Fraud and Abuse Investigator / CPC - Remote
Sentara Workforce Solutions, LLC —Brownsville, WI
- $25.60 - $42.67 an hour
- Overtime
- Remote
- Mid-level
- Bachelor's degree
- 2 years
- 403(b) matching
- Paid parental leave
Quick Apply
3d
Senior Compliance Investigator
Centene —Wisconsin
- $70,100 - $126,200 a year
- Full-time
- Remote
- Writing skills
- High school diploma or GED
- Fair chance
- Paid holidays
- Health insurance
13d
Investigator, Special Investigations Unit (Meritain Health)
CVS Health —Madison, WI
- $46,988 - $122,400 a year
- Full-time
- Customer service
- Research
- Mid-level
- Health insurance
- Dental insurance
Regulatory Coordinator
University of Wisconsin–Madison —Madison, WI
- $60,000 a year
- Full-time
- Hybrid work
- Writing skills
- Mid-level
- Analysis skills
- Retirement plan
11d
Consumer Protection Investigator Advanced - Real Estate Appraisals (Project Position)
State of Wisconsin - Safety & Professional Services —Madison, WI
- $29.88 an hour
- Temporary
- Office
- Analysis skills
- Criminal background check
- Wellness program
- Paid holidays
Surveillance Agent
Marshall Investigative Group —Milwaukee, WI
- $22 - $32 an hour
- Part-time
- Microsoft Word
- 11+ years
- Research
Quick Apply
Private Investigator
DigiStream Investigations, Inc. —Waukesha, WI
- $18 an hour
- Overtime
- Background check
- High school diploma or GED
- 21 years or older
- Travel reimbursement
- Paid training
2d
Account Management / Skip Trace Investigator / Collector / Repo Coordinator
AMI Asset Management, Inc —Mukwonago, WI
- From $17 an hour
- Full-time
- Public speaking
- High school diploma or GED
- Analysis skills
- Health insurance
- 401(k)
Quick Apply
17h
Agent
Pinkerton —Milwaukee, WI
- Part-time
- Military
- Computer literacy
- Mid-level
Private Investigator
DigiStream Investigations, Inc. —Kenosha, WI
- $18 an hour
- Overtime
- Background check
- High school diploma or GED
- 21 years or older
- Travel reimbursement
- Paid training
2d
Surveillance Investigator
Allied Universal® Compliance and Investigations —La Crosse, WI
- Weekends as needed
- Microsoft Word
- Military
- Mid-level
- AD&D insurance
- Paid holidays
Quick Apply
14d
Private Investigator
DigiStream Investigations, Inc. —Milwaukee, WI
- $18 an hour
- Overtime
- Background check
- High school diploma or GED
- 21 years or older
- Travel reimbursement
- Paid training
2d
Surveillance Investigator - Part Time
Allied Universal® Compliance and Investigations —Madison, WI
- Part-time
- Microsoft Word
- Military
- Mid-level
- AD&D insurance
- Paid holidays
Quick Apply
14d
Private Investigator
DigiStream Investigations, Inc. —Racine, WI
- $18 an hour
- Overtime
- Background check
- High school diploma or GED
- 21 years or older
- Travel reimbursement
- Paid training
2d
Contract Investigative Technician
ADC LTD NM —Wisconsin
- Contract
- Mid-level
Quick Apply
Research Program Coordinator
University of Wisconsin–Madison —Madison, WI
- $80,000 a year
- Full-time
- Hybrid work
- Mid-level
- University
- Bachelor's degree
- Retirement plan
6d
Surveillance Investigator
Digistream Investigations —Wisconsin
- $18 an hour
- Overtime
- Remote
- Background check
- 21 years or older
- Travel
- Travel reimbursement
- Health insurance
Quick Apply
Advocacy Specialist-Investigator
Disability Rights Wisconsin —Milwaukee, WI
- $52,020 - $64,826 a year
- Full-time
- Microsoft Outlook
- Experience working with individuals with disabilities
- Writing skills
- Disability insurance
- Dental insurance
Quick Apply
LAS Operations Training Specialist
Abbott Laboratories —Madison, WI
- $61,300 - $122,700 a year
- Full-time
- Senior level
- Associate's degree
- Medical terminology
3d
Worker's Compensation Compliance Investigator
State of Wisconsin - Workforce Development —Madison, WI
- $28.10 an hour
- Online Application
- Background check
- Office
- Analysis skills
- Paid holidays
- Health insurance
12d

I want to receive the latest job alert for investigator in wisconsin

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

investigator jobs near wisconsin

Health Unit Coordinator jobs in Madison, WI

Training Specialist jobs in Madison, WI

Real Estate Appraiser jobs in Madison, WI

Surveillance Investigator jobs in Wisconsin

Patient Advocate jobs in Milwaukee, WI

Private Investigator jobs in Milwaukee, WI

Unit Secretary Night jobs in Georgia

Health Unit Coordinator jobs in Medina, OH

Health Unit Coordinator jobs in Pittsburgh, PA

Health Unit Coordinator jobs in Milwaukee, WI

Health Unit Coordinator jobs in Pittsfield, MA

Health Unit Coordinator jobs in Toledo, OH

Account Manager jobs in Harrisburg, PA

Account Manager jobs in Georgia

Account Manager jobs in Peoria, IL

Account Manager jobs in Akron, OH

Healthcare Operations Manager jobs in Houston, TX

Fp&a Manager jobs in New Jersey

Surveillance Investigator jobs in Atlanta, GA

Insurance Fraud Investigator jobs in Florida

Fraud and Abuse Investigator / CPC - Remote

Sentara Workforce Solutions, LLC
Brownsville, WI

Quick Apply

Job Details

Full-time
$25.60 - $42.67 an hour
3 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

investigator jobs in wisconsin

Fraud and Abuse Investigator / CPC - Remote

Senior Compliance Investigator

Investigator, Special Investigations Unit (Meritain Health)

Regulatory Coordinator

Consumer Protection Investigator Advanced - Real Estate Appraisals (Project Position)

Surveillance Agent

Private Investigator

Account Management / Skip Trace Investigator / Collector / Repo Coordinator

Agent

Private Investigator

Surveillance Investigator

Private Investigator

Surveillance Investigator - Part Time

Private Investigator

Contract Investigative Technician

Research Program Coordinator

Surveillance Investigator

Advocacy Specialist-Investigator

LAS Operations Training Specialist

Worker's Compensation Compliance Investigator

I want to receive the latest job alert for investigator in wisconsin

Related Searches

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