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Job Description Healthcare Fraud Investigator I – Medicaid Dallas, TX (hybrid) OR Remote U.S. @Orchard LLC is retained by a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Our Client is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for under-served communities. Serves as an entry level professional who develops baseline plans for ensuring the integrity and accuracy of claims processes and protocols. Collects data for audits/investigations into claims, utilizing a combination of analytical skills and attention to detail, reviewing documentation, interviewing involved parties, and communicating with various stakeholders to gather relevant information for successful resolution and closure. Identifies opportunities to target fraud, waste, and abuse or discrepancies in claims submissions. Adheres to industry regulations and company policies for managerial follow-up. Analyzes data in order to effectively assess the validity of claims. Provides accurate recommendations to management for claim resolution and closure. Documents and inputs all findings, while preparing comprehensive reports that may be used for legal or audit/investigative purposes. Essential Duties and Responsibilities: • Conducts routine and impartial audits/investigations into customer claims, ensuring accurate and fair assessments of claims validity., • Provides customer service by addressing inquiries and concerns, and escalates audit/investigation, as needed., • Compiles detailed and organized records of audit/investigation findings, ensuring accuracy and compliance with legal and regulatory requirements., • Applies functional knowledge to create and implement strategies to identify and prevent fraudulent activities, safeguarding the integrity of the claims process., • Conducts interviews with relevant witnesses, claimants, and other stakeholders to gather additional information and perspectives on claims., • Communicates with appropriate internal teams to ensure the proper processing of audits/investigations, while adhering to legal and regulatory standards., • Ensures that all audit and investigative documents and records are processed into the database in a timely and accurate manner., • Communicates audit/investigation findings clearly and professionally to customers, claimants, and other stakeholders, managing expectations and providing updates., • Supports management in regular audit and investigation proceedings, ensuring full compliance with all applicable regional and federal standards, regulations, and protocols. Education and /or Skills and Experience Required: • Minimum Bachelor's Degree, • Prior experience in federal or state healthcare programs or a related field that demonstrates expertise in reviewing, analyzing, and making appropriate decisions related to fraud, waste and abuse. Preferred Skills/Experience: • Certified Fraud Examiner or Accredited Healthcare Anti-Fraud Investigator, • Prior successful experience with CMS and OIG/FBI or similar agencies, • Medicaid investigation experience strongly preferred, • Claims Analysis or Policy Research experience preferred If you match the requirements for this opportunity and believe you have the experience and talent to succeed in the role, we need to hear from you! Established in 2010, @Orchard LLC, also known as, Talent Orchard has an exceptional reputation, providing staffing solutions to time-sensitive, talent scarcity issues to deliver better talent management ROI. Our specialty lies in the critical area of program talent acquisition and resource management, not in one narrow skillset, but across many areas of technical and functional delivery. To learn more about our other exciting opportunities, visit our Jobs Page at .

Job Description WHO WE ARE: At CITON Claims Solutions, we don’t just stand out for what we do - we shine because of how we do it. By integrating cutting-edge, proprietary technology, innovative solutions, and compassion for serving our customers, we are redefining the insurance experience. Our vision is to be the global premier provider of insurance solutions, and our mission is to deliver an exceptional insurance experience through innovative technology, unparalleled customer service, and a comprehensive suite of products. Join Us as an Seasonal Claims Desk Adjuster Are you a detail-oriented investigator with a passion for helping others? We’re looking for an Seasonal W2 Desk Adjuster to work in our office located in Florida and or/Irving, TX. In this role, you’ll play a pivotal part in investigating, evaluating, and resolving insurance claims, ensuring fair and efficient processing in line with policy terms and company guidelines. WHAT YOU’LL DO: • Review Claims: Assess and analyze submitted claims documentation to determine validity and coverage., • Gather Essential Information: Communicate with policyholders, witnesses, and other involved parties to collect relevant details for claims evaluation., • Document Findings Thoroughly: Create detailed reports and maintain comprehensive notes to support claims assessments., • Analyze Coverage: Review insurance policies to determine applicable coverage and assess liability., • Prepare Reports: Submit thorough reports with findings and well-supported recommendations for claim settlements., • Negotiate Settlements: Work with policyholders and third parties to negotiate settlements that ensure fair and just outcomes., • Resolve Disputes: Handle disputes professionally and efficiently, ensuring favorable resolutions., • Maintain Clear Communication: Foster transparent and professional communication with policyholders and all stakeholders throughout the claims process., • Collaborate Across Teams: Partner with internal teams, including underwriters and legal advisors, to resolve complex claims., • Ensure Compliance: In all claims processes, comply with state and federal regulations and company policies., • Support Catastrophe Response: Provide critical support for claims management efforts during disaster events as needed. WHAT WE’RE LOOKING FOR: • Experience: Minimum of 3+ years in desk claims adjusting or related fields, with experience dealing with public adjusters., • Technical Skills: Proficiency with Xactimate and other Xactware products; strong analytical and problem-solving abilities; familiarity with local building codes and repair processes., • Licensing and Certifications: Valid adjuster’s license in Texas and/or Florida, • Insurance Knowledge: Strong understanding of insurance policies and claims processes., • Negotiation Skills: Excellent negotiation skills and experience in dispute resolution. WHAT’S IN IT FOR YOU: • Dynamic Environment: Thrive in a fast-paced, collaborative, and results-driven office where your contributions make a real impact., • Career Growth: Opportunities for professional development and advancement within a supportive company culture. If you’re excited to join a company that values innovation, teamwork, and your technical expertise, we’d