Top 49 Claims lead Jobs in Colorado

Lead SIU Investigator
Centene —Colorado
- $70,100 - $126,200 a year
- Full-time
- Remote
- Master's degree
- High school diploma or GED
- Mentoring
- Paid holidays
- Health insurance
7d
Financial Success Lead - Revenue Cycle IT (Senior Project Manager)
UCHealth —Aurora, CO
- $48.56 - $72.84 an hour
- Full-time
- Remote
- High school diploma or GED
- Analysis skills
- Bachelor's degree
- 403(b) matching
- Health savings account
Licensed Insurance Professional P&C Licensed- Inhouse leads
Schomp Insurance —Denver, CO
- $56,485 - $80,000 a year
- Full-time
- Hybrid work
- Dealership
- Mid-level
- US work authorization
- Paid training
- Health insurance
Quick Apply
Lead Inventory Team Member
Chick-fil-A Supply LLC —Aurora, CO
- $28 an hour
- Weekends as needed
- Microsoft Outlook
- Mid-level
- High school diploma or GED
- Health insurance
- Dental insurance
Quick Apply
Revenue Cycle Management / RCM Leader
Candid Health —Denver, CO
- $150,000 - $185,000 a year
- Full-time
- Writing skills
- Office
- Analysis skills
- Health insurance
Healthcare Market Finance Lead
Humana —Colorado
- $104,000 - $143,000 a year
- Full-time
- CPA
- Office
- Master's degree
- Paid parental leave
- Paid holidays
Lead Eligibility Technician
City and County of Denver —Denver, CO
- $25.30 - $37.96 an hour
- Full-time
- Hybrid work
- Mid-level
- Office
- 3 years
- Paid holidays
- Health insurance
3d
Public & Labor Practice Leader - Employee Benefits
IMA Financial Group —Denver, CO
- $180,000 - $240,000 a year
- 5 years
- Writing skills
- Bachelor's degree
- Health savings account
- AD&D insurance
Quick Apply
Lead Diagnostic Radiologic Technologists
US Veterans Health Administration —Aurora, CO
- $92,272 - $119,961 a year
- Weekends as needed
- Background check
- Management
- Heavy lifting
- On-the-job training
Lead Product Manager
Trimble —Westminster, CO
- $170,600 - $234,600 a year
- Online Application
- Hybrid work
- Google Workspace
- 5 years
- Office
- Paid parental leave
- Employee stock purchase plan
Client Service Leader
Gallagher Benefit Services —Greenwood Village, CO
- $73,000 - $142,500 a year
- Full-time
- Hybrid work
- High school diploma or GED
- Supervising experience
- Bachelor's degree
- Paid parental leave
- Health savings account
AI Enablement Lead
IMA Financial Group —Denver, CO
- $125,000 - $175,000 a year
- Continuous improvement
- Senior level
- Communication skills
- Health savings account
- AD&D insurance
Quick Apply
EHS Leader
The Sygma Network —Denver, CO
- $97,400 - $146,000 a year
- Spanish
- English
- Research
- Work from home
9d
Lead Coder
OnPoint Medical Group —Highlands Ranch, CO
- $31 - $34 an hour
- Full-time
- Bilingual
- Computer literacy
- HIPAA
- Disability insurance
- Health insurance
Quick Apply
10d
AI Engineering Lead
IMA Financial Group —Denver, CO
- $147,000 - $220,000 a year
- Azure
- Databases
- Senior level
- Health savings account
- AD&D insurance
Quick Apply
Lead Consultant, Healthcare Performance Improvement
Forvis Mazars —Denver, CO
- Full-time
- Oracle
- Mid-level
- Finance
Quick Apply
Accenture Life Insurance and Annuity Industry (ALIP) Integration Architect Lead
Accenture —Denver, CO
- $122,700 - $338,300 a year
- Full-time
- Azure
- Management
- Computer Science
- Paid holidays
- Disability insurance
O/N Merchandising Lead
Sam's Club —Denver, CO
- $26 - $34 an hour
- 18 years or older
- High school
- Merchandising
- Paid jury duty
- Disability insurance
(USA) Member Team Lead
Sam's Club —Arvada, CO
- $25 - $33 an hour
- 18 years or older
- High school
- Merchandising
- Paid jury duty
- Disability insurance
5d
Marketing Strategist, P&C Marketing Leader
IMA Financial Group —Denver, CO
- $120,000 - $145,000 a year
- 7 years
- Writing skills
- Research
- Health savings account
- AD&D insurance
Quick Apply

