Top 31 & fraud Jobs in Worcester, Ma

Medical Program Auditor/ Analyst
University of Massachusetts Medical School —Westborough, MA
- $80,000 - $95,000 a year
- Full-time
- Microsoft Excel
- Customer service
- Mid-level
Revenue Assurance Investigator (Hybrid)
Eversource Energy Service Company —Southborough, MA
- $96,690 - $107,430 a year
- Full-time
- Microsoft Word
- Bachelor of Science
- Engineering
10d
Mgr of Ecommerce Fraud Prevention & Investigations
Sierra —Framingham, MA
- $117,000 - $152,100 a year
- Full-time
- Office
- Analysis skills
- Mentoring
- Health savings account
- Paid holidays
20h
Senior Security & Fraud Specialist
St. Mary's Credit Union —Marlborough, MA
- $34.50 - $42.50 an hour
- Full-time
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
Quick Apply
Fraud Prevention Specialist
MutualOne Bank —Natick, MA
- $65,959 - $85,142 a year
- Full-time
- Customer service
- Computer literacy
- Research
Quick Apply
Claim Rep Sr, SIU - Casualty (Hybrid or Remote)
MAPFRE —Webster, MA
- $52,100 - $82,200 a year
- Remote
- Bilingual
- Customer service
- Research
- Profit sharing
- Health savings account
Senior Fraud Analyst
First Technology Federal Credit Union —Marlborough, MA
- $93,000 - $111,000 a year
- Email
- Computer science
- Computer Science
- Customer service
- Paid holidays
- Health insurance
Quick Apply
Licensed Covert Surveillance Investigator - Part Time - Worcester, MA
Meridian Investigative Group, Inc —Worcester, MA
- $20 - $30 an hour
- Extended hours
- Microsoft Word
- Computer literacy
- Writing skills
Investigators – Workers’ Comp Cases (Part-Time) | Law Enforcement, Military, or Investigative Experience Required – Alliance Risk Group
Alliance Risk Group —Worcester, MA
- $25 - $30 an hour
- Part-time
- Remote
- Military
- Mid-level
- Office
Quick Apply
BSA & Fraud Officer
Savers Bank —Southbridge, MA
- $75,981 - $95,803 a year
- Full-time
- 5 years
- Office
- Analysis skills
Quick Apply
As Needed Field Investigator- Worcester, MA
J T Becker & Co Inc —Worcester, MA
- Writing skills
- Mid-level
- Driver's License
- Flexible schedule
Quick Apply
VP, Fraud Risk Management
First Technology Federal Credit Union —Marlborough, MA
- $220,000 - $260,000 a year
- Email
- 8 years
- Bachelor's degree
- Continuous improvement
- Paid holidays
- Health insurance
Quick Apply
1d
Medical Billing Code Auditor- Healthcare Internal Audit - Hybrid work schedule
Fallon Health —Worcester, MA
- $87,500 a year
- Full-time
- Hybrid work
- Writing skills
- Mid-level
- 3 years
Surveillance Investigator
Lemieux & Associates LLC —Framingham, MA
- $25 - $32 an hour
- Full-time
- Bilingual
- Microsoft Word
- Computer literacy
- Flexible schedule
Quick Apply
Regional Compliance Manager (Hybrid - Marlborough, MA)
Quest Diagnostics —Marlborough, MA
- $110,000 - $125,000 a year
- Full-time
- Management
- Bachelor of Science
- Analysis skills
- Employee stock purchase plan
- Disability insurance
Quick Apply
Surveillance Investigator
Frasco Inc —Marlboro, MA
- $20 - $26 an hour
- Weekends as needed
- Clean driving record
- Military
- High school diploma or GED
- Paid training
- Mileage reimbursement
2d
Private Investigator Trainee - Prior Military
Lemieux & Associates LLC —Framingham, MA
- $23 - $25 an hour
- Weekends as needed
- Background check
- Military
- Driver's License
- Paid training
- Opportunities for advancement
Quick Apply
As Needed Field Investigator- Putnam, CT
J T Becker & Co Inc —Putnam, CT
- Writing skills
- Mid-level
- Driver's License
- Flexible schedule
Quick Apply
Massachusetts, Leominster Surveillance Investigator PT
Insight Service Group (ISG) —Leominster, MA
- $20 - $27 an hour
- Part-time
- Writing skills
- Mid-level
- Driver's License
Quick Apply
Massachusetts, Leominster Surveillance Investigator
Insight Service Group (ISG) —Leominster, MA
- $20 - $27 an hour
- Weekends as needed
- Writing skills
- Mid-level
- Driver's License
Quick Apply

