Top 37 Fraud Jobs in Raynham Ma

Investigator
UnitedHealthcare —Warwick, RI
- $49,700 - $88,800 a year
- Full-time
- Hybrid work
- Microsoft Word
- Up to 50% travel
- Pass drug screening
Private Investigator - Retired/Former Law Enforcement
Lemieux & Associates LLC —Taunton, MA
- $25 - $30 an hour
- Part-time
- Bilingual
- Computer literacy
- Mid-level
- Mileage reimbursement
Quick Apply
Investigator II
Citizens Financial Group —Johnston, RI
- $70,000 - $85,000 a year
- Full-time
- Background check
- Microsoft Outlook
- Research
- Health insurance
- Dental insurance
9d
Investigators – Workers’ Comp Cases (Part-Time) | Law Enforcement, Military, or Investigative Experience Required – Alliance Risk Group
Alliance Risk Group —New Bedford, MA
- $25 - $30 an hour
- Part-time
- Remote
- Military
- Mid-level
- Office
Quick Apply
Senior Investigator - Rhode Island
UnitedHealthcare —Warwick, RI
- $60,200 - $107,400 a year
- Full-time
- Hybrid work
- Microsoft Word
- Up to 50% travel
- Pass drug screening
Surveillance Investigator
Frasco Inc —New Bedford, MA
- $20 - $26 an hour
- Weekends as needed
- Clean driving record
- Military
- High school diploma or GED
- Paid training
- Mileage reimbursement
3d
Customer Service or Alcohol Compliance Evaluator
DATA QUEST INVESTIGATIONS LTD —Hanover, MA
- $20 an hour
- Part-time
- Bar
- Customer service
- Hotel
Quick Apply
Surveillance Investigator I - Entry Level
Command Investigations, LLC —Taunton, MA
- $20 - $25 an hour
- 8 hour shift
- Microsoft Word
- Clean driving record
- Customer service
- Health insurance
- Dental insurance
Quick Apply
Surveillance Investigator II - Experienced
Command Investigations, LLC —Taunton, MA
- $25 - $30 an hour
- 8 hour shift
- Microsoft Word
- Clean driving record
- Customer service
- Health insurance
- Dental insurance
Quick Apply
Product Manager, Fraud & Abuse
CVS Health —Providence, RI
- $92,700 - $203,940 a year
- Full-time
- Mid-level
- 3 years
- Bachelor's degree
- Health insurance
- Dental insurance
Retail Banking Compliance Manager, VP
BankFive —Fall River, MA
- $106,990 - $181,880 a year
- Full-time
- 5 years
- Office
- Finance
Alcohol Compliance Evaluator
DATA QUEST INVESTIGATIONS LTD —Dorchester, MA
- $20 - $30 an hour
- Part-time
- Bar
- Hotel
- Restaurant
Quick Apply
Investigator
Ethos Risk Services —Plymouth, MA
- $23 - $28 an hour
- Weekends as needed
- Mid-level
- Residential
- Driver's License
- Disability insurance
- Health insurance
Quick Apply
13d
Claims Investigator - Part Time
Command Investigations, LLC —Providence, RI
- $23 - $30 an hour
- Overtime
- Microsoft Excel
- Microsoft Outlook
- Customer service
Quick Apply
Sr. Audit Specialist
Blue Cross Blue Shield of Massachusetts —Hingham, MA
- $89,460 - $109,340 a year
- Full-time
- Microsoft Excel
- Office
- High school diploma or GED
- Health insurance
- Dental insurance
Claims Quality Control Auditor
Neighborhood Health Plan of Rhode Island —Smithfield, RI
- Full-time
- Microsoft Outlook
- Basic math
- Research
Quick Apply
3d
Surveillance Investigator
VRC Investigations —Providence, RI
- Clean driving record
- Military
- Computer literacy
- Profit sharing
- Paid training
Quick Apply
Senior Risk Manager: Payments
Citizens Financial Group —Johnston, RI
- $117,000 - $153,000 a year
- Full-time
- Background check
- 6 years
- Office
- Health insurance
- Dental insurance
Contract and Compliance Administrator
New England Life Care —Canton, MA
- $75,000 - $85,000 a year
- Full-time
- Microsoft Excel
- 5 years
- HIPAA
- Disability insurance
- Health insurance
Quick Apply
Rhode Island, Cranston Surveillance Investigator
Insight Service Group (ISG) —Cranston, RI
- $20 - $27 an hour
- Part-time
- Mid-level
- Analysis skills
- Driver's License
Quick Apply

