Top 38 Fraud prevention Jobs in Saint Petersburg Fl

Special Investigation Unit (SIU) Lead/Investigator (Medicare Advantage Plan)
Ultimate Health Plans —Tampa, FL
- From $75,000 a year
- Full-time
- Anatomy knowledge
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
Threat Finance SME
Cherokee Federal —Tampa, FL
- Full-time
- 5 years
- Bachelor of Science
- Finance
- Health insurance
- Dental insurance
Special Agent: Military/Law Enforcement Expertise
Federal Bureau of Investigation —Tampa, FL
- $103,326 - $133,200 a year
- Full-time
- Military
- Mid-level
- Bachelor's degree
Fraud Analyst I
GTE Financial —Tampa, FL
- Full-time
- Hybrid work
- Writing skills
- Office
- High school diploma or GED
1d
Premium Auditor
ARMStrong Insurance Services —Clearwater, FL
- $44 - $50 an hour
- Full-time
- Remote
- Microsoft Word
- Mid-level
- Analysis skills
- Paid holidays
- Health insurance
Quick Apply
SVP, Investigations and Recovery
Bank OZK —Clearwater, FL
- Extended hours
- Microsoft Excel
- Microsoft Outlook
- Writing skills
- Dental insurance
- Paid time off
USA Manager I, Asset Protection - All DC/FC
Walmart —Tampa, FL
- $73,500 - $106,500 a year
- High school
- Mid-level
- Continuous improvement
- Paid jury duty
- Disability insurance
Citi Security and Investigative Services (CSIS) Senior Investigator- AVP
Citi —Tampa, FL
- $87,360 - $131,040 a year
- Weekends as needed
- Hybrid work
- Microsoft Outlook
- CPA
- 5 years
- Paid holidays
- Disability insurance
1d
VP, Fraud Prevention Manager
Bank OZK —Clearwater, FL
- Extended hours
- Microsoft Excel
- Microsoft Outlook
- Writing skills
- Dental insurance
- Paid time off
Deputy BSA/AML Compliance Officer
Sutton Bank —Tampa, FL
- Full-time
- Writing skills
- Data analysis skills
- Office
- Disability insurance
- Health insurance
Quick Apply
5d
68064379 - MEDICAL HEALTH CARE PROGRAM ANALYST
The State of Florida —Tampa, FL
- $3,666.78 a month
- Monday to Friday
- Microsoft Word
- Background check
- Microsoft Excel
- Paid holidays
- Health insurance
4d
Fraud Analyst-Bilingual in English/Portuguese
JPMorganChase —Tampa, FL
- Full-time
- Writing skills
- English
- Research
- Health insurance
- Tuition reimbursement
10d
Market Activation & Narrative Operator
Sabhi —Tampa, FL
- $24.84 - $35.00 an hour
- Full-time
- Hybrid work
- 7 years
- Mid-level
- Office
- Paid time off
Quick Apply
Cybersecurity Engineer Principal
General Dynamics Information Technology —Tampa, FL
- $129,813 - $172,500 a year
- System design
- HIPAA
- 8 years
Assistant Vice President, Information Security
University of Tampa —Tampa, FL
- Online Application
- Background check
- 7 years
- Computer Science
- Free parking
- Disability insurance
8d
Security Center Operator - Bealls FL
Bealls Inc —Bradenton, FL
- $18 an hour
- Full-time
- Office
- High school diploma or GED
- Typing
Quick Apply
Store Protection Specialist
Ross Stores —Tampa, FL
- Background check
- Supervising experience
- Conflict management
Corporate Vice President, Data Scientist - Advanced Analytics
New York Life —Tampa, FL
- $130,000 - $170,000 a year
- Hybrid work
- Computer Science
- 5 years
- Continuous improvement
- Loan repayment program
- Adoption assistance
Lead Teller
PNC Financial Services Group —Saint Petersburg, FL
- Full-time
- Mid-level
- Office
- Team management
- Wellness program
- Health savings account
SBA Business Development Officer
Climate First Bank —Saint Petersburg, FL
- Full-time
- Remote
- Data analysis skills
- Office
- Residential
- Health savings account
- Disability insurance
Quick Apply

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fraud prevention jobs near saint petersburg fl

Special Investigation Unit (SIU) Lead/Investigator (Medicare Advantage Plan)

Ultimate Health Plans -
Tampa, FL

Quick Apply

Job Details

Full-time
From $75,000 a year

Benefits

Health insurance
Dental insurance
401(k)
Vision insurance
401(k) matching

Qualifications

Healthcare financial misconduct investigations
Customer communication
Anatomy knowledge
Microsoft Excel
Investigations regulatory compliance
Microsoft Outlook
Medicare
Managed care
Customer service
Managed care organization experience
Writing skills
Health insurance policy knowledge
Presentations for conferences or internal meetings
Investigative data analysis
Driver's License
Insurance regulation
Healthcare regulatory compliance research
Medicare regulations
Risk management
SharePoint
Medicaid regulations
Medicaid
Healthcare claims compliance audits
Research findings presentation
Medical terminology
Professional development training

Full Job Description

Company Overview

CSTS Customer Service and Technology Solutions LLC is a dedicated third-party administrator specializing in managing the administrative and operational functions for insurance plans. Our mission is to revolutionize the healthcare experience by delivering exceptional products and services to our partners, ensuring compliance and efficiency at every step.