love to hear from you. Take the next step in your IT career and help us keep our technology running smoothly! Apply Now and Become a Key Player in Our Success Story! CITON Claims Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Job Description Position Overview: We are seeking a highly skilled and experienced Principal Investigator medical physician to join our team. As the Principal Investigator, you will be responsible for oversight of all clinical trial studies according to study protocols, company processes and GCP. This is a part-time position with flexible hours, ranging from 20 to 30 hours per week. The exact hours will vary based on the needs of the clinical trial study, offering both adaptability and the opportunity to work on a dynamic and engaging project. Responsibilities: • Ensure the medical safety of study participants., • Oversee site personnel in the execution and delivery of safe trial practices., • Review and report on screening failures, safety and participant retention rates., • Oversee clinical evaluation and assessments of clinical trial studies., • Interface with IRBs and study Sponsors on a regular basis., • Comply with all medical duties per study protocols, SOP, GCP and state regulations., • Collect and analyze data to identify patterns or trends of the clinical trials., • Prepare detailed reports documenting findings and recommendations for improvement., • Stay up-to-date with the latest developments in SOPs and documentation requirements. Qualifications: • Active and unrestricted Medical License - Texas., • 2 years experience as a Principal Investigator of Sub-Investigator, preferred. Although we are willing to train the right candidate., • Strong analytical skills with the ability to collect, analyze, and interpret complex data., • Excellent written and verbal communication skills for report writing and presenting findings, • Ability to effectively manage a team and prioritize tasks in a fast-paced environment., • Attention to detail and ability to maintain confidentiality when handling sensitive Information. If you are a highly motivated individual with a passion for clinical research, we encourage you to apply for this position. License/Certification: • DEA License (Required), • Texas Physician's License (Required)

Job DescriptionSalary: $20 - $30 an hour DOE Delta Group is a privately held, woman-owned, national investigative firm established in 1983 and headquartered in Buford, Georgia. With over 40 years of experience, Delta Group was built on the foundations of three key factors: People, Innovation and Results. People have always been at the core of who we are at Delta Group, and we pride ourselves on a culture that fosters the development and growth of our team. When it comes to Innovation, Delta Group has integrated innovation as a key driver in the development of our quality investigative performance and results across everything that we do. Throughout 4 decades in business, Delta Group has always been a results-driven company. We have a longstanding history of commitment to our clients in building trust based on our results and relationships. Weve seen many changes during our tenure, but one thing that has never changed is our commitment to providing quality results. As we say at Delta Group, we are Big Enough to Matter, but Small Enough to Care!. We strive to provide a work culture that maintains our roots as a family-owned business and partner with our employees to get the results our clients need! Position Description: We are currently seeking talented and experienced Private Investigators to join our growing team. This role involves ethical and professional investigative work on Workers Compensation and Liability claims, primarily through surveillance and factual data collection. Details around Open PTO, field specific programs, and other perks can be discussed during the interview process. Job Responsibilities • Conduct surveillance on Liability and Work Comp Insurance claims., • Prolonged periods of sitting in a vehicle or other stationary positions during surveillance up to 12 hours per day., • Ability to travel to different locations for investigations, which may involve driving, walking, or using public transportation., • Maintain visual focus during surveillance activities, often for extended periods., • Ability to navigate various environments, including urban, rural, and indoor settings., • Ability to review and dissect comprehensive reports, as well as Police reports., • Ability to write a detailed surveillance report to Company Standards., • Ability to review video in order to properly prepare reports., • Ability to covertly document a Subject without being detected., • Ability to search, locateand utilizeSocial Mediathroughout the investigative process., • Ability to react quicklyand use good judgementto scenarios that may arise during surveillance., • Knowledge of pretexting is preferable., • Ability to think outside the box. Required: • Must be 18 years of age unless otherwise stated by State Licensure Laws, • Associate degree or comparable field experience preferred, • Must pass background check, • Must pass a clean driving record, • Must be willing to obtain investigator licensing within your home state Diligent Compensation Package: • $20-$30 per hour dependent on experience and geographical location, • Competitive Travel Rates, • Mileage Pay, • Lodging Cost Coverage, • Covert Video Pay, • Daily Report Writing Pay, • Overnight Stay Per Diem., • Opportunity for Potential Quarterly Bonus, • Additional Pay for Holiday Work, • Licensure Reimbursement for Eligible States (for Delta-specific licenses only) Competitive Benefits We offer competitive benefits to our field investigation employees. Benefits include: • Medical, dental and vision insurance, • Ancillary benefits to include short-term disability, long-term disability, accident, voluntary term and/or whole life insurance, critical illness and more!, • 401K eligible after 90 days!, • Field specific benefit programs, • Open PTO The Delta Difference • Supportive, dynamic, and collaborative work environment, • Dedicated Regional Field Supervisors with Investigative Experience, • Attentive Case Managers committed to client and investigator experience., • Flexible Schedule The final job level and annual salary will be determined based on the education, qualification, knowledge, skills, ability, and experience of the final candidate(s), and calibrated against relevant market data and internal team equity. Delta Group is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, age, religion, sex (including pregnancy, sexual orientation, gender identity / expression), national origin or ancestry, genetic information (including family medical history), physical or mental disability, protected veteran status, or any other characteristic protected under federal, state or local law, where applicable, and those with criminal histories will be considered in a manner consistent with applicable state and local laws. remote work