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From Home Target Investigator Jobs (NOW HIRING)

Humana

Fraud and Waste Investigator

Prepares complex investigative and audit reports. Understands department, segment, and ... Remote anywhere in US, work at home. While this is a remote position, occasional travel to Humana ...

Humana

Fraud and Waste Investigator

Prepares complex investigative and audit reports. Understands department, segment, and ... Remote anywhere in US, work at home. While this is a remote position, occasional travel to Humana ...

Luxus

Architectural Project Manager

Seattle, WA · Remote

$110K - $150K/yr

Seattle, WA (Remote / Work-From-Home) Target Hire Date: September 2026 Salary Range: $110,000 - $150,000 (DOE) Employment Type: Full-Time Reports To: U.S. Leadership Team About Zebra Global ...

VRC Investigations

SIU Investigator

Atlanta, GA · On-site

We have several work from home, part-time and full-time hourly positions available in our rapidly expanding Special Investigations Unit. This hybrid style position that requires travel within the ...

Humana

Fraud and Waste Investigator

Use your skills to make an impact WORK STYLE: Work at Home. While this is a remote position ... investigations and auditing experience Knowledge of healthcare payment methodologies, claims ...

VRC Investigations

SIU Investigator

Atlanta, GA · On-site

$30 - $35/hr

We have several work from home, part-time and full-time hourly positions available in our rapidly expanding Special Investigations Unit. This hybrid style position that requires travel within the ...

Humana, Inc.

Fraud and Waste Investigator

Use your skills to make an impact WORK STYLE: Work at Home. While this is a remote position ... fraud investigations and auditing experience • Knowledge of healthcare payment methodologies ...

Humana

Fraud and Waste Investigator

Use your skills to make an impact WORK STYLE: Work at Home. While this is a remote position ... investigations and auditing experience Knowledge of healthcare payment methodologies, claims ...

VRC Investigations

SIU Investigator

Syracuse, NY · On-site

$30 - $35/hr

We have several work from home, part-time and full-time hourly positions available in our rapidly expanding Special Investigations Unit. This hybrid style position that requires travel within the ...

Luxus

Architectural Project Manager

Seattle, WA · On-site

$110K - $150K/yr

Seattle, WA (Remote / Work-From-Home) Target Hire Date: September 2026 Salary Range: $110,000 - $150,000 (DOE) Employment Type: Full-Time Reports To: U.S. Leadership Team About Zebra Global ...

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Coding Investigator Auditor - Work From Home

Tulsa, OK • Remote

Health Care Service Corporation
Outpatient Health Care • 10K+ employees
Learn more about Health Care Service Corporationexternal

$55K - $123K/yr

Full-time

Medical, Life, Retirement, PTO

Posted 11 days ago

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job SummaryThis position is responsible for auditing clinical, billing, coding and lowest cost setting reviews for services pre and post payment utilizing medical, contractual, legislative, policy, and other information to validate claims submitted and billed. Conducting research. Preparing documentation of findings and consulting with special investigation and the affordability of care area as needed. Coordinating with all departments involved in each case required such as medical director special investigations, customer service, pass, network management, marketing, case management, medical review, legal, pricing and database.

Required Job Qualifications:

  • Bachelor's degree; one year of business experience, law enforcement experience, or regulatory agency experience may substitute for each year of college.
  • Certified Coding Certification, or acquire within 24 months of hire
  • 3 years of experience in claims processing operations and reporting systems, including 2 years of experience in auditing or developing computer system reports.
  • Knowledge of accreditation, i.e. URAC, NCQA standards and health insurance legislation.
  • Awareness of claims processes and claims processing systems.
  • PC proficiency to include Microsoft Word and Excel and health insurance databases.
  • Verbal and written communication skills with ability to communicate to physicians, members and providers and compose and explain document findings.
  • Organizational skills and prioritization skills

Preferred Job Qualifications:

  • Current AAPC Medical Coding Certification

#LI-MW2

#LI-Remote

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range$55,900.00 - $123,500.00

Exact compensation may vary based on skills, experience, and location.

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