Fraud and Abuse Investigator / CPC - Remote
Sentara Workforce Solutions, LLC —Virginia Beach, VA
- $25.60 - $42.67 an hour
- Overtime
- Remote
- Mid-level
- Bachelor's degree
- 2 years
- 403(b) matching
- Paid parental leave
Quick Apply
7h
Benefits Program Worker II - Fraud
City of Chesapeake —Chesapeake, VA
- $50,607 a year
- Overtime
- Customer service
- Mid-level
- Office
13d
Asset Protection Investigation Analyst
Family Dollar —Chesapeake, VA
- $63,000 - $75,000 a year
- Full-time
- Mid-level
- Office
- Analysis skills
2d
Part Time SIU Investigator
The Robison Group —Virginia Beach, VA
- $30 - $35 an hour
- Part-time
- Background check
- 5 years
- Computer literacy
Quick Apply
Director, Compliance
Childrens Hospital of The Kings Daughters —Norfolk, VA
- $77.18 an hour
- Full-time
- CPA
- HIPAA
- Office
6d
Benefit Programs Specialist II - Fraud
550-Chesapeake Bureau Of Social Services —Chesapeake, VA
- $50,607 a year
- Full-time
- Mid-level
- Office
- Driver's License
6d
Virginia, Chesapeake SIU Investigator PT
Insight Service Group (ISG) —Chesapeake, VA
- $20 - $27 an hour
- Part-time
- Mid-level
- Driver's License
- Travel
Quick Apply
Adjunct Faculty - Fraud & Forensic Accounting
Regent University —Virginia Beach, VA
- Up to $100 an hour
- Part-time
- 18 years or older
- Doctoral degree
- CPA
Licensed Covert Surveillance Investigator - Part Time - Virginia Beach, VA
Meridian Investigative Group, Inc —Virginia Beach, VA
- $20 - $30 an hour
- Extended hours
- Microsoft Word
- Computer literacy
- Writing skills
Manager - Internal Audit
Family Dollar —Chesapeake, VA
- $111,000 - $133,000 a year
- Full-time
- CPA
- 5 years
- Office
DTVB Night Audit
HARMONY HOSPITALITY INC —Virginia Beach, VA
- $17 an hour
- Mid-level
- Hotel
- Front desk
Quick Apply
Loss Prevention Investigator
All Star Elite, LLC —Virginia Beach, VA
- $18 - $20 an hour
- Full-time
- Mid-level
- High school diploma or GED
- Associate's degree
Quick Apply
Title IV Compliance Officer
Hampton University —Hampton, VA
- $50,000 - $55,000 a year
- Full-time
- Mid-level
- Office
- 3 years
- Disability insurance
- Dental insurance
Senior Auditor / Accountant (N)
SimIS Inc. —Norfolk, VA
- Full-time
- 6 years
- Bachelor of Science
- Office
- Paid holidays
- Disability insurance
Quick Apply
Night Auditor - Hilton Norfolk The Main
Professional Hospitality Resources, Inc. and Ocean Beach Club LLC —Norfolk, VA
- Microsoft Word
- Basic math
- Mid-level
13d
Marketing Manager, Identity & Fraud Product Owner
Altria —United States
- $119,600 - $173,450 a year
- Full-time
- 7 years
- Marketing
- Office
- Profit sharing
- Paid parental leave
7d

More jobs to discover

Find similar jobs that you might be interested in.

Benefits Program Worker II - Fraud
City of Chesapeake —Chesapeake, VA
SPECIAL CERTIFICATIONS AND LICENSES: Depending on departmental operational requirements, may require valid driver’s license and driving record in compliance…
$50,607 a year
13d
Benefit Programs Specialist II
830-Williamsburg Dept Of Social Services —Williamsburg, VA
Valid Virginia driver’s license. Knowledge and understanding of local government, economic and basic human behavior issues, and financial assistance programs at…
$50,242 - $58,860 a year
5d

Show more similar jobs

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Business Process Red Team Operator
JPMorganChase —Columbus, OH
Conduct business process assessments to include tabletop or workshop sessions, live testing of business process controls by technical and social engineering…
$156,750 - $260,000 a year
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
7h

Show more jobs in cities nearby

I want to receive the latest job alert for fraud in virginia beach, va

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 jobs near virginia beach, va

Fraud and Abuse Investigator / CPC - Remote

Sentara Workforce Solutions, LLC
Virginia Beach, VA

Quick Apply

Job Details

Full-time
$25.60 - $42.67 an hour
7 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

fraud jobs in virginia beach, va

Fraud and Abuse Investigator / CPC - Remote

Benefits Program Worker II - Fraud

Asset Protection Investigation Analyst

Part Time SIU Investigator

Director, Compliance

Benefit Programs Specialist II - Fraud

Virginia, Chesapeake SIU Investigator PT

Adjunct Faculty - Fraud & Forensic Accounting

Licensed Covert Surveillance Investigator - Part Time - Virginia Beach, VA

Manager - Internal Audit

DTVB Night Audit

Loss Prevention Investigator

Title IV Compliance Officer

Senior Auditor / Accountant (N)

Night Auditor - Hilton Norfolk The Main

Marketing Manager, Identity & Fraud Product Owner

More jobs to discover

Explore jobs in cities nearby

I want to receive the latest job alert for fraud in virginia beach, va

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