Investigator - New York, NY
4 days ago
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.
About NYC Health + HospitalsMetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
Position Overview
MetroPlusHealth is seeking a highly qualified candidate for an Investigator role within our Special Investigations Unit. The Investigator will support the Plan in the detection, prevention and investigation of suspected fraud, waste, and abuse. The position reports to the Director of Special Investigations Unit.
Job Description- Investigates allegations of fraud, waste, and abuse from internal and external sources at multiple levels of complexity
- Assists in conducting claims investigations and audits to identify potential Fraud, Waste and Abuse
- Maintains thorough documentation of cases and refers issues to the appropriate parties
- Develops reports and other monitoring parameters, utilizing multiple internal/external resources to identify outliers and areas of risk
- Provides case updates and coordinates with the SIU team and other MetroPlusHealth stakeholders to ensure case progression and resolution
- Prepare detailed and summary reports to internal and external parties including Federal and State agencies
- Completes special projects and audits as required
- An Associate’s Degree or Bachelor’s Degree in criminal justice or a related field; and
- Relevant work experience meeting one of the following criteria:
- 5 years in the healthcare field working in fraud, waste and abuse investigations and audits; (or)
- 5 years of insurance claims investigation experience or professional investigation experience with law enforcement agencies; (or)
- 7 years of professional investigation experience involving economic or insurance related matters
- Medical Coding Experience - Preferred
- Preferred candidate will have experience in Medicaid, Medicare, and Marketplace/Exchange
Licensure and/or Certification Required:
- Certified Fraud Examiner designation and /or Accredited Healthcare Fraud Investigator – Preferred
Professional Competencies:
- Integrity and Trust
- Customer Focus
- Excellent Microsoft Office Suite skills
- Written/Oral Communication
-
Writer/Investigative Analyst
6 days ago
New York, United States New York State Civil Service Full timeNY HELP No Agency Judicial Conduct, State Commission on Title Writer/Investigative Analyst Occupational Category Other Professional Careers Salary Grade NS Bargaining Unit M/C - Managerial/Confidential (Unrepresented) Salary Range From $55005 to $68805 Annually Employment Type Full-Time Appointment Type Permanent Jurisdictional Class "Other"...
-
Diagnostic Imaging Specialist
2 weeks ago
New York, New York, United States New York Imaging Full timeJob OverviewNew York Imaging is a pioneering diagnostic imaging facility in Manhattan, NY, dedicated to delivering unparalleled patient care. Our team of highly skilled radiologists and technologists utilizes cutting-edge technologies to provide precise diagnostic solutions.SalaryThe salary for this position ranges from $48 to $57.83 per hour, determined by...
-
Auditor 1/Auditor Trainee 1/2
4 days ago
New York, United States New York State Civil Service Full timeNY HELP Yes Agency Labor, Department of Title Auditor 1/Auditor Trainee 1/2 - New York City (NY HELPS) Occupational Category Financial, Accounting, Auditing Salary Grade 18 Bargaining Unit PS&T - Professional, Scientific, and Technical (PEF) Salary Range From $52198 to $82656 Annually Employment Type Full-Time Appointment Type...
-
Associate Investigative Analyst
3 days ago
New York, United States City of New York Full timeCompany DescriptionJob Description The New York City Department of Investigation (DOI) is one of the oldest law enforcement agencies in the country with a mission of combating municipal corruption. It serves the people of New York City by acting as an independent and nonpartisan watchdog for New York City government, City agencies, and City employees,...
-
Environmental Health and Safety Manager
1 month ago
New York, New York, United States New York City, NY Full timeCompany Overview:New York City, NY is a dynamic and diverse environment where professionals can grow and contribute to the community's well-being. Our organization is committed to providing high-quality services while ensuring a safe and healthy work environment for all employees.Job Description:We are seeking an experienced Senior EHS Specialist to join our...
-
Investigative Data Reporter
5 days ago
New York, United States New York Public Radio Full timeInvestigative Data Reporter WNYC/Gothamist Newsroom The WNYC and Gothamist newsroom seeks an ambitious, detail-oriented and experienced investigative data reporter to join the Investigative & Narrative reporting team. The reporter should have experience producing informative, engaging and accurate data-driven stories. Our newsroom strives to have an impact...
-
New York, United States Hunt Hive Talent Full timeAbout the job Securities Litigation Associate | New York, NY Elevate Your Legal Career with Hunt Hive Talent At Hunt Hive Talent, we connect exceptional legal professionals with opportunities tailored to their expertise and aspirations. We collaborate with top-tier law firms and organizations to place talented attorneys in roles where they can thrive....
