Conduct fraud, waste, and abuse investigations and audits.
Prepare reports and correspondence of a confidential nature.
Assist in developing FWA program documentation and training.
CareOregon is a nonprofit, mission-driven health plan focused on providing care to low-income Oregonians. They offer a comprehensive benefits package and emphasize equity, diversity, and inclusion.
Coordinate national Medicaid program planning, governance, implementation milestones, and status reporting across participating U.S. offices.
Support readiness assessments, office onboarding, go-live preparation, and expansion planning for consistent Medicaid program implementation.
Maintain program dashboards, KPIs, and track risks, issues, and performance to support long-term sustainability and continuous improvement.
World Relief is a global Christian humanitarian organization that responds to humanitarian crises and partners with local churches to build thriving communities. Founded after WWII, the organization has operated for 80 years across 100 countries and is rapidly expanding its team to meet increasing global needs.
Perform audits of enrollment, disenrollment, eligibility, and plan/PCP change transactions for health plan enrollment associates.
Review enrollment (834) file transactions and coordinate with state systems to confirm member effective dates and eligibility.
Collate, compile, and report QA performance to management and individuals, providing feedback for improvement.
HealthEdge provides AI-powered operational infrastructure for health insurance companies. UST HealthProof has a global workforce of over 4,000 people built on a foundation of simplicity, integrity, people-centricity, and leadership.
Interpret federal and state regulations to ensure compliance and drive process improvements.
Analyze data in Excel to identify trends, savings, and process improvements.
SIHO Insurance Services provides health insurance administration and related services, focusing on payment integrity and regulatory compliance. The company operates in a managed care environment and emphasizes collaboration, professionalism, and adaptability among its employees.
Conduct clinical audits for suspected fraud, waste, and abuse with high autonomy.
Document findings in formal reports, graphs, and audit logs, aligning with unit goals.
Develop and present FWA-related education to Oscar teams, ensuring compliance with regulations.
Oscar is a health insurance company built on a full stack technology platform, focused on serving members like a doctor in the family. Founded in 2012, it is a forward-thinking company that values diversity and innovation, with a culture of fostering belonging and support.
Independently manage Medicare, Medicaid, and TriCare cost reports and coordinate audits.
Lead the annual cost report peer-review process and manage provider appeals.
Collaborate with internal stakeholders and external reimbursement organizations to ensure compliance.
They are a large health system providing patient-focused healthcare services. The organization is collaborative and mission-driven, with a focus on financial sustainability.
Facilitate discovery and requirements sessions with Medicaid, business, technical, and vendor stakeholders.
Analyze provider enrollment processes and translate complex needs into detailed user stories, process flows, and acceptance criteria.
Support Agile delivery, testing, and requirements traceability across system integrations and portals.
They support a major Medicaid provider enrollment modernization initiative focused on improving digital experiences, workflows, integrations, and data quality. The environment is highly collaborative and Agile, with a family-oriented culture and emphasis on work-life balance.
Translate regulatory and financial reporting requirements into report logic and data definitions.
Develop, maintain, and update compliance reports for state filings, audits, and other obligations.
Investigate reporting discrepancies, isolate root causes, and drive remediation with engineering and finance.
Kin makes homeowners insurance and related products simpler and more affordable using data, technology, and human support. Founded in 2016, Kin is a remote-first employer with over 35 states and has been recognized as a Best Place to Work and a Great Place to Work.
Oversee the administration, compliance, and audit readiness of the 340B Drug Pricing Program for assigned Covered Entity clients.
Serve as the primary compliance resource, conducting routine reviews, internal audits, and operational assessments to identify risks.
Collaborate with clients, internal teams, and third-party administrators to ensure compliant and effective program operations.
NuvemRx helps community health providers simplify pharmacy operations with a suite of scalable solutions integrating software, intelligence, and expert support. We are a fast-growing, mission-driven team that values integrity, collaboration, and a bias toward action.
Lead documentation excellence by conducting evaluations and identifying opportunities for improvement.
Collaborate with physicians and clinical staff to enhance coding accuracy and compliance.
Drive data-driven decisions and mentor remote teams to optimize revenue integrity.
Henry Ford Health is a leading academic health system committed to advancing health and improving lives across Michigan. With 12 hospitals and hundreds of care locations, we empower team members to grow and make a meaningful difference.
Plan, analyze, and evaluate OCI interoperability programs and operations, such as VHIE and exchange partner management.
Use qualitative and quantitative methods to assess program performance, including exchange volume, ticket resolution, and partner onboarding.
Support outcome measurement, risk mitigation, and process improvement recommendations for VA health information exchange.
