- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The role of the Special Investigations Unit (SIU) Investigator , Sr. is to assist in the reduction and recuperation of losses ... of financial business records, provider and subscriber medical data, claims , systems? reports, medical records, analysis of contract documents, provider/subscriber… more
- Elevance Health (Indianapolis, IN)
- …paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use ... **Senior Investigator ( Investigator Sr)** _Location: This position will work...of proprietary data and claim systems for review of facility, professional… more
- USAA (Chicago, IL)
- …of what makes us so special! **The Opportunity** As a dedicated SIU field investigator , within defined guidelines and framework, you will help protect USAA and our ... members from potential fraudulent claims by investigating complex fraud investigations with significant financial...state laws and regulations. + Must be a skilled investigator with experience taking sophisticated statements from multiple parties… more
- Elevance Health (Houston, TX)
- …paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use ... ** Investigator II** **Supporting the Payment Integrity line of business** _Location:...of proprietary data and claim systems for review of facility, professional… more
- University of Rochester (Rochester, NY)
- GENERAL PURPOSE: The Equal Employment Opportunity and Title IX Investigator (EEO/Title IX Investigator ) serves as part of a team investigating and resolving ... and meet the University's legal obligations to address discrimination and harassment claims and sexual misconduct. Document findings as to the basis for significant… more
- University of Rochester (Rochester, NY)
- GENERAL PURPOSE: The Equal Employment Opportunity and Title IX Investigator (EEO/Title IX Investigator ) serves as part of a team investigating and resolving ... and meet the University's legal obligations to address discrimination and harassment claims and sexual misconduct. Document findings as to the basis for significant… more
- USAA (San Antonio, TX)
- …a part of what makes us so special! **The Opportunity** As a dedicated SIU investigator , you will protect USAA and our members from potential fraudulent claims ... on any questionable or suspect first or third part claims . + Participates in the development of fraud prevention...offer:** **Compensation:** USAA has an effective process for assessing market data and establishing ranges to ensure we remain… more
- Elevance Health (Los Angeles, CA)
- **Nurse and CPC - Clinical Fraud Investigator II - SIU Fraud & Abuse** **Location:** This position will work a hybrid model (remote and office). The ideal candidate ... **Hybrid Workplace Strategy:** 1-2 days in office per week The **Clinical Fraud Investigator II** is responsible for identifying issues and/or entities that may pose… more
- Elevance Health (Columbus, GA)
- ** Investigator Assistant** **_Location:_** _This position will work a hybrid model (1-2 days/week in office). The ideal candidate will live within 50 miles of one of ... to recover, eliminate and prevent unnecessary medical-expense spending. The ** Investigator Assistant** is responsible for providing administrative support to the… more
- US Army Joint Munitions Command (Mcalester, OK)
- …Command located at McAlester Army Ammunition Plant. This position serves as an investigator of offenses committed by or against military and civilian personnel, or ... use, assaults, rape, murder, robbery, etc. Conducts investigations of Workers' Compensation claims and recipients of benefits to identify fraud or reduce cost.… more
- Highmark Health (Dover, DE)
- …Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of provider facility payment ... methodology, claims processing systems and coding and billing proficiency +...and expected contributions, as well as internal peer equity, market , and business considerations. The displayed salary range does… more
- USAA (San Antonio, TX)
- …Property & Casualty** , you will be responsible for operational management of Claims fraud investigative teams. Directs staff in the investigation of cases involving ... for insurance fraud detection and investigation services to reduce fraud-related claim payments and costs, while avoiding unwarranted risk. + Ensures compliance… more
- Lilly (IN)
- …Lilly. + Phase 3 development planning (patient reported outcome plans, key market regulatory needs, CT material sourcing, drug substance commercial format, pediatric ... + Commercial strategy development (innovation readiness activities, asset profiling, market research, payer insights, generic naming convention, product naming,… more
- J&J Family of Companies (Cincinnati, OH)
- …with R&D, Global Strategic Marketing, Commercial, and HEMA (Health Economics and Market Access). This role will also provide strong input on long-term product ... to drive evidence generation and dissemination activities that support product approvals, claims development, and product adoption. This role will also work closely… more
- Mount Sinai Health System (New York, NY)
- …preferred. ? Firm understanding of Facility, Professional and Pharmacy claim reimbursement preferred. ? Verbal presentation experience, especially with senior ... partners and ensure key milestones are achieved. * Perform market research to collect key industry data points related...and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges.… more
- BAE Systems (Broomfield, CO)
- …experience advising clients on labor and employment matters and managing employment litigation, claims , and disputes. This position is part of the BAE Systems Legal ... of employee relations and ethics matters. Serve as lead investigator in high-level or sensitive matters. + Review and...$278800.000 Please note: This range is based on our market pay structures. However, individual salaries are determined by… more
- MyFlorida (Miami, FL)
- …cosmetics. Your Specific Responsibilities: This is a career service, non-sworn investigator position assigned to the Jacksonville Office. The selected applicant: + ... also established an email where people can electronically file claims or ask questions. The email is ###@fdva.state.fl.us. The...by the close of the vacancy announcement. Location: MIAMI, FL, US, 33166 DORAL, FL, US, 33166 Nearest Major Market… more
- Mount Sinai Health System (New York, NY)
- …when limited patient information is available and ensures that quoted estimates are market competitive. 3.Notifies and submits the estimate of charge summary as well ... and representatives to ensure billing format is updated and claims are submitted in a timely manner per protocols....and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges.… more
- Stanford University (Stanford, CA)
- …will work with minimal supervision under the direction of the project Principal Investigator . We are looking for candidates highly proficient in SAS and SQL with ... Warehouse is a plus. + Prior experience with medical claims and billing data is a plus. + Prior...departmental budget availability, internal equity, geographic location, and external market pay for comparable jobs.** **At Stanford University, base… more
- MyFlorida (Miami, FL)
- …Legal. Your Specific Responsibilities: This is a career service, non-sworn investigator position assigned to the Tallahassee Headquarters Office. The selected ... established an email where people can electronically file claims or ask questions. The email is ###@fdva.state.fl.us.… more