-
Investigative Analyst
6 days ago
New York, United States City of New York Full timeCompany DescriptionJob Description The New York County District Attorney's Office (DANY) has an opening for an Investigative Analyst in its Violent Criminal Enterprises Unit (VCEU). VCEU is responsible for the investigation and prosecution of violent organized crime in Manhattan and beyond, including drug-related homicides, armed street gangs, interstate gun...
-
Nurse Home Visitor Position in New York City
3 weeks ago
New York, New York, United States New York City, NY Full timeJob OverviewWe are seeking a highly skilled Nurse Home Visitor to join our team at the New York City Department of Health and Mental Hygiene. As a key member of our Division of Family and Child Health, you will play a vital role in supporting the health and well-being of mothers and their children.
-
New York, United States New York-Presbyterian Hospital Full timeColumbiaDoctors Division of Digestive Diseases in partnership with NewYork-Presbyterian Medical Group Westchester is looking for a BC/BE Gastroenterologist to join our growing division in Eastchester, NY. This position is open to both new grads and experienced gastroenterologists.NewYork-Presbyterian Westchester (formerly NewYork-Presbyterian/Lawrence...
-
New York, United States ArchiECHO Full timeGraphics/Multimedia Editor in New York, NY, USThe mission of The New York Times is to seek the truth and help people understand the world. That means independent journalism is at the heart of all we do as a company. It’s why we have a world-renowned newsroom that sends journalists to report on the ground from nearly 160 countries. It’s why we focus...
-
Investigative Data Analyst
4 weeks ago
New York, New York, United States New York Public Radio Full timeJob OverviewNew York Public Radio seeks a skilled Investigative Data Reporter to join its Investigative & Narrative reporting team. The successful candidate will be responsible for producing high-quality, data-driven stories that impact public policy and the lives of New Yorkers.This is a key role in an evolving and ambitious newsroom, with a focus on...
-
Investigative Data Reporter
4 days ago
New York, United States New York Public Radio, Inc Full timeInvestigative Data ReporterWNYC/Gothamist NewsroomThe WNYC and Gothamist newsroom seeks an ambitious, detail-oriented and experienced investigative data reporter to join the Investigative & Narrative reporting team.The reporter should have experience producing informative, engaging and accurate data-driven stories. Our newsroom strives to have an impact on...
-
Public Safety Investigative Reporter
12 hours ago
New York, New York, United States New York Public Radio Full timeJob DescriptionWe are seeking a highly skilled Public Safety Investigative Reporter to join our team at New York Public Radio. The ideal candidate will have a proven track record of producing high-quality, engaging content that sheds light on the complexities of policing and public safety in New York City.About the RoleInvestigate and report on news stories...
-
New York, United States Jameson Legal Full timeWe are looking to speak with white-collar and investigations Associates to join our client’s top-tier White Collar and Government practice in New York.This is an opportunity to join a team home to a former Attorney General, Deputy Attorney General, several Assistant Attorneys General, members of Congress, and a myriad of other elected and appointed...
-
Investigator for Police Reform
2 weeks ago
New York, New York, United States City of New York Full time**About the Role:**The City of New York is seeking a highly skilled Investigator to join the Protest Policing Monitoring Unit. As a key member of the team, you will play a critical role in reviewing the NYPD's response to protests and ensuring their compliance with settlement terms.You will work closely with the Inspector General to plan and execute...
-
Lateral Associate
2 days ago
New York, United States Hunt Hive Talent Full timeJob DescriptionJob DescriptionElevate Your Legal Career with Hunt Hive TalentAt Hunt Hive Talent Recruiting Agency, we don't just connect talent with opportunities we build bridges to success. Our candidates rely on us to open doors to fulfilling careers. If you're ready to take the next step in your career, Hunt Hive Talent is here to make it...
-
Nurses, Registered/NEW YORK, NY
1 month ago
New York, United States Suncap Technology, Inc. Full timeTitle: Nurses, Registered Location: NEW YORK, NY Duration: 2 Years contract Job Description Shift Days/Times : Evenings,10-hour shifts. Hours are 12pm-10pm Summary of Need: To provide nursing interventions and medication administration consistent with the established systematic problem-solving approach for the delivery of comprehensive nursing care,...
-
Background Investigator
4 days ago
New York, United States ADC LTD NM Full timeSummaryThe 1099-Contract Investigator is responsible for conducting federal background investigations on a contract basis in direct support of national security and suitability investigations.This position requires travel into Manhattan, NY for in-person work on a regular basis.Conduct fieldwork, including interviews and retrieval of records, to produce...
-
New York, United States Hunt Hive Talent Full timeJob DescriptionJob DescriptionElevate Your Legal Career with Hunt Hive TalentAt Hunt Hive Talent, we connect exceptional legal professionals with opportunities tailored to their expertise and aspirations. We collaborate with top-tier law firms and organizations to place talented attorneys in roles where they can thrive. Whether you're an experienced...