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Investigator

UnitedHealthcare -
Warwick, RI

Apply Now

Job Details

Full-time
$49,700 - $88,800 a year

Qualifications

Microsoft Word
Spreadsheets
Driver's License

Full Job Description

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The Investigator is responsible for identification, investigation and prevention of healthcare fraud, waste, and abuse. The Investigator will utilize claims data, applicable guidelines, and other sources of information to identify aberrant billing practices and patterns. The Investigator is responsible for conducting investigations which may include field work to perform interviews and obtain records and/or other relevant documentation.

Office location: Warwick, RI

Hybrid role with expectation to work out of the Warwick, RI office approximately 3-4 times per week.

25-50% of expected travel within Rhode Island.

If you reside in the state of Rhode Island, you will have the flexibility to hybrid-remote* as you take on some tough challenges.

Primary Responsibilities:

Assess complaints of alleged misconduct received within the Company
Investigate low to medium complex cases of fraud, waste, and abuse
Detect fraudulent activity by members, providers, employees, and other parties against the Company
Develop and deploy the most effective and efficient investigative strategy for each investigation
Maintain accurate, current, and thorough case information in the Special Investigations Unit's (SIU's) case tracking system
Collect and secure documentation or evidence and prepare summaries of the findings
Participate in settlement negotiations and/or produce investigative materials in support of the latter
Collect, collate, analyze, and interpret data relating to fraud, waste, and abuse referrals
Ensure compliance of applicable federal/state regulations or contractual obligations
Report suspected fraud, waste, and abuse to appropriate federal or state government regulators
Comply with goals, policies, procedures, and strategic plans as delegated by SIU leadership
Collaborate with state/federal partners, at the discretion of SIU leadership, to include attendance at workgroups or regulatory meetings
Communicate effectively, including written and verbal forms of communication
Develop goals and objectives, track progress and adapt to changing priorities
Must participate in legal proceedings, arbitration, and depositions at the direction of management

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

Associate's degree or above
Intermediate level of proficiency in Microsoft Excel and Word
Reside within a commutable distance to Warwick, RI
Ability to travel up to 50%, access to reliable transportation, and & valid US driver's license

Preferred Qualifications:

Experience in health care fraud, waste and abuse (FWA) investigations/audit
Experience with state/federal laws and regulations pertaining to healthcare FWA
Experience in analyzing data to identify fraud, waste and abuse trends
Knowledge/training in healthcare FWA investigations
Active affiliations with the National Health Care Anti-Fraud Association (NHCAA)
Accredited Health Care Fraud Investigator (AHFI)
Certified Fraud Examiner (CFE)
Certified Professional Coder (CPC)
Medical Laboratory Technician (MLT)
- Statistical Analysis
All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $49,700 to $88,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO #YELLOW

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Refine Your Search

fraud jobs in raynham ma

Investigator

Private Investigator - Retired/Former Law Enforcement

Investigator II

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

Senior Investigator - Rhode Island

Surveillance Investigator

Customer Service or Alcohol Compliance Evaluator

Surveillance Investigator I - Entry Level

Surveillance Investigator II - Experienced

Product Manager, Fraud & Abuse

Retail Banking Compliance Manager, VP

Alcohol Compliance Evaluator

Investigator

Claims Investigator - Part Time

Sr. Audit Specialist

Claims Quality Control Auditor

Surveillance Investigator

Senior Risk Manager: Payments

Contract and Compliance Administrator

Rhode Island, Cranston Surveillance Investigator

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