I want to receive the latest job alert for claims lead in colorado

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

claims lead jobs near colorado

Engineering Lead jobs in Denver, CO

Marketing Specialist jobs in Denver, CO

Revenue Cycle Specialist jobs in Denver, CO

Insurance Agent jobs in Denver, CO

Lead Technician jobs in Denver, CO

Siu Investigator jobs in Colorado

Laborer jobs in Denver, CO

Radiologic Technologist jobs in Aurora, CO

IT Project Manager jobs in Aurora, CO

Shift Leader jobs in Denver, CO

Environmental Science jobs in Kansas City, MO

Environmental Health And Safety Specialist jobs in Somerset, KY

Environmental Health And Safety Specialist jobs in Hauppauge, NY

Environmental Health And Safety Specialist jobs in Iowa City, IA

Environmental Compliance jobs in Washington State

Environmental jobs in Asheville, NC

Contract Specialist jobs in Maryland

Environmental Health And Safety Specialist jobs in Wilmington, OH

Client Services jobs in Eureka, CA

Client Services jobs in St. Louis, MO

Lead SIU Investigator

Centene -
Colorado

Apply Now

Job Details

Full-time
$70,100 - $126,200 a year
7 days ago

Benefits

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

Qualifications

Healthcare financial misconduct investigations
Investigations regulatory compliance
Medicare
Medical law
Managed care
Managed care organization experience
Health insurance policy knowledge
Regulatory legal research
Medicare regulations
Insurance investigations
Centers for Medicare & Medicaid Services (CMS) billing regulations
Medicaid regulations
Medicaid

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.

*This is a remote role anywhere within the continental US.*

Position Purpose: Position acts as a subject matter expert in the field of Special Investigations Unit (SIU) investigations. Provides direction and guidance to staff who investigate and remediate compliance and fraud, waste, and abuse related matters; while maintaining an investigative workload of moderate to high complexity. Assists manager on monitoring team caseload and report on metrics.

Provides guidance to team members who investigate and remediate compliance and fraud, waste, and abuse related matters.
Assists manager on monitoring team caseload and report on metrics.
Identifies training needs and develop training aids and step actions.
Provides training and mentoring to team on casework and other SIU activities.
Evaluates and assesses allegations to determine those criteria, including federal and state regulations, Centers for Medicare & Medicaid Services (“CMS”) guidelines, and internal policies, procedures, and standards that are alleged to have been violated.
Conducts and documents interviews investigatory purposes.
Reviews investigative interviews prepared by junior investigators.
Manages caseloads of moderate to high complexity, develops investigative plans for multiple investigations, prioritizing and managing through execution.
Thoroughly documents actions, organizes, and reviews case files.
Consults with management, in-house counsel, and/or senior leadership to resolve difficult or complex issues.
Identifies risks and recommends and communicates remedial actions to mitigate future potential risks.
Performs follow up to ensure remedial and disciplinary measures are implemented appropriately and timely.
Prepares clear and concise investigative plans and reports.
Provides support and guidance to junior investigative staff.
Identifies trends and aberrant activity to generate proactive leads for investigations and analyzes data to detect potentially fraudulent activity.
Attends, actively participates in, and/or leads meetings with various business area managers.
Communicates directly with Federal or State regulators.
Prepares cases for referral to management, government agencies, and law enforcement.
Develops and maintains strong working relationships with associates and regulators.
Testifies in criminal and civil matters.
Participates in and lead special projects as needed.
Performs other duties as assigned.
Complies with all policies and standards.

Education/Experience:

Bachelor's Degree in related field; or Associate's degree with 6 years related experience; or High School Diploma/GED with 7 years related experience. required.
Master's Degree preferred.
5+ years Healthcare fraud-related investigations with audit and risk analysis required.
1+ years Managed care or working with health insurance company required.
In-depth knowledge of government programs, the managed care industry, Medicare, Medicate laws and requirements, federal, state, civil and criminal statutes required.
Reading, analyzing and interpreting State and Federal laws, rules and regulations. Knowledge of community, state and federal laws and resources required.
Knowledge and understanding of managed care claims processing systems and medical claims coding preferred preferred.

Licenses/Certifications:

Accredited Health Care Fraud Investigator (AHFI), Certified Fraud Examiner (CFE) or other industry related certification preferred.

Pay Range: $70,100.00 - $126,200.00 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

claims lead jobs in colorado

Lead SIU Investigator

Financial Success Lead - Revenue Cycle IT (Senior Project Manager)

Licensed Insurance Professional P&C Licensed- Inhouse leads

Lead Inventory Team Member

Revenue Cycle Management / RCM Leader

Healthcare Market Finance Lead

Lead Eligibility Technician

Public & Labor Practice Leader - Employee Benefits

Lead Diagnostic Radiologic Technologists

Lead Product Manager

Client Service Leader

AI Enablement Lead

EHS Leader

Lead Coder

AI Engineering Lead

Lead Consultant, Healthcare Performance Improvement

Accenture Life Insurance and Annuity Industry (ALIP) Integration Architect Lead

O/N Merchandising Lead

(USA) Member Team Lead

Marketing Strategist, P&C Marketing Leader

I want to receive the latest job alert for claims lead in colorado

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected