Top 295 Processing supervisors & leads Jobs in Idaho

Lead SIU Investigator
Centene —Idaho
- $70,100 - $126,200 a year
- Full-time
- Remote
- Master's degree
- High school diploma or GED
- Mentoring
- Paid holidays
- Health insurance
3d
IT Manager II – Agency Relationship Manager
State of Idaho —Boise, ID
- $41.43 - $45.57 an hour
- Full-time
- System design
- Research
- Mid-level
- Paid holidays
- Health insurance
2d
Office Manager
Plumbing Solutions of Idaho —Meridian, ID
- From $26 an hour
- Full-time
- Mid-level
- Office
- In-person
- Health savings account
- Paid holidays
Quick Apply
Customer Service Team Leader
PacificSource Health Plans —Boise, ID
- $50,830.78 - $81,329.23 a year
- Full-time
- Microsoft Word
- Microsoft Excel
- Writing skills
6d
Payment Integrity and Fraud, Waste and Abuse Team Lead
PacificSource Health Plans —Boise, ID
- $83,310.45 - $145,793.28 a year
- Full-time
- HIPAA
- English
- Office
2d
Development Operations Manager_Fundraising
Planned Parenthood GNHI —Meridian, ID
- $64,677 - $110,000 a year
- Full-time
- 5 years
- Bachelor of Science
- System design
- Disability insurance
- Health insurance
Office Supervisor
Kootenai Health —Coeur d'Alene, ID
- Full-time
- Word processing
- Mid-level
- Office
- Wellness program
- Health insurance
Quick Apply
7d
Team Leader Production
Lamb Weston —American Falls, ID
- $71,410 - $107,110 a year
- Weekends as needed
- Ability to walk for extended periods
- Mid-level
- High school diploma or GED
- Health savings account
- Employee stock purchase plan
Electrical Process Control Supervisor - Caldwell, ID
Simplot —Caldwell, ID
- $95,000 - $100,000 a year
- Overtime
- Background check
- 3 years
- Programmable logic controllers
- Health savings account
- Health insurance
Night Shift Maintenance Supervisor - Caldwell, ID
Simplot —Caldwell, ID
- $85,000 - $90,000 a year
- Night shift
- Background check
- Bachelor of Science
- Mid-level
- Health savings account
- Health insurance
2d
Leasing Manager
Confidential —Victor, ID
- $45,000 - $60,000 a year
- Full-time
- Background check
- Marketing
- Ability to walk for extended periods
- Health insurance
- Dental insurance
Quick Apply
Registered Nurse - House Supervisor
Rehabilitation Hospital of the Northwest —Post Falls, ID
- $40 - $55 an hour
- Full-time
- Acute care
- CPR Certification
- Nursing
- Wellness program
- Health savings account
Quick Apply
2d
Assistant Manager, part-time
J.Crew Factory- Boise —Boise, ID
- $18.50 an hour
- Part-time
- Background check
- 18 years or older
- Mid-level
- Health insurance
- 401(k)
Quick Apply
3d
Credit Manager
Commercial Tire Inc —Meridian, ID
- $70,000 - $90,000 a year
- Full-time
- Mid-level
- Office
- 3 years
- Health insurance
- Dental insurance
Warehouse Lead & Quality Control
Illinois Foundation Seeds Inc. —Nampa, ID
- $55,000 - $65,000 a year
- Part-time
- Ability to walk for extended periods
- Bachelor of Science
- Mid-level
- Paid holidays
- Disability insurance
Office Manager
Knudtsen Chevrolet —Post Falls, ID
- Full-time
- Clean driving record
- Dealership
- Word processing
- Paid holidays
- Health insurance
Quick Apply
Human Resources Manager
Cedar Ridge Dairy —Filer, ID
- $68,000 - $96,000 a year
- Full-time
- Office
- Travel
- Construction experience
- Paid holidays
- Health insurance
Quick Apply
2d
McDonald's Quality Manager America
Simplot —Caldwell, ID
- Microsoft Word
- Oracle
- 5 years
10d
Manager Field Support
KLA —Boise, ID
- $98,200 - $166,900 a year
- Full-time
- Bachelor of Science
- Bachelor's degree
- Smartphone
- Employee stock purchase plan
- Paid holidays
10d
De-Packaging Plant Manager
Gibby Group Inc. —Burley, ID
- $70,000 - $100,000 a year
- Weekends as needed
- Spanish
- Customer service
- Ability to walk for extended periods
Quick Apply

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processing supervisors & leads jobs near idaho

Lead SIU Investigator

Centene -
Idaho

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Job Details

Full-time
$70,100 - $126,200 a year
3 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

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Refine Your Search

processing supervisors & leads jobs in idaho

Lead SIU Investigator

IT Manager II – Agency Relationship Manager

Office Manager

Customer Service Team Leader

Payment Integrity and Fraud, Waste and Abuse Team Lead

Development Operations Manager_Fundraising

Office Supervisor

Team Leader Production

Electrical Process Control Supervisor - Caldwell, ID

Night Shift Maintenance Supervisor - Caldwell, ID

Leasing Manager

Registered Nurse - House Supervisor

Assistant Manager, part-time

Credit Manager

Warehouse Lead & Quality Control

Office Manager

Human Resources Manager

McDonald's Quality Manager America

Manager Field Support

De-Packaging Plant Manager

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