125 fraud compliance auditor jobs found

ARMStrong Insurance Services is seeking a Premium Auditor to join our team. This role involves examining financial records of insured businesses, looking for evidence of fraud, and ensuring regulatory compliance. You will work from home but travel to policyholder locations within a limited territory. Responsibilities include conducting audits for Workers’ Comp, General Liability, Garage, and Auto policies; reviewing records; scheduling on-site audits; communicating with policyholders; submitting #J-18808-Ljbffr

ARMStrong Insurance Services is seeking a Premium Auditor to join our team. This role involves examining financial records of insured businesses, looking for evidence of fraud, and ensuring regulatory compliance. You will work from home but travel to policyholder locations within a limited territory. Responsibilities include conducting audits for Workers’ Comp, General Liability, Garage, and Auto policies; reviewing records; scheduling on-site audits; communicating with policyholders; submitting #J-18808-Ljbffr

A healthcare organization in Sunrise, Florida is seeking a Certified Medical Coder to conduct audits related to potential fraud, waste, and abuse. The role involves post-payment medical records reviews to ensure compliance with coding guidelines. Candidates must have medical coding certification and knowledge of Medicaid rules. The position offers a hybrid work schedule and requires strong analytical and communication skills. #J-18808-Ljbffr

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The CPC will ensure correct coding and proper documentation across medical, behavioral health, transportation and other healthcare services. The role requires 3+ years of coding experience, CPC certification, and strong knowledge of CPT/HCPCS/ICD-10, CMS guidelines, and ability to communicate findings to investigators and regulators. #J-18808-Ljbffr

ARMStrong Insurance Services is seeking a Premium Auditor to join our team. This role involves examining financial records and ensuring compliance in insured businesses while working from home and traveling within a limited territory. The ideal candidate will have an associate’s degree or equivalent experience, strong analytical skills, and proficiency in Microsoft Excel. We offer a generous compensation package with benefits, flexible hours, and the potential to earn over $75k annually. #J-18808-Ljbffr

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and compliant documentation. The role requires 3+ years of experience and CPC certification, with strong knowledge of CPT/HCPCS/ICD-10 and CMS guidelines. The candidate will conduct audits, provide written findings, and communicate results to investigators and regulators. Proficiency in Excel/Word and attention to detail are essential for success in this full-time #J-18808-Ljbffr

CVS Health is seeking a Certified Professional Coder (CPC) to review medical records for the Special Investigations Unit (SIU) to ensure coding accuracy and compliance. The role requires identifying billing patterns and ensuring state and federal guidelines are met. The position emphasizes detailed audit work, clear written findings, and communication with investigators and leadership, with full-time hours and competitive benefits. #J-18808-Ljbffr

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). You will ensure coding accuracy, review documentation, and verify compliance with state and CMS guidelines. The role requires 3+ years of coding or auditing experience and proficiency with Excel/Word. The position is full-time in the United States with a typical 40-hour work week and a comprehensive benefits package. #J-18808-Ljbffr

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and compliant documentation. The role requires 3+ years of experience and CPC certification, with strong knowledge of CPT/HCPCS/ICD-10 and CMS guidelines. The candidate will conduct audits, provide written findings, and communicate results to investigators and regulators. Proficiency in Excel/Word and attention to detail are essential for success in this full-time #J-18808-Ljbffr

Location: Baltimore, Maryland, United StatesCompany: State of MarylandPosted: 2026-08-13IntroductionIntroductionGRADE20LOCATION OF POSITION100 South Charles Street Baltimore, Maryland 21201Main Purpose of JobThe main purpose of this position is to supervise a staff of UI Contributions Tax Auditors assigned to ensure fair and equal administration of Unemployment Insurance law to all Maryland employers. This position educates Maryland employers, accountants, and attorneys about the Maryland Unemployment Insurance program and state and federal unemployment insurance laws. The Auditor VI position supervises the assigned team of Auditors IV to Auditors I with the audit staff. This position ensures efficient resource management and quality customer service within the Field Investigation and Audit Unit.POSITION DUTIESThis position will supervise and assist in the training of UI Contributions Tax Auditors, and perform audits, disputed claims, claimant questionnaires, delinquency...

Labcorp is a global leader in laboratory services, providing the insights and answers that help healthcare providers, patients, researchers, pharmaceutical companies and health systems make confident decisions and improve outcomes. Through our unparalleled science, data, technology and laboratory network, we advance diagnostics, accelerate innovation and help address some of the world’s most important health challenges. As we shape the future of healthcare, we are leveraging advanced technologies, intelligent digital solutions and data-driven innovation across our operations to enhance how work gets done and deliver greater value to customers and patients. With our global scale and deep expertise, you’ll have the opportunity to do meaningful work, grow your career and make a real impact on people’s health around the world. Together, we’re improving health and improving lives. Labcorp is seeking a Compliance Auditor II to join our team in Burlington or Durham, NC! Work Schedule:...

