Investigate suspected incidents of healthcare fraud, waste, or abuse through data analysis and interviews.
Analyze information, report findings, and recommend settlements or denials while supporting legal proceedings.
Conduct training on fraud detection and maintain knowledge of relevant laws and regulations.
Cotiviti is a healthcare analytics company that helps clients reduce costs and improve outcomes through data-driven insights. As a global leader in payment accuracy and network performance, Cotiviti fosters a collaborative and inclusive culture.
Identify fraud, waste, and abuse patterns in Medicaid home and community-based care data.
Translate findings into scalable detection capabilities embedded within the HHAeXchange platform.
Collaborate with product, engineering, and customer teams to ensure detection logic is operationally sound and actionable.
HHAeXchange is a leading technology platform for home and community-based care, providing an end-to-end homecare solution for aging or disabled individuals. Founded in 2008, the company employs passionate professionals transforming healthcare by connecting patients, providers, managed care organizations, and states.
Evaluate SIU referrals to identify suspicious fraud indicators and create investigative plans.
Conduct data analysis and manage vendor assignments while collaborating with law enforcement.
Prepare detailed investigative reports and referrals to NICB and Departments of Insurance.
Core Specialty is a multi-state commercial insurance carrier offering property and casualty insurance for small to mid-sized businesses. The company has underwriting offices across the U.S. and emphasizes niche markets and local distribution.
Conduct investigations of high-risk or potential fraud activity, including platform abuse and suspicious financial movement patterns.
Use an investigative, data-driven approach to analyze cases and make fair, compliant, and risk-mitigated determinations.
Leverage tools such as Excel, Google Sheets, Snowflake, SQL, and Tableau to uncover fraud patterns and communicate findings to stakeholders.
Clair is a digital banking platform that gives America's workers instant access to their earned wages by embedding financial products into payroll and workforce management apps. The company is a fintech startup with a focus on financial freedom for hourly workers.
Oversee internal and external staff conducting fraud and complaint investigations, including training, monitoring, and management.
Gather and analyze evidence using investigative techniques to uncover fraudulent schemes and identify responsible parties.
Collaborate with stakeholders to develop risk-based prevention strategies and controls to safeguard company assets.
Forbright is a nationwide full-service bank and commercial lender focused on building a brighter future for clients and communities. We are a dynamic, high-energy, and fast-paced organization with a culture of collaboration, inclusion, flexibility, and giving back.
Monitor and interpret CMS guidance for Medicare, Medicaid, and other healthcare programs.
Partner with internal teams to ensure compliance with regulations and contract obligations.
Maintain regulatory tracking documentation and support development of training materials.
HealthEdge provides healthcare software and services to payers and providers. It is a growing company with a focus on compliance and innovation, fostering a collaborative and remote-friendly culture.
Investigate and analyze suspected fraud cases affecting Veriff’s customers.
Develop new countermeasures and strategies to address emerging fraud patterns while minimizing false positives.
Collaborate with cross-functional teams to improve fraud detection processes and ensure product readiness.
Veriff is a global identity verification platform that helps businesses verify and safeguard users online. The company is backed by investors including Accel, Alkeon, IVP, Tiger Capital, and Y Combinator, has offices in the US, UK, Spain, and Estonia, and is dedicated to being a benchmark for trust online.
Support implementation and operation of the Compliance Program, including conflict of interest, compliance hotline, and regulatory reviews.
Serve as liaison for compliance questions and incidents, and recommend corrective actions and education opportunities.
Work with all levels to ensure internal controls provide accurate, complete, and compliant processes.
Cooper University Health Care is a healthcare organization dedicated to providing extraordinary health care and fostering clinical innovation. It offers competitive compensation, comprehensive benefits, and opportunities for professional growth.