Director, Compliance on Special Investigations Unit and Fraud, Waste and Abuse Job at L.A. Care Health Plan (Los Angeles)

Director, Fraud Prevention and Program Oversight

Community First Health Plans, Inc. (Community First) is an HMO providing health ...

Location

United States , San Antonio

Salary:

40.87 - 91.35 USD / Hour

University Health

Expiration Date

Until further notice

Requirements

Bachelor’s degree is required in accounting, business administration or related field
Experience in interpretation of regulatory agency policies is preferred
Experience with anti-fraud detection and prevention is required
Three years of supervisory experience is preferred
Experience with SEC SOX and/or NAIC MAR audits, and Enterprise Risk Management (ERM) is highly desirable
At least three years of professional audit experience is required

Job Responsibility

Leads the organization’s efforts to prevent, detect, investigate, and remediate fraud, waste, and abuse (FWA) across all product lines
Ensures program integrity by setting organizational standards, strengthening internal controls, and overseeing the Special Investigations Unit (SIU) operations, payment integrity analytics, and vendor oversight
Ensures program integrity by setting enterprise standards, strengthening internal controls, and overseeing SIU operations, payment integrity analytics, vendor oversight, and internal auditing functions

Fulltime

Director, Payment Integrity

The Director, Payment Integrity provides strategic leadership and oversight for ...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

10 years of experience in Payment Integrity, Special Investigation Unit, or healthcare anti-fraud
7+ years of experience in management role
2+ years of experience in Vendor Partner Oversight
contracting and vendor management of external payment vendors and/or audit firms
Demonstrated success in developing and executing enterprise-wide strategies
Bachelor's Degree in business, statistics, healthcare administration or related field of study
Intermediate PC proficiency
Intermediate skill in use of office equipment
Basic skill in word processing and presentation software
Intermediate proficiency in spreadsheet, statistical analysis, query / data mining, and business intelligence software

Job Responsibility

Develop and execute enterprise-wide Payment Integrity strategy aligned with organizational objectives and cost of care targets
Lead the design, implementation, and continuous improvement of payment integrity programs, including pre- and post-payment audits, recovery, and investigative functions
Establish and maintain governance structures, including cross-functional committees, to oversee payment integrity controls and policy development
Representing the organization in internal and external forums, collaborating with industry peers, regulatory bodies, and vendor partners to share best practices and drive innovation
Stay abreast of emerging trends, technologies, and regulatory shifts in the healthcare payment integrity space
Oversee day-to-day operations, ensuring timely, accurate, and compliant claims payment and recovery activities
Direct vendor management, including contracting, performance oversight, and strategic partnerships for payment integrity solutions
Drive automation and technology adoption to enhance payment integrity processes and reporting capabilities
Lead cost-benefit analyses to determine optimal resource allocation (internal vs. outsourced functions)
Set and monitor KPIs, SMART goals, and financial targets for payment integrity initiatives

Fulltime

Accountant

We are seeking a detail-oriented Accountant to support daily accounting operatio...

Location

United States , Miami

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Bachelor’s degree in Accounting, Finance, or related field
2+ years of accounting experience
Knowledge of general accounting principles and financial reporting
Experience with general ledger, reconciliations, and close processes
Proficiency in Microsoft Excel and accounting software or ERP systems
Strong attention to detail, organization, and problem-solving skills
Ability to work independently and collaboratively in a team environment
Strong written and verbal communication skills

Job Responsibility

Prepare and record journal entries, accruals, and adjustments
Maintain and reconcile general ledger accounts
Perform monthly bank and account reconciliations
Assist with month-end, quarter-end, and year-end close
Prepare financial statements, reports, and supporting schedules
Analyze account activity and investigate discrepancies
Support accounts payable, accounts receivable, and payroll processes as needed
Help ensure compliance with company policies, internal controls, and accounting standards
Assist with audits by preparing documentation and responding to requests
Contribute to budgeting, forecasting, and variance analysis

What we offer

medical insurance
vision insurance
dental insurance
life insurance
disability insurance
401(k) plan

Fulltime

Critical Environment Technician Manager

In alignment with our Microsoft values, we are committed to cultivating an inclu...