Position Description & Qualifications Serco is excited to continue our support to the Defense Heath Agency (DHA) Medical Coding Program Branch (MCPB). The DHA is a joint, integrated Combat Support Agency that enables the Army, Navy, and Air Force medical services to provide a medically ready force to Combatant Commands in both peacetime and wartime. The essential mission of the DHA Medical Coding Program Branch (DHA-MCPB) is to improve the accuracy and quality of medical coding and documentation across DHA in support of the DHA mission. Medical Coding Auditing consists of a systematic, unbiased, independent examination of medical documentation and coding to validate that all codes entered into the Military Health System (MHS) systems are in conformity with official coding policies, regulations, requirements, and standards. The auditing task involves developing or following a disciplined, systematic process that defines what is to be audited and why, how errors are defined and...

What we offer Excellent health benefits plan, which includes medical, vision and dental options 401(k) with company match Company profit sharing plan Generous paid time-off and paid holidays Paid parental leave 2 free on-site fitness rooms Employee Assistance Program Employee Resource Groups Personal and professional development program Job Summary The Jr. Franchise Compliance Auditor II will manage and optimize our audit activities. They will conduct and oversee company franchise audits from planning through to completion. Tasks will include planning the audit process, research, reviewing current processes, and providing recommendations to enhance company policies and provide training to Franchise owners in the royalty reporting process. The Jr. Franchise Compliance Auditor II will assist in developing skills, provide training and support for the audit staff and Franchisee. You will Guide and assist franchise audit staff within...

Open Recruitment Position Specific Recruitment This is a position specific recruitment, open to anyone who meets the minimum and selective qualifications listed below. The resulting list of eligible candidates will be used to fill this position or function only. You will need to reapply for any future recruitment conducted for this job classification. The Maryland Aviation Administration (MAA) is the owner & operator of both Baltimore/Washington International Thurgood Marshall and Martin State Airports, serving over 27 million passengers annually. Powered by PERFORMANCE . Inspired by INNOVATION . Fueled by FUN . We are chartering careers to unprecedented Successes , Opportunities , Advancements , Results , and Services . If you’re beginning your career journey or performing at your peak level, we invite you to consider our aviation family for your career. MAA is currently accepting applications for the position of DOT Internal Auditor Supervisor within the Office of Enterprise...

Position Specific Recruitment This is a position specific recruitment, open to anyone who meets the minimum and selective qualifications listed below. The resulting list of eligible candidates will be used to fill this position or function only. You will need to reapply for any future recruitment conducted for this job classification. Description Open Recruitment Position Specific Recruitment This is a position specific recruitment, open to anyone who meets the minimum and selective qualifications listed below. The resulting list of eligible candidates will be used to fill this position or function only. You will need to reapply for any future recruitment conducted for this job classification. The Maryland Aviation Administration (MAA) is the owner & operator of both Baltimore/Washington International Thurgood Marshall and Martin State Airports, serving over 27 million passengers annually. Powered by PERFORMANCE . Inspired by INNOVATION . Fueled by FUN . We are...

Salary Range $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Job Summary The Delegation Oversight Compliance Auditor III is responsible for planning, coordination, and conducting comprehensive compliance audits and reviews to assess adherence to regulatory requirements, contractual obligations, and internal policies for L.A. Care subcontracted providers. Additionally, the Auditor III will provide updates and recommendations to Management on quality and delegation oversight responsibilities, participate in fraud, waste, and abuse investigations as applicable, and oversee pre‑delegation and annual audits for new and existing delegated entities to drive continuous improvement and adherence to regulatory standards by ensuring delegates are compliant with regulatory requirements. Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff. Duties Applies subject expertise in evaluating business operations and processes. Identifies areas where...

Scheduled Hours 37.5 Position Summary The purpose of the Washington University Compliance Program is to minimize instances of noncompliance with external laws and regulations, as well as related internal policies and procedures. Although university administration, faculty, and staff are responsible for various aspects of compliance as part of their roles, the Senior Lead Compliance Auditor plays a significant part in the overall compliance program. The Senior Lead Compliance Auditor works in the Office of University Compliance and Internal Audit. This position is responsible for evaluating the University’s state of compliance with federal research and other federal regulations, as well as related University policies. Such compliance is crucial to the success and mission of the University. Results of the compliance audits are critical measures for the University. The Senior Lead Compliance Auditor reports to the Director of Compliance Audit. The Senior Lead Compliance Auditor is...

