobs in Saint Paul, MN

Private Investigator jobs in Minneapolis, MN

Security Officer jobs in Saint Paul, MN

Internal Investigator jobs in Remote

Disease Investigator jobs in California

Entry Level Investigator jobs in Chicago, IL

Surveillance Investigator jobs in Little Rock, AR

Surveillance Investigator jobs in Denver, CO

Surveillance Investigator jobs in Murrells Inlet, SC

Medicaid Fraud Investigator jobs in Texas

Surveillance Investigator jobs in Houston, TX

Credit Analyst jobs in Austin, TX

Investigations Analyst jobs in Cleveland, OH

Investigations Analyst jobs in Long Island, NY

Investigations Analyst jobs in Omaha, NE

Fraud and Abuse Investigator / CPC - Remote

Sentara Workforce Solutions, LLC
Osseo, MN

Quick Apply

Job Details

Full-time
$25.60 - $42.67 an hour
4 days ago

Benefits

403(b) matching
Paid parental leave
Caregiver leave
Disability insurance
Dental insurance
Tuition reimbursement
Paid time off
Parental leave
Employee assistance program
Vision insurance
401(k) matching
403(b)
Life insurance
Pet insurance

Qualifications

Statistics
Healthcare financial misconduct investigations
Investigations regulatory compliance
Regulatory compliance in claims processing
Mid-level
Internal investigations
Certified Professional Coder
Quality assurance audits
Insurance investigation report preparation
Retrospective medical coding audits
Bachelor's degree
Health insurance knowledge
Healthcare billing investigations
Settlement negotiation
Quality audits
Insurance claims auditing
Healthcare claims compliance audits
Research findings presentation
2 years
Healthcare compliance
Documentation review

Full Job Description

City/State

Norfolk, VA

Work Shift

First (Days)

Overview:

Sentara Health Plan is currently hiring a Fraud and Abuse Investigator/Certified Professional Coder (CPC) Remote!

Status: Full-time, permanent position (40 hours)

Work hours: 8am to 5pm EST, M-F

Location: This position is remote for candidates that live in the following states: Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming; With travel to Virginia Beach 1x a year.

Job Summary:

Responsible for contributing to in-depth investigations for suspected fraud or abuse with respect to provider, pharmacy, employer, member, and broker interactions involving the full range of products through Sentara Health Plans lines of business. Responsible for contributing to the review of the quality of pharmacy, physician, ancillary and hospital-based coding in routine desk audits as well as occasional on-site audits. Contributes to the review of reimbursement systems relating to health insurance claims processing and ensures adherence to health plan policies and procedures for its various product offerings.

Job Description:

Identify, investigate, analyze, and evaluate instances of potential fraud, waste, and abuse.
Conduct interviews or correspond with patients, providers, witnesses, or other relevant parties to determine settlement, denial, or review.
Analyze information gathered by investigation and report findings and recommendations as a written summary and/or presentation.
Learn and conduct statistical sampling of complex medical claims.
Assists in drafting settlements

Education:

Bachelor's degree preferred

Certifications/Licenses:

Certified Professional Coder preferred (or achieved within 12 months of hire date)

Experience:

2 years combined experience required in Internal/External Audit OR regulatory/Compliance OR Healthcare preferred

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.

Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.

We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health.

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.

Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for Full Time employment is: $25.60/hour- $42.67/hour. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-102996

Talroo-Health Plan

Keywords: Healthcare, Health Plan, Remote, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming, Bachelor's Degree, Medical Coding, Medical Chart Review, Insurance Billing, Internal/External Audit, Regulatory, Compliance, Claims Investigations, Criminal Investigation, White Collar Crime, Certified Professional Coder (CPC), Fraud, Waste, Abuse, Program Integrity, FWA, PI, SIU, Special Investigations Unit

Benefits: Caring For Your Family and Your Career

Medical, Dental, Vision plans
Adoption, Fertility and Surrogacy Reimbursement up to $10,000
Paid Time Off and Sick Leave
Paid Parental & Family Caregiver Leave
Emergency Backup Care
Long-Term, Short-Term Disability, and Critical Illness plans
Life Insurance
401k/403B with Employer Match
Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
Student Debt Pay Down – $10,000
Pet Insurance
Legal Resources Plan
Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

Quick Apply

Refine Your Search

fraud investigator jobs in richfield mn

Fraud and Abuse Investigator / CPC - Remote

Special Investigator

Field Investigator (FT & PT) – Minneapolis- St. Paul, MN

SIU Investigator III

SIU Investigator IV

Investigator, Special Investigations Unit (Meritain Health)

Senior Fraud Intelligence Analyst

Surveillance Investigator

Surveillance Investigator

SIU Investigator - Minneapolis, MN

Private Investigator - Minneapolis, MN

Minnesota, Minneapolis Surveillance Investigator

Surveillance Investigator

Senior AML Analyst – Surveillance & Investigations

Affirmative Civil Enforcement (ACE) Investigator/Analyst

Minnesota, Minneapolis SIU Investigator PT

SIU Investigator

Claims Investigator - Part Time

Part Time SIU Investigator

Security Officer

I want to receive the latest job alert for fraud investigator in richfield mn

Explore jobs in more locations

Sentara Health Plan is currently hiring a Fraud and Abuse Investigator/Certified Professional Coder (CPC) Remote!

Job Seeker Tools

Employer Tools

Browse

Stay Connected