Location

United States , Mount Pleasant

Salary:

75400.00 - 167900.00 USD / Year

Microsoft Corporation

Expiration Date

Until further notice

Requirements

High School Diploma, GED, or equivalent AND 3+ years mission critical services work/applied learning experience (e.g., high availability assembly/manufacturing/critical infrastructure environments such as data centers, oil and gas refineries, hospitals, pharmaceutical, manufacturing, or related fields) OR equivalent experience
Ability to work shifts, including shift assignments during non-standard business hours that may include evening, nighttime, weekends, and/or holidays
Ability to meet Microsoft, customer and/or government security screening requirements are required for this role
High School Diploma, GED, or equivalent AND 6+ years mission critical services experience OR Associate's Degree or technical trade certification (e.g., military, trade school), or higher-equivalent education AND 5+ years mission-critical services experience OR equivalent experience
1+ year(s) people management experience
1+ year(s) experience in a specialized area (e.g., mechanical field, electrical field, controls field) or related field

Job Responsibility

People Management: Managers deliver success through empowerment and accountability by modeling, coaching, and caring. Model - Live our culture
Embody our values
Practice our leadership principles. Coach - Define team objectives and outcomes
Enable success across boundaries
Help the team adapt and learn. Care - Attract and retain great people
Know each individual’s capabilities and aspirations
Invest in the growth of others
Equipment and Systems Operations: Serve as an operations specialist one or more major area of operations (e.g., electrical, mechanical, controls, generators, and work on advanced tasks independently. Oversee and coach team with the inspection of critical environment-related facility equipment (e.g., controls, heating, ventilation, and air conditioning [HVAC], mechanical systems), building, and grounds regularly for unsafe or abnormal conditions to develop and analyze trends. Monitor performance of maintenance and operations utilizing telemetry, control systems, and other platforms and is able to identify all alarms. Utilize internal computerized maintenance management system (CMMS) to track all equipment assets and to complete work order requests for maintenance work and generate reporting to identify outstanding and ongoing work orders. Safely and quickly respond to and lead an onsite incident response team for all abnormal conditions that impact operations and coordinate with other critical facilities professionals to perform corrective repairs. Enhances, develops new, or follows preexisting emergency operating procedures (EOPs), methods of procedure (MOPs), and standard operating procedures (SOPs) in relation to incidents. Gathers necessary information and creates incident timelines/data, root-cause analyses, and/or action items following an abnormal condition
Equipment and Systems Maintenance: Guide, oversee, and perform various types of maintenance (e.g., planned, predictive, corrective) and repairs following methods of procedure (MOPs), and standard operating procedures (SOPs) for one or more disciplines and one or more types of equipment (e.g., electrical, mechanical, cooling systems) and escalate when appropriate. Serve as a subject matter expert for one type of equipment and oversee everyday tasks and troubleshooting within their area of expertise. Have a hands-on understanding of how equipment works within disciplines they have been trained and how to troubleshoot equipment, systems, subsystems, and components independently within their trained discipline(s). Provide and/or assign team to provide necessary escort to third-party contractors, sub contractors, vendors, and service providers on site for all severity leveled procedures. Coordinate and schedule supplier/vendor on-site activities and recognizes circumstances when to stop supplier work to address potential and/or identified concerns. Take part in getting third-party work underway (e.g., making sure systems are properly energized/deenergized), ensuring the work is started and completed in a safe manner in accordance with standard practices, procedures, federal/local legislation, and municipal codes. Advises junior colleagues on inspection and supervision issues. Provides consultation to lower-level colleagues in troubleshooting systems and problems
Critical Environment Culture: Understands, follows, ensures, and coaches team on safety and security requirements (e.g., job hazard assessments [JHAs], toolbox talks), and business processes and procedures to properly perform work in a safe, quality, and reliable manner in accordance with applicable federal, state, local, and Microsoft requirements. Proactively ensures safety and security requirements are followed and met for the work of themselves and others. Maintain safe working conditions and escalate immediately when unsafe working conditions are observed. Assesses and identifies appropriate resources and equipment necessary to fully support environmental health and safety (EH&S) objectives. Participates in required meetings, trainings, and necessary handoffs

What we offer

Benefits and other compensation (details at https://careers.microsoft.com/us/en/us-corporate-pay)

Fulltime

Psychologist/Psychological Assessment and Evaluation

Join a clinician-centered multidisciplinary team of counselors, social workers, ...

