Top 24 Claims lead Jobs in Nevada

Lead SIU Investigator
Centene —Nevada
- $70,100 - $126,200 a year
- Full-time
- Remote
- Master's degree
- High school diploma or GED
- Mentoring
- Paid holidays
- Health insurance
1d
Coding Lead
Renown Health —Reno, NV
- $32.76 - $45.87 an hour
- Full-time
- Remote
- Anatomy knowledge
- Microsoft Excel
- Microsoft Outlook
Market Finance Lead
Humana —Nevada
- $104,000 - $143,000 a year
- Full-time
- CPA
- Office
- Master's degree
- Paid parental leave
- Paid holidays
Medical Billing Lead (Bilingual) - Pediatrics
Nevada Pediatric Specialists —Henderson, NV
- $18 - $23 an hour
- Full-time
- Spanish
- Management
- English
Quick Apply
Lead Director, Healthcare Medicaid Risk Adjustment Analytics
CVS Health —Nevada
- $100,000 - $231,540 a year
- Full-time
- Remote
- 3 years
- SQL
- Bachelor's degree
- Health insurance
- Dental insurance
TEAM LEADER - APPEALS
Western CBO —Las Vegas, NV
- $25.85 - $38.77 an hour
- Full-time
- Mid-level
- 3 years
- High school diploma or GED
- Health insurance
- Dental insurance
Workers’ Compensation Claims Careers – Representative, Examiner & Team Leads
Sedgwick —Las Vegas, NV
- 6 years
- Senior level
- Health insurance
- Dental insurance
5d
Clinical Risk Consultant Lead
Alliant Insurance Services —Nevada
- $150,000 - $160,000 a year
- Email
- Writing skills
- Research
- Bachelor's degree
Quick Apply
6d
Lead Medical Billing Specialist
Resolution Medical Billing —Las Vegas, NV
- $23.11 - $27.84 an hour
- Full-time
- Hybrid work
- Mentoring
- Organizational skills
- Senior level
Quick Apply
Wholesale Operations Leader - GRS North America
Liberty Mutual —Las Vegas, NV
- $156,000 - $281,000 a year
- Full-time
- Hybrid work
- 11+ years
- Office
- Mentoring
12d
(USA) Member Team Lead
Sam's Club —Las Vegas, NV
- $21 - $29 an hour
- 18 years or older
- High school
- Merchandising
- Paid jury duty
- Disability insurance
Member Team Lead
Sam's Club —Las Vegas, NV
- $21 - $29 an hour
- 18 years or older
- High school
- Merchandising
- Paid jury duty
- Disability insurance
Lead PT Freight Ops
Freeman Company —Las Vegas, NV
- Part-time
- Management
- Mid-level
- Office
- Retirement plan
4d
Shift Lead
Walgreens —Las Vegas, NV
- $17.00 - $20.50 an hour
- Part-time
- Computer literacy
- Basic math
- English
- Health insurance
- Dental insurance
5d
Lead Dental Assistant
Summerlin Dental Solutions —Las Vegas, NV
- $24 - $26 an hour
- Full-time
- Private practice
- Dental office
- Mid-level
- Employee discount
Quick Apply
Universal Lead Teller (Floating)
America First Credit Union —Sparks, NV
- $23.13 - $26.02 an hour
- Full-time
- Inventory management
- Mid-level
- Office
10d
Lead Event Specialist Part Time
Product Connections —Las Vegas, NV
- $16.50 an hour
- Part-time
- Serving
- Computer literacy
- Mid-level
Quick Apply
Data Center COE Project Management Leader
ABB Inc. —Henderson, NV
- $119,000 - $190,400 a year
- Full-time
- Engineering
- Team management
- US work authorization
- Health savings account
- AD&D insurance
Quick Apply
1d
Lead Dockworker
Saia Motor Freight Line LLC —Reno, NV
- $25.00 - $28.35 an hour
- Weekends as needed
- 18 years or older
- Ability to walk for extended periods
- English
Quick Apply

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Coding Lead
Renown Health —Reno, NV
Responsibility for maintaining coding certification and referencing current ICD-10 coding guidelines and regulatory changes. Ability to work well with others.
$32.76 - $45.87 an hour
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HEALTHPLANONE, LLC —Las Vegas, NV
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5d

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Performs other administrative tasks at the request of management as related to credentialing and board certification documentation.
7d
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Lead SIU Investigator

Centene -
Nevada

Apply Now

Job Details

Full-time
$70,100 - $126,200 a year
1 day 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 nevada

Lead SIU Investigator

Coding Lead

Market Finance Lead

Medical Billing Lead (Bilingual) - Pediatrics

Lead Director, Healthcare Medicaid Risk Adjustment Analytics

TEAM LEADER - APPEALS

Workers’ Compensation Claims Careers – Representative, Examiner & Team Leads

Clinical Risk Consultant Lead

Lead Medical Billing Specialist

Wholesale Operations Leader - GRS North America

(USA) Member Team Lead

Member Team Lead

Lead PT Freight Ops

Shift Lead

Lead Dental Assistant

Universal Lead Teller (Floating)

Lead Event Specialist Part Time

Data Center COE Project Management Leader

Lead Dockworker

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