Healthcare Fraud Investigator Salary in South Dakota

Company : Highmark Inc. Job Description : JOB SUMMARY The incumbent is responsible for developing and maintaining an anti-fraud program which includes development and delivery of training and filing of Fraud Plans and Reports. The incumbent is responsible for conducting investigations of organizational or functional activities related to alleged fraud, waste and abuse perpetrated by providers, members, facilities, pharmacies, groups and/or employees of the organizations and Subsidiaries. The incumbent is responsible for interviews which might include providers and members and may be conducted onsite or offsite. The incumbent is also responsible for the field investigative work necessary to complete a review of a special project, potential fraud, waste and abuse case, conducting the initial investigations and coordinating the recovery/savings of money related to fraud, waste and abuse. Must be able to testify in a court of law, prepare cases for referral to various federal, state and lo

Company : Highmark Inc. Job Description : JOB SUMMARY The incumbent is responsible for developing and maintaining an anti-fraud program which includes development and delivery of training and filing of Fraud Plans and Reports. The incumbent is responsible for conducting investigations of organizational or functional activities related to alleged fraud, waste and abuse perpetrated by providers, members, facilities, pharmacies, groups and/or employees of the organizations and Subsidiaries. The incumbent is responsible for interviews which might include providers and members and may be conducted onsite or offsite. The incumbent is also responsible for the field investigative work necessary to complete a review of a special project, potential fraud, waste and abuse case, conducting the initial investigations and coordinating the recovery/savings of money related to fraud, waste and abuse. Must be able to testify in a court of law, prepare cases for referral to various federal, state and lo

Company : Highmark Inc. Job Description : JOB SUMMARY The incumbent is responsible for developing and maintaining an anti-fraud program which includes development and delivery of training and filing of Fraud Plans and Reports. The incumbent is responsible for conducting investigations of organizational or functional activities related to alleged fraud, waste and abuse perpetrated by providers, members, facilities, pharmacies, groups and/or employees of the organizations and Subsidiaries. The incumbent is responsible for interviews which might include providers and members and may be conducted onsite or offsite. The incumbent is also responsible for the field investigative work necessary to complete a review of a special project, potential fraud, waste and abuse case, conducting the initial investigations and coordinating the recovery/savings of money related to fraud, waste and abuse. Must be able to testify in a court of law, prepare cases for referral to various federal, state and lo

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Qualifications: •A minimum of a four-year college degree, either specifically in accounting, finance, economics, computer science with data analysis, applied statistics, or equivalent post-college work experience. •Excellent analytical, communication, and organizational skills. •The ability to function as an integral part of an investigative team and work in a group setting. •Knowledge of fundamental computer applications, such as Word, Excel, and Access. •Proficiency with presentation software, such as PowerPoint. Preferred Skills: •The ability to review financial records and advise or assist in the investigation of alleged fraud. •Designation as a Certified Fraud Examiner. •Experience with statistical sampling and/or advanced statistical training. •Knowledge of the healthcare industry and medical coding concepts (CPT, ICD-9 / 10, DRGs) and/or experience analyzing health care claims data. •A CPA is not required; but the position qualifies for CPA accreditation purposes. Duties Descrip

Job Description Job Description Fraud Investigator-Nassau, NY TruView Background Screening and Investigations, a New York based Investigations Company is seeking qualified individuals to work within a squad of investigators to investigate public assistance fraud in Nassau County. Individuals MUST meet the following criteria for consideration: Minimum of 2- 5 years of investigative field experience, which includes: • Minimum of 1 year of field Medicaid Fraud or related investigation experience • Minimum of 1-3 years of professional investigation experience with a law enforcement agency, including referral of investigations for criminal prosecution or civil hearings, and courtroom testimony. Additional experience in the following areas is a plus: • Professional investigation experience as a credentialed background investigator conducting personnel background investigations on behalf of the Federal Government. • An ability to perform background checks, document retrieval, and front-end-de