Healthcare Fraud Investigator Miami, FL / Remote / Hybrid / Tampa, FL Litigation Support / Full Time Hybrid / Hybrid Healthcare Fraud Investigator Employment Type: Full-Time, Mid-Level Department: Litigation Support CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project in Nashville, TN. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently, accurately, and under pressure, and be…

Healthcare Fraud Investigator Los Angeles, CA / Remote / Hybrid / San Francisco, CA Litigation Support / Full Time Hybrid / Hybrid Healthcare Fraud Investigator Employment Type: Full-Time, Mid-Level Department: Litigation Support CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project in Nashville, TN. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently, accurately, and under pr…

Healthcare Fraud Investigator New York, NY / Remote / Hybrid / Albany, NY Litigation Support / Full Time Hybrid / Hybrid Healthcare Fraud Investigator Employment Type: Full-Time, Mid-Level Department: Litigation Support CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project in Nashville, TN. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently, accurately, and under pressure, an…

Pega Developer/Architect 100% Remote 6 Months Contract Pega opportunities and your background could be a great fit. 1. Lead Pega Developer / Architect – Senior Lead Pega architecture and solution design Design claims-matching, business rules, routing, and exception handling Drive integrations with claims/enterprise systems Healthcare payer/claims experience strongly preferred CLSA/CSSA certification preferred 2. Pega Developer – Mid-Level Hands-on Pega development and workflow configuration Bus…

Manager, Cybersecurity (Governance & Compliance) - REMOTE Our client is seeking an experienced cybersecurity leader to oversee governance, risk, and compliance initiatives while serving as a trusted advisor to business leaders, customers, and technology teams. This is an excellent opportunity to make a strategic impact by driving enterprise security programs, leading client-facing security engagements, and strengthening compliance across a complex organization. If you have a strong background i…

Overview We are looking for an experienced MuleSoft Developer to design, develop, integrate, and support enterprise-level APIs and integration solutions. The ideal candidate will have strong hands-on experience with MuleSoft, API architecture, ESB, microservices, messaging middleware, API security, and healthcare/pharma domain projects. Key Responsibilities Design, develop, and implement scalable APIs and integration solutions using MuleSoft API Platform. Develop and maintain APIs integrating A…

Job Description: Business Analysis & Solution Design Elicit, analyze, and document complex business, operational, and system requirements Translate business problems into functional requirements, workflows, process models, and user stories AI & Intelligent Automation Enablement Translate business risks and operational challenges into AI-ready business requirements Define business rules, signals, thresholds, and intervention logic supporting AI-enabled workflows Preferred Experience 10 years of …

Technical Skills: Advanced SQL (complex joins, aggregations, data reconciliation, performance tuning) Data profiling and validation techniques (completeness, accuracy, consistency checks) Experience working with large-scale data platforms (e.g., Snowflake, SQL Server) Ability to analyze and validate data transformations and source-to-target mappings Strong troubleshooting skills for data issues across multiple datasets Healthcare Data Experience. Experience working with healthcare claims data (…

Healthcare Fraud Investigator Employment Type: Full-Time, Mid-Level Department: Litigation Support CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project in Nashville, TN. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently, accurately, and under pressure, and be enthusiastic about learning and applying knowledge to provide excellent litigation support to the client. CGS brings…

Healthcare Fraud Investigator Employment Type: Full-Time, Mid-Level Department: Litigation Support CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project in Nashville, TN. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently, accurately, and under pressure, and be enthusiastic about learning and applying knowledge to provide excellent litigation support to the client. CGS brings…

Healthcare Fraud Investigator Employment Type: Full-Time, Mid-Level Department: Litigation Support CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project in Nashville, TN. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently, accurately, and under pressure, and be enthusiastic about learning and applying knowledge to provide excellent litigation support to the client. CGS brings…

Healthcare Fraud Investigator Employment Type: Full-Time, Mid-Level Department: Litigation Support CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project in Nashville, TN. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently, accurately, and under pressure, and be enthusiastic about learning and applying knowledge to provide excellent litigation support to the client. CGS brings…

REMOTE CANDIDATES ARE ACCEPTABLE Preferred qualifications include a minimum of five years of labor relations experience; however, they are willing to consider candidates with less experience if they have a healthcare background. SUMMARY : This position reports directly to the Director/Manager of Labor Relations, serving under the Vice President of Labor and Employee Relations and Employment Law. This position is responsible for maintaining an individual caseload working with a highly integrated…

Title: Healthcare Case Management Coordinator - Onsite Mandatory skills: Case management, Long term care, Microsoft Office, Excel, case management, quality management processes, assessing, planning, implementing, coordinating, information review, data review, healthy lifestyle, Condition management information, Medication review, Community resources, supports, Comprehensive Program enrollees, care coordination, care management tools, care management resources Description: We are seeking self-mo…

Overview Job Title: Sr Business Analyst - Healthcare AI Strategy Location: Hybrid - Atlanta, GA Job Type: Independent Contract (Contractor / Non-Employee) Start Date: October 19th Pay Rate: $75-$95 per hour (1099/C2C) Contract Length: 5 months Employment in this role is conditional upon successful execution of the contract by the client. We are seeking an experienced IT Business Analyst to drive the comprehensive requirements gathering, discovery phase, and baseline prioritization framework for…

Job Title: Healthcare Quality Assurance Automation Lead Location: Remote Duration : Fulltime Job Description : Key Points : 1. We need a hands-on QA Lead with a consulting background. 2. Healthcare experience should be strong. 3. TOSCA experience is a must Healthcare payer domain skills Lines of business . Medicaid, Medicare Advantage, Duals/MMP, TRICARE, and Marketplace — each with its own eligibility, submission, and reconciliation rules. Medicaid depth matters most for this client. Facets . …

W2 direct Candidates - No C2C employees Vega is hiring! Software QA/Test lead. Seeking candidates with Healthcare, Automation & AWS testing experience for a short term 3 month project. Job Requirements: Must have 8 years Software design, development, testing and software requirement management Experience working in the healthcare industry 8-10 years of experience in a technical discipline, 5 of which must be in automated software testing with core framework development. Knowledge of AWS and clo…

Title: Systems Analyst II Location: Detroit MIHybird Dept: PCR & HCR Units Healthcare payer and NASCO exp is must Will this position be required to work onsite for any reason at any time? Yes, resource will be required to come onsite twice a week. Engagement Description Responsible for the delivery of major health care payer National Health Care Reform benefit policy changes. The work includes but is not limited to business requirement assessment, detailed system analysis, benefit designs and c…

Healthcare Financial Clearance/Authorization: I Primary Location : Nationwide. shift is CST 11-7:30 PM V-Soft Consulting is currently hiring for a Healthcare Financial Clearance/Authorization: I for our premier client Nationwide. shift is CST 11-7:30 PM. Education and Experience Certified pharm tech/ Rx Prior Authorizations experience. Knowledge and Skills: WHAT YOULL DO: Job Responsibilities: Serves as a key point of contact for the Clinical Hub and proactively communicates with Pharmacists, F…

Job Description: 1 – A technical system analyst with good understanding of the healthcare process flow – Eligibility & Enrollment – Provider contract pricing – Claims adjudication – Billing – Appeals and Grievances 2 – Technical understanding of Sql and Dot net – full stack preferable 3 – knowledge of Facets platform from a developer point of view – i.e. data models, architecture, and process flow 4 – Good experience in working with Business and technical teams to prepare system requirements an…