Claims investigator [h1.location_city]
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Claims investigator • baltimore md
[last_updated.last_updated_variable_days]
Employment Type : Full-Time, Mid-Level.Department : Litigation Support.CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project in Nashville, TN.The...[show_more][last_updated.last_updated_30]
Step into a new opportunity as a Assistant Investigator Associate, where you will work with supervisors to meet daily goals, coordinate with other departments when needed, and support returns and e...[show_more][last_updated.last_updated_30]
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Looking for a company that treats associates with respect, understanding, and appreciation? Looking for a company that is passionate about teamwork and the growth of it's associates and communities...[show_more][last_updated.last_updated_variable_days]
Ethos Risk Services is a leading insurance claims investigation and medical management company, specializing in surveillance and fraud detection.
At the forefront, we provide accurate data and actio...[show_more][last_updated.last_updated_30]
The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers' compensation claims within delegated limited authority to best possible outcome, un...[show_more][last_updated.last_updated_30]
Becker & Company is seeking skilled and experienced Field Investigators to join our team on an "as needed" basis.This role is perfect for a licensed investigator looking for flexible ...[show_more][last_updated.last_updated_30]
CGS is seeking a Financial Investigator to join our team providing legal support and investigative services to a large federal agency.
CGS brings motivated, highly skilled, and creative people toget...[show_more][last_updated.last_updated_30]
Advance Your Career in Insurance Claims with Allied Universal Compliance and Investigation Services.Allied Universal Compliance and Investigation Services is the premier destination for a career in...[show_more][last_updated.last_updated_30]
Care Access is working to make the future of health better for all.With hundreds of research locations, mobile clinics, and clinicians across the globe, we bring world-class research and health ser...[show_more][last_updated.last_updated_variable_days]
Saks OFF 5TH is the premier luxury off-price destination.In its more than 100 stores in the U.Canada, and online, at SaksOFF5TH.
What This Position Is All About : .At Saks OFF 5TH, we are continuously...[show_more][last_updated.last_updated_variable_days]
Industry Operations Investigator.This position is an entry-level Industry Operations Investigator responsible for conducting investigations and inspections that require knowledge of industry operat...[show_more][last_updated.last_updated_30]
The main purpose of this position will be to conduct investigations of cases that are referred to the Office of the Chief Medical Examiner (OCME).
This position will conduct investigations to includ...[show_more][last_updated.last_updated_30])
We have an immediate opening in our home office located in Hanover, Maryland.This inside position is responsible for conducting liability and coverage investigations, bodily injury and property dam...[show_more][last_updated.last_updated_30]
The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers’ compensation claims within delegated limited authority to best possible outcome, un...[show_more][last_updated.last_updated_30]
MDH Office of the Chief Medical Examiner (OCME).The main purpose of this position will be to conduct investigations of cases that are referred to the Office of the Chief Medical Examiner (OCME).Thi...[show_more][last_updated.last_updated_variable_days]
CGS is seeking a Financial Investigator to join our team providing legal support and investigative services to a large federal agency.
CGS brings motivated, highly skilled, and creative people toget...[show_more][last_updated.last_updated_variable_days]
Seeking experienced Claims / SIU and / or Workers’ Comp.Investigators for Insurance Investigations that include Recorded Statements, Accident Scene, and Industrial / workplace accidents.We are seeking in...[show_more][last_updated.last_updated_variable_days]
Davies Claims North America seeks an experienced Claims Representative to manage claims related to MTA operations, including minor property damage and complex bodily injury.Reporting to the MTA Cla...[show_more][last_updated.last_updated_30]
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Healthcare Fraud Investigator
Contact Government Services, LLCBaltimore, MD, US[job_card.30_days_ago]
[job_preview.job_type]
- [job_card.full_time]
[job_card.job_description]Four (4) year undergraduate degree or higher in criminal justice, finance, project management, or other related field. Minimum three (3) years of professional work experience in healthcare, fraud, or other related investigative field of work. Proficiency in Microsoft Office applications including Outlook, Word, Excel, PowerPoint, etc. Proficiency in analyzing data that would assist in providing specific case support to the Government in civil HCF matters (E.g., Medicare data, Medicaid data, outlier data). Communication skills : Ability to interact professionally and effectively with all levels of staff including AUSAs, support staff, client agencies, debtors, debtor attorneys and their staff, court personnel, business executives, witnesses, and the public. Communication requires tact and diplomacy. U.S. Citizenship and ability to obtain adjudication for the requisite background investigation. Experience and expertise in performing the requisite services in Section 3. Must be a US Citizen. Must be able to obtain a favorably adjudicated Public Trust Clearance. Relevant Healthcare Fraud experience including compliance, auditing duties, and other duties in Section 3. Relevant experience working with a federal or state legal or law enforcement entity.
Job Description
Job Description
Healthcare Fraud Investigator
Employment Type : Full-Time, Mid-Level
Department : Litigation Support
CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project in Nashville, TN. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently, accurately, and under pressure, and be enthusiastic about learning and applying knowledge to provide excellent litigation support to the client.
CGS brings motivated, highly skilled, and creative people together to solve the government’s most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities.
Responsibilities will Include :
- Review, sort, and analyze data using computer software programs such as Microsoft Excel.
- Review financial records, complex legal and regulatory documents and summarize contents, and conduct research as needed. Preparing spreadsheets of financial transactions (e.g., check spreads, etc.).
- Develop HCF case referrals including, but not limited to :
- Ensure that HCF referrals meet agency and USAO standards for litigation.
- Analyze data for evidence of fraud, waste and abuse.
- Review and evaluate referrals to determine the need for additional information and evidence, and plan comprehensive approach to obtain this information and evidence.
- Advise the HCF attorney(s) regarding the merits and weaknesses of HCF referrals based upon applicable law, evidence of liability and damages, and potential defenses, and recommend for or against commencement of judicial proceedings.
- Assist the USAO develop new referrals by ensuring a good working relationship with client agencies and the public, and by assisting in HCF training for federal, state and local agencies, preparing informational literature, etc.
- Assist conducting witness interviews and preparing written summaries.
Qualifications :
Preferred qualifications :
#CJ
We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.