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& fraud jobs near worcester, ma

Medical Program Auditor/ Analyst

University of Massachusetts Medical School -
Westborough, MA

Apply Now

Job Details

Full-time
$80,000 - $95,000 a year

Qualifications

Customer communication
Bachelor's degree
Data-driven problem-solving

Full Job Description

Overview:

Under the general direction of the Associate Director or designee, the Fraud, Waste, and Abuse (FWA) Auditor serves a crucial role in identifying, investigating, and preventing fraud, waste and abuse for Medicaid programs. A major function of this position is to conduct desk and onsite audits across various provider types to ensure compliance with federal and state regulations. The Auditor performs investigative activities to develop leads and detect aberrant billing practices, including data mining, claims analysis, and medical record assessment.

Onsite requirement 1-2 times per month, all other aspects of the job are remote.

Responsibilities:

Responsibilities:

Ensure compliance with federal and state regulations and healthcare FWA industry standards.
Perform independent data mining and data analysis utilizing claims data to detect patterns and trends that may uncover fraud, waste, or non-compliant billing practices.
Conduct onsite audits as required, to assess the completeness of medical and administrative records and the compliance with applicable regulatory requirements.
Prepare detailed audit documentation, summaries of investigative findings, compile case files, calculate sanctions and overpayments based on violations cited.
Communicate with providers regarding issues such as general regulatory compliance, audit findings, and the recovery process.
Recommend policy, procedure and system changes to enhance investigative outcomes.
Update appropriate internal management staff regularly on progress of investigations.
Stay current with regulatory updates, coding changes, and industry standards.
Identify trends from national fraud-related publications and recommend new or improved strategies to strengthen fraud-detection efforts.
Assist with document management, updating case-tracking system and adhering to record retention policies and procedures.
Perform other duties as assigned.

Qualifications:

Qualifications:

Bachelor's degree in business, health care administration, or other related field
4-6 years of related experience in the healthcare industry, business,; with at least two years of experience conducting data mining in the healthcare insurance industry, healthcare claim audits, administrative medical record reviews or other claims analysis related experience
Knowledge of CPT, HCPCS and ICD-10 coding, reimbursement and claims processing policies
Strong analytical and qualitative skills as well as problem solving skills with the ability to look for root causes and implement workable solutions
Ability to interpret and apply law and regulations as it relates to fraud and fraud investigations
Ability to multi-task, establish priorities and work independently and collaboratively to achieve audit objectives
Proficiency in Microsoft Office applications (Word, Excel, PowerPoint and Access)
Excellent Customer service skills with the ability to interact professionally and effectively with providers, clients, and internal stakeholders from all departments
Ability to travel within Massachusetts and be on-site as needed for audits

Additional Information:

Preferred Qualifications:

Prefer individual possessing any of the following certifications or licensure: CPC or CPMA
Knowledge of state and federal regulations as they apply to public assistance programs

#LI-AC1

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Refine Your Search

& fraud jobs in worcester, ma

Medical Program Auditor/ Analyst

Revenue Assurance Investigator (Hybrid)

Mgr of Ecommerce Fraud Prevention & Investigations

Senior Security & Fraud Specialist

Fraud Prevention Specialist

Claim Rep Sr, SIU - Casualty (Hybrid or Remote)

Senior Fraud Analyst

Licensed Covert Surveillance Investigator - Part Time - Worcester, MA

Investigators – Workers’ Comp Cases (Part-Time) | Law Enforcement, Military, or Investigative Experience Required – Alliance Risk Group

BSA & Fraud Officer

As Needed Field Investigator- Worcester, MA

VP, Fraud Risk Management

Medical Billing Code Auditor- Healthcare Internal Audit - Hybrid work schedule

Surveillance Investigator

Regional Compliance Manager (Hybrid - Marlborough, MA)

Surveillance Investigator

Private Investigator Trainee - Prior Military

As Needed Field Investigator- Putnam, CT

Massachusetts, Leominster Surveillance Investigator PT

Massachusetts, Leominster Surveillance Investigator

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