Position Overview

CSTS is seeking an experienced and highly The SIU Lead/Investigator is responsible for supporting the prevention, detection, investigation, reporting (when appropriate), and recovery of money related to health care Fraud, Waste, and Abuse (FWA). The SIU Lead is accountable for managing the day-to-day SIU activities. This position will ensure compliance with federal and state guidance related to FWA, and for reviewing and analyzing information to draw conclusions on allegations of FWA and/or may determine appropriateness of care.

Job Duties

Responsible for developing leads presented to the SIU to assess and determine whether potential FWA is corroborated by evidence.
Claims review for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims.
Lead investigation caseloads, document all case files appropriately to meet regulatory guidelines. Completing investigations within the mandated period of time required by state and/or federal contracts and/or regulations.
Communicate orally and in writing with all customers, internal and external, regarding findings.
Prepare reports to document findings and maintain up-to-date case files for management review.
Collaborate with other departments within UHP and outside vendors to ensure the success of the UHP SIU program.
Provide inter-departmental input regarding controls for preventing and monitoring FWA issues.
Develop strategies to create and maintain a FWA Unit that has the flexibility, knowledge, situational awareness, and capacity to successfully address the dynamic FWA environment.
Provide recommendations or intervention strategies to correct and/or prevent abusive practices, including proposals to recover inappropriately paid monies or to suspend or terminate program participation.
Lead the development and delivery of educational awareness and training programs for the organization and providers.
Maintain outcome-focused SIU Policies & Procedures that are consistent with all applicable contractual and regulatory requirements.
Develop and maintain a high degree of rapport and cooperation with the Federal, State, and local law enforcement and regulatory agencies which can assist in investigative efforts.
Prepares appropriate FWA referrals to regulatory agencies and law enforcement.
Present provider review findings to internal and external entities as requested.
Other duties as assigned

Job Qualifications

Required Education

Bachelor’s degree or associate degree, in criminal justice or equivalent combination of education and experience.

Required Experience/Knowledge, Skills & Abilities

1-3 years of Medicare managed care compliance and/or investigation experience, unless otherwise required by state contract.
Proven investigatory skill; ability to organize, analyze, and effectively determine risk with corresponding solutions; ability to remain objective and separate facts from opinions.
Knowledge of Managed Care and the Medicaid and Medicare programs.
Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems.
Understanding of datamining and use of data analytics to detect fraud, waste, and abuse.
Proven ability to research and interpret regulatory requirements.
Effective interpersonal skills and customer service focus; ability to interact with individuals at all levels.
Excellent oral and written communication skills; presentation skills with ability to create and deliver training, informational and other types of programs.
Excellent skills in Microsoft Office (Word, Excel, PowerPoint, Outlook), SharePoint and Intra/Internet as well as proficiency with incorporating/merging documents from various applications.
Strong logical, analytical, critical thinking and problem-solving skills.
Initiative, excellent follow-through, persistence in locating and securing needed information.
Fundamental understanding of audits and corrective actions.
Detail-oriented, self-motivated, able to meet tight deadlines.
Ability to develop realistic, motivating goals and objectives, track progress and adapt to changing priorities.
Collaborative and team-oriented

Required License, Certification, Association:

Valid driver’s license required.

Preferred Experience:

At least 5 years of experience in FWA and/or compliance in Medicare managed care organizations is required.

Preferred License, Certification, Association:

Health Care Anti-Fraud Associate (HCAFA)
Accredited Health Care Fraud Investigator (AHFI)
Certified Fraud Examiner (CFE)

CSTS is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Pay: From $75,000.00 per year

Benefits:

401(k)
401(k) matching
Dental insurance
Health insurance
Vision insurance

Application Question(s):

How many years of Medicare Advantage experience do you have?
Can you describe your experience with Medicare or Medicaid fraud and waste investigations?
How do you prioritize and manage your workload when dealing with multiple fraud cases at once?

Work Location: In person

Quick Apply

Refine Your Search

fraud prevention jobs in saint petersburg fl

Special Investigation Unit (SIU) Lead/Investigator (Medicare Advantage Plan)

Threat Finance SME

Special Agent: Military/Law Enforcement Expertise

Fraud Analyst I

Premium Auditor

SVP, Investigations and Recovery

USA Manager I, Asset Protection - All DC/FC

Citi Security and Investigative Services (CSIS) Senior Investigator- AVP

VP, Fraud Prevention Manager

Deputy BSA/AML Compliance Officer

68064379 - MEDICAL HEALTH CARE PROGRAM ANALYST

Fraud Analyst-Bilingual in English/Portuguese

Market Activation & Narrative Operator

Cybersecurity Engineer Principal

Assistant Vice President, Information Security

Security Center Operator - Bealls FL

Store Protection Specialist

Corporate Vice President, Data Scientist - Advanced Analytics

Lead Teller

SBA Business Development Officer

I want to receive the latest job alert for fraud prevention in saint petersburg fl

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