Introduction Introduction GRADE 20 LOCATION OF POSITION 100 South Charles Street Baltimore, Maryland 21201 Main Purpose of Job The main purpose of this position is to supervise a staff of UI Contributions Tax Auditors assigned to ensure fair and equal administration of Unemployment Insurance law to all Maryland employers. This position educates Maryland employers, accountants, and attorneys about the Maryland Unemployment Insurance program and state and federal unemployment insurance laws. The Auditor VI position supervises the assigned team of Auditors IV to Auditors I with the audit staff. This position ensures efficient resource management and quality customer service within the Field Investigation and Audit Unit. POSITION DUTIES This position will supervise and assist in the training of UI Contributions Tax Auditors, and perform audits, disputed claims, claimant questionnaires, delinquency collection, and special investigation assignments. While ensuring fair and equal...

To support accurate claims processing, the part-time Certified Medical Coding Auditor will remotely review and analyze medical records against submitted claims, ensuring compliance with coding guidelines and identifying potential errors or fraud. Key responsibilities Performs clinical reviews of CPT, HCPCS, and modifiers for claims submitted by providers Determines accuracy of medical coding and provides payment recommendations based on comprehensive evaluations Identifies aberrant billing patterns and trends, recommending providers for further review as necessary Required qualifications Certified Coder AHIMA (CCA, CCS, CCS-P) or AAPC Certified coder (CPC, CPC-I) 2+ years of experience as an AHIMA or AAPC Certified coder 2+ years of CPT/HCPCS/Modifiers coding experience 2+ years of strong medical record review experience 1+ year of experience in the health insurance business, utilizing industry terminology and regulatory guidelines

Introduction OPEN TO ALL QUALIFIED APPLICANTS This is a position specific recruitment. The resulting certified eligible list may be used to staff several current and future vacancies for this position/function only. This recruitment will be closed once all positions have been filled. GRADE 16 (*Please note, state salary guidelines will apply for current state employees) LOCATION OF POSITION Baltimore, Maryland POSITION DUTIES The Comptroller of Maryland’s Compliance Division is looking to add new tax auditors to their Business Tax Audit and Individual Tax Audit teams. We offer flexible work schedules that include telework options and opportunities to work from the field (outside of the office) for certain audit assignments. If you’re interested in tax auditing and want to join our team. We look forward to meeting you! Business Tax Audit The main purpose of this position is to audit business entities for compliance with the State of Maryland’s revenue laws and regulations...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale.Join us to start Caring. Connecting. Growing together. You'll enjoy the flexibility to telecommute* as you take on some tough challenges. The Medical Coding Auditor is required to determine the accuracy of claims submitted by a provider to UnitedHealth Group by comparing it to the medical record(s) submitted for the date(s) of service being reviewed. This position supports the identification of suspected Waste & Error of health insurance claims and...

Billing And Coding Compliance Auditor Billing and Coding Compliance Auditors conduct audits and monitoring activities to identify and address compliance risks related to billing and coding practices. They review and evaluate healthcare regulatory compliance, focusing on the detection of documentation, coding, and billing errors. Responsibilities include assessing the adequacy and accuracy of documentation supporting billed services, including ICD, CPT, HCPCS, and other third-party payer codes, as well as adherence to Teaching Physician guidelines, Evaluation & Management criteria, DRG and APC assignments, medical necessity, and reimbursement accuracy. Auditors serve as a communication channel, partnering with Billing and Coding Compliance Educators to address compliance issues. They are responsible for conducting thorough investigations into billing and coding compliance matters, ensuring adherence to regulatory standards, and identifying discrepancies. This role involves...

What we offer Excellent health benefits plan, which includes medical, vision and dental options 401(k) with company match Company profit sharing plan Generous paid time-off and paid holidays Paid parental leave 2 free on-site fitness rooms Employee Assistance Program Employee Resource Groups Personal and professional development program Job Summary The Jr. Franchise Compliance Auditor II will manage and optimize our audit activities. They will conduct and oversee company franchise audits from planning through to completion. Tasks will include planning the audit process, research, reviewing current processes, and providing recommendations to enhance company policies and provide training to Franchise owners in the royalty reporting process. The Jr. Franchise Compliance Auditor II will assist in developing skills, provide training and support for the audit staff and Franchisee. You will Guide and assist franchise audit staff within the audit...

Overview Certified Medical Coder required (AHIMA, AAPC, or PMI). Hybrid-Sunrise, Florida The Medical Coding Auditor conducts audits to provide investigative support related to potential fraud, waste, abuse and/or overpayment. Through post payment medical records review, the Medical Coding Auditor ensures appropriate coding on claims paid and maintains compliance documentation of any fraud, waste or abuse identified based on coding guidelines and regulatory and contract requirements. Essential Duties and Responsibilities Performs post payment medical record review audits of claims payments to identify potential fraud, waste, abuse and/or overpayment. Completes and maintains detailed documentation of audits including but not limited to coding guidelines reviewed, medical necessity documentation, decision methodology, and monetary discrepancies identified. Coordinates overpayment recoveries with the Fraud Investigative Unit Manager. Responsible for assisting the Fraud Investigative...