Fraud and Abuse Investigator / CPC - Remote
Sentara Workforce Solutions, LLC —Lehi, UT
- $25.60 - $42.67 an hour
- Overtime
- Remote
- Mid-level
- Bachelor's degree
- 2 years
- 403(b) matching
- Paid parental leave
Quick Apply
4d
Investigator, Special Investigations Unit (Meritain Health)
CVS Health —Salt Lake City, UT
- $46,988 - $122,400 a year
- Full-time
- Customer service
- Research
- Mid-level
- Health insurance
- Dental insurance
Field Investigator (Full-Time & Part-Time) – Salt Lake, UT
Origin Investigations Inc —Salt Lake City, UT
- $20 - $35 an hour
- Part-time
- Background check
- Military
- High school diploma or GED
Quick Apply
BSA Investigations Analyst II
STRIDE BANK NA —Salt Lake City, UT
- Full-time
- Research
- Mid-level
- Office
12d
BSA/AML Investigator - UT, AZ, NV (In Office)
Zions Bancorporation —Midvale, UT
- $52,878 - $77,550 a year
- Full-time
- Microsoft Word
- Research
- Mid-level
- Profit sharing
- Paid training
BSA Compliance Manager
Mountain America Credit Union —Sandy, UT
- Full-time
- Hybrid work
- 7 years
- Writing skills
- Office
Special Investigations Unit (SIU) Investigator II or III DOE
Cambia Health Solutions —Salt Lake City, UT
- $54,000 - $97,000 a year
- Full-time
- Hybrid work
- Background check
- Mid-level
- Office
- Health savings account
- Paid holidays
Financial Intelligence and Investigations Manager
Workman Forensics —South Jordan, UT
- $120,000 - $150,000 a year
- Full-time
- Background check
- CPA
- Office
Quick Apply
6d
Surveillance Investigator II - Experienced
Command Investigations, LLC —Salt Lake City, UT
- $25 - $30 an hour
- 8 hour shift
- Microsoft Word
- Clean driving record
- Customer service
- Health insurance
- Dental insurance
Quick Apply
Director of Financial Intelligence & Investigations
Workman Forensics —South Jordan, UT
- $240,000 - $300,000 a year
- Full-time
- CPA
- Office
- Supervising experience
Quick Apply
Residential Cleaning Lead Investigator
The GreenClean Effect —Salt Lake City, UT
- $25 an hour
- Contract
- Spanish
- English
- Mid-level
Quick Apply
3d

More jobs to discover

Find similar jobs that you might be interested in.

Investigator, Special Investigations Unit (Meritain Health)
CVS Health —Salt Lake City, UT
The SIU Investigator will conduct investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover…
$46,988 - $122,400 a year

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Surveillance Investigator II
Command Investigations, LLC —Columbus, OH
Valid driver’s license with clean DMV record. In this role, you will conduct field surveillance investigations by observing, tracking, and documenting subjects’…
$25 - $30 an hour
Quick Apply
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
4d

I want to receive the latest job alert for fraud investigation in sandy ut

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

fraud investigation jobs near sandy ut

Health Unit Coordinator jobs in Salt Lake City, UT

Siu Investigator jobs in Salt Lake City, UT

Cleaning Technician jobs in Salt Lake City, UT

Field Investigator jobs in Salt Lake City, UT

Surveillance Investigator jobs in Salt Lake City, UT

Bsa Analyst jobs in Salt Lake City, UT

Unit Secretary jobs in Indianapolis, IN

Health Information Management Manager jobs in New York, NY

Franciscan Health jobs in Michigan City, IN

Health Unit Coordinator jobs in Clermont, FL

Oil & Gas Operations Coordinator jobs in Houston, TX

Health Unit Coordinator jobs in Orlando, FL

Health Unit Coordinator jobs in League City, TX

Health Unit Coordinator jobs in Saint Paul, MN

Siu Investigator jobs in Anywhere

Siu Investigator jobs in San Jose, CA

Siu Investigator jobs in Phoenix, AZ

Investigator jobs in Tennessee

Siu Investigator jobs in Mount Airy, NC

Crime Scene Investigator jobs in New York State

Fraud and Abuse Investigator / CPC - Remote

Sentara Workforce Solutions, LLC
Lehi, UT

Quick Apply

Job Details

Full-time
$25.60 - $42.67 an hour
4 days 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

fraud investigation jobs in sandy ut

Fraud and Abuse Investigator / CPC - Remote

Investigator, Special Investigations Unit (Meritain Health)

Field Investigator (Full-Time & Part-Time) – Salt Lake, UT

BSA Investigations Analyst II

BSA/AML Investigator - UT, AZ, NV (In Office)

BSA Compliance Manager

Special Investigations Unit (SIU) Investigator II or III DOE

Financial Intelligence and Investigations Manager

Surveillance Investigator II - Experienced

Director of Financial Intelligence & Investigations

Residential Cleaning Lead Investigator

More jobs to discover

Explore jobs in cities nearby

I want to receive the latest job alert for fraud investigation in sandy ut

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