Aptive partners with federal agencies to improve performance, streamline operations, and enhance service delivery. Founded in 2012, the company has over 300 employees nationwide and focuses on technology, creativity, and human-centered services.
Develop and execute comprehensive Asset Protection programs to reduce shrink and enhance safety across the Midwest and Canada.
Leverage AI, data analysis, and emerging technologies to identify theft, fraud, and operational risks with proactive strategies.
Build strong partnerships with retail operations, district leadership, and law enforcement to support brand expansion and protect assets.
Alo is a mindful movement company dedicated to yoga and activewear, inspired by the studio-to-street lifestyle. It is a growing brand with a culture of integrity, accountability, and innovation.
Support program planning, tracking, and reporting for VA clinical informatics programs, keeping schedules, metrics, risks, and deliverables organized.
Maintain integrated schedules, track deliverables against due dates, and prepare biweekly sprint reports and status updates in Jira.
Manage risk and issue logs, support EHR issue management, patient safety monitoring, and informatics workforce program tracking.
Aptive is a professional services firm supporting federal health care programs, including the Department of Veterans Affairs' Office of Clinical Informatics. The company works within Scaled Agile Framework to help delivery teams stay focused and keep program operations running smoothly.
Own claims adjudication, denials management, and EDI workflows to ensure accurate payment and compliance.
Build reporting dashboards and KPIs to track claims performance and drive process improvements.
Collaborate with prior auth, finance, and client teams to close the loop between authorization and payment.
OneImaging is a concierge radiology service that connects patients with a network of over 5,000 vetted providers across 48 states, reducing imaging costs by 60-80%. We are a high-growth company building the infrastructure for fair and transparent medical imaging, with a focus on employer and payer ROI.
Analyze fraud risk trends across programs using enrollment, payment, and survey data.
Design and maintain fraud-risk indicators and collaborate with data engineering and product teams.
Translate findings into clear recommendations for stakeholders and support fraud investigations.
GiveDirectly delivers cash transfers directly to people living in poverty across 15 countries. The organization is one of Time100's Most Influential Companies of 2026, with a candid, analytical, and non-hierarchical culture.
Review and analyze Medicare claims sampled by the Department of Justice to determine correct coding and payment based on coverage and utilization.
Conduct in-depth claims analysis to detect fraudulent or abusive billing practices using ICD-10, CPT-4, and CMS guidelines.
Complete summary reports and communicate findings internally while maintaining confidentiality and compliance with DOJ and CMS regulations.
Empower AI provides AI-powered solutions for federal government agencies, helping them transform their workforce and operations. Headquartered in Reston, Va., the company has three decades of experience in Health, Defense, and Civilian missions and is recognized as a 2024 Military Friendly Employer.
Develop and maintain operational, clinical, quality, compliance, and executive dashboards supporting the LTSS program.
Transform complex healthcare, operational, and financial data into actionable insights for program oversight and improvement.
Partner with cross-functional teams to monitor performance indicators, support compliance, and drive data-informed decisions.
The hiring partner is a healthcare organization supporting a large-scale Long-Term Services and Supports (LTSS) program. The role offers substantial autonomy and cross-functional collaboration in a fully remote environment.
Own outcomes measurement and savings analysis to quantify the impact of RightMove's care model on total cost of care and patient outcomes.
Analyze medical claims, referral patterns, and provider performance to identify savings opportunities and guide patients to high-value care.
Communicate findings through executive-ready reports and presentations to support commercial teams and customer stakeholders.
RightMove is redefining musculoskeletal (MSK) care by shifting from fragmented, volume-driven care to a coordinated, expert-led model powered by AI and data. Backed by leading investors and built in partnership with the Hospital for Special Surgery, the company is a rapidly expanding startup with a high-performing team that values impact, direct communication, and collaboration.
Collaborate with corporate personnel, program managers, and stakeholders to identify and implement process improvements.
Perform audits, root cause analysis, and cost-benefit analysis to streamline operations and reduce costs.
Monitor project timelines, conduct risk assessments, and coordinate with departments to drive operational excellence.
MVM, Inc. is a professional services firm providing support services to government customers, with expertise in counter-narcotics, investigations, public safety, and national security. With 2,500 employees and nearly forty years of experience, they value integrity, service, and support, offering a mission-driven culture.
Manage third-party and FDR oversight, including due diligence, risk tiering, and ongoing monitoring.
Lead privacy and security incident response, including breach risk assessment and reporting.
Administer compliance program, including drafting policies, presenting training, and conducting internal audits.
Evermore is a technology company that administers Smart Benefits to connect people to products and services they need. It is a Series B stage company backed by leading investors, fostering a culture of innovation and health equity.