Location

United States , Georgetown

Salary:

Not provided

Ellie Mental Health

Expiration Date

Until further notice

Requirements

Clinical licensure is required (PhD or PsyD)
Experience with completing diagnostic evaluations, scoring and interpreting results, writing reports that clients can understand, and providing feedback to clients
Comfort and familiarity working with a diverse client base from an affirming perspective
Candidates must be able to work in Maryland with a Maryland license, or be license-eligible
Opportunity to provide supervision to psychology associates and trainees for qualified candidates with a demonstrated history of success with Ellie

Job Responsibility

Completing diagnostic evaluations
Scoring and interpreting results
Writing reports that clients can understand
Providing feedback to clients
Providing supervision to psychology associates and trainees for qualified candidates

What we offer

Competitive salary
Flexible schedule
Opportunity for advancement
Health insurance
PTO
Weekly case consultation groups
Free CEUs
Monthly team activities focused on clinician well-being
We will cover all testing costs and expenses as well as administrative tasks like marketing, scheduling, and billing
Cash pay service: clients pay upfront, and you’ll earn 50% of what we collect

Fulltime

Temporary Lettings Administrator

As a Lettings Administrator, you will play a vital role in managing a portfolio ...

Location

United Kingdom , Manchester

Salary:

30000.00 GBP / Year ▼

Office Angels

Expiration Date

Until further notice

Requirements

Strong administration and customer service skills
Previous experience in property management is a bonus
Excellent communication, organisational and problem-solving abilities
Confident in working independently and taking the initiative
A proactive mindset with a genuine care for delivering outstanding service
Full UK driving licence and access to a vehicle (mileage allowance provided)

Job Responsibility

Manage a diverse portfolio of student rental properties across Manchester
Conduct regular property inspections to ensure everything is in tip-top shape
Coordinate tenancy check-ins and check-outs like a pro
Handle rent collections, deposit returns and tenancy agreements efficiently
Address tenant queries and resolve issues promptly and professionally
Conduct viewings and manage enquiries during the bustling student letting cycle
Oversee health and safety, fire safety and compliance across all properties

What we offer

Opportunity to transition into a permanent role for the right candidate
Work in a fun and dynamic environment that values your growth
Make a real difference in the lives of students and enhance their rental experience
Mileage allowance provided

Fulltime

Senior Quantity Surveyor

A highly respected, multi-disciplinary construction consultancy is seeking a Sen...

Location

United Kingdom , Leeds

Salary:

55000.00 - 65000.00 GBP / Year

Brandon James

Expiration Date

Until further notice

Requirements

Proven experience operating as a Senior Quantity Surveyor within a consultancy environment
A degree in Quantity Surveying or Commercial Management
MRICS status (or working towards chartership)
Strong knowledge of JCT contracts
Experience delivering commercial, residential or industrial shed projects
Excellent communication and client-facing skills

Job Responsibility

Cost planning and estimating
Tender preparation and procurement advice
Contract administration (JCT)
Valuations, variations and final accounts
Risk management and value engineering
Client-facing reporting and stakeholder management

What we offer

25 Days holiday + Bank holidays
Health insurance
Hybrid working
Generous Pension Plan
Life assurance
Mobile and Laptop
Car allowance
Regular socials
Cycle to work scheme
Supportive culture

Fulltime

Billing Specialist

We are seeking a Billing Specialist to support accurate, timely invoicing and re...

Location

United States , York

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Prior experience in client billing, e-billing or invoicing
Familiarity with billing systems, billing software, or accounting platforms
Strong Excel skills for data review, reconciliation, and reporting
Ability to manage multiple deadlines in a fast‑paced environment
Clear written and verbal communication skills

Job Responsibility

Prepare, generate, and review customer invoices in accordance with contract terms and billing schedules
Verify billing accuracy, including rates, quantities, and supporting documentation
Resolve billing discrepancies and respond to internal and external billing inquiries
Maintain billing records, documentation, and audit trails
Collaborate with Accounts Receivable, Sales, and Operations to support smooth invoicing and collections processes
Assist with month‑end billing activities and reporting as needed

What we offer

Competitive pay and benefits package
medical
vision
dental
life and disability insurance
401(k) plan

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Director, Compliance on Special Investigations Unit and Fraud, Waste and Abuse

Job Description

Job Responsibility

Requirements

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What we offer

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