Fraud and Abuse Investigator / CPC - Remote
Sentara Workforce Solutions, LLC —Ambridge, PA
- $25.60 - $42.67 an hour
- Overtime
- Remote
- Mid-level
- Bachelor's degree
- 2 years
- 403(b) matching
- Paid parental leave
Quick Apply
6h
Special Agent I/II
Pennsylvania Office of Attorney General —North Huntingdon, PA
- $68,455 - $77,447 a year
- Full-time
- Military
- Mid-level
- Master's degree
- Paid holidays
- Health insurance
9d
Investigations Manager
Allegheny County Pennsylvania —Allegheny County, PA
- $93,000 - $117,000 a year
- Online Application
- Background check
- Management
- Office
Forensic Evidence Specialist
Allegheny County Pennsylvania —Allegheny County, PA
- $18.93 an hour
- Online Application
- Background check
- Microsoft Excel
- Pass drug screening
Assistant Federal Public Defender
Pennsylvania Western Federal Public Defender —Pittsburgh, PA
- $79,351 - $197,100 a year
- Full-time
- Background check
- Writing skills
- Mid-level
- Commuter assistance
- Paid parental leave
SIU Claims Investigator
Lemieux & Associates LLC —West Mifflin, PA
- $25 - $32 an hour
- Part-time
- Bilingual
- Computer literacy
- Mid-level
- Flexible schedule
Quick Apply
Surveillance Investigator
Frasco Inc —Pittsburgh, PA
- $18 - $26 an hour
- Weekends as needed
- Clean driving record
- Military
- High school diploma or GED
- Paid training
- Mileage reimbursement
Caseworker 2-Investigator
SOUTHWESTERN PENNSYLVANIA AREA —Charleroi, PA
- Full-time
- Adults
- Mid-level
- Master's degree
- Dental insurance
- Opportunities for advancement
Quick Apply
Lieutenant Armed Security Officer
Bering Straits Native Corporation —Pittsburgh, PA
- $31.37 an hour
- Background check
- CPR Certification
- Microsoft Excel
Quick Apply
Claims Investigator - Part Time
Command Investigations, LLC —Pittsburgh, PA
- $23 - $30 an hour
- Overtime
- Microsoft Excel
- Microsoft Outlook
- Customer service
Quick Apply
Military Service - U.S. Navy, Security & Law Enforcement (Master-at-Arms)
U.S. Navy —United States
- $59,000 - $87,000 a year
- Weekends as needed
- Background check
- Management
- High school diploma or GED
- Loan repayment program
- Health insurance
Criminal Investigator (Special Agent) - $40,000 Recruitment Incentive
United States Secret Service —United States
- $47,562 - $115,079 a year
- Full-time
- Background check
- Pass drug screening
- Mid-level
- Health insurance
- Paid time off

More jobs to discover

Find similar jobs that you might be interested in.

Special Agent I/II
Pennsylvania Office of Attorney General —North Huntingdon, PA
Graduation from an accredited college or university with a bachelor's degree in Criminology, Criminal Justice, Police Science, Police Administration, or a…
$68,455 - $77,447 a year
9d

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Investigative Support Analyst
City of Hilliard —Hilliard, OH
Possess or obtain a valid Ohio driver’s license. Associate's degree from an accredited college or university with a focus on criminology, sociology, data…
$60,900 - $85,000 a year
Quick Apply
8d
Fraud and Abuse Investigator / CPC - Remote
Sentara Workforce Solutions, LLC —Columbus, OH
Keywords: Healthcare, Health Plan, Remote, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada,…
$25.60 - $42.67 an hour
Quick Apply
6h

I want to receive the latest job alert for criminal investigator in pittsburgh pa

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

criminal investigator jobs near pittsburgh pa

Surveillance Investigator jobs in Pittsburgh, PA

Public Defender jobs in Pittsburgh, PA

Investigations Manager jobs in Allegheny County, PA

Claims Investigator jobs in Pittsburgh, PA

Armed Security Officer jobs in Pittsburgh, PA

Surveillance Investigator jobs in Albany, NY

Investigator jobs in Seattle, WA

Surveillance Investigator jobs in Pensacola, FL

Surveillance Investigator jobs in Norfolk, VA

Criminal Investigator jobs in Chicago, IL

Surveillance Investigator jobs in Dallas Fort Worth, TX

Special Agent jobs in New Mexico

Paid Training Insurance Agent jobs in Georgia

Freight Broker Agent jobs in California

Special Agent jobs in Fort Myers, FL

Special Education jobs in Washington, DC

Special Agent jobs in Edinburg, TX

Special Agent jobs in New Jersey

Caseworker Ii jobs in Lebanon, PA

Caseworker Ii jobs in Iredell County, NC

Fraud and Abuse Investigator / CPC - Remote

Sentara Workforce Solutions, LLC
Ambridge, PA

Quick Apply

Job Details

Full-time
$25.60 - $42.67 an hour
6 hours 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

criminal investigator jobs in pittsburgh pa

Fraud and Abuse Investigator / CPC - Remote

Special Agent I/II

Investigations Manager

Forensic Evidence Specialist

Assistant Federal Public Defender

SIU Claims Investigator

Surveillance Investigator

Caseworker 2-Investigator

Lieutenant Armed Security Officer

Claims Investigator - Part Time

Military Service - U.S. Navy, Security & Law Enforcement (Master-at-Arms)

Criminal Investigator (Special Agent) - $40,000 Recruitment Incentive

More jobs to discover

Explore jobs in cities nearby

I want to receive the latest job alert for criminal investigator in pittsburgh pa

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