- Elevance Health (Nashville, TN)
- ** Investigator Senior ** **Supports the Payment Integrity line of business** _Location: This position will work a hybrid model (remote and office)._ _Alternate ... determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** Investigator Senior ** is responsible for the independent identification,… more
- Elevance Health (Tampa, FL)
- ** Investigator Senior ** **Location:** This position will work a hybrid model (remote and office). Ideal candidates must live within 50 miles of one of our ... to recover, eliminate and prevent unnecessary medical-expense spending. The ** Investigator Senior ** will be responsible for the...claims . **How you will make an impact:** + Claim reviews for appropriate coding, data mining, entity review,… more
- City of New York (New York, NY)
- …in their agreement to repay. Claims &Collection is recruiting for (4) four Fraud Investigator II to function as a Senior Fraud Investigator , who will: - ... Job Description Claims and Collections pursues monetary recoveries owed to...and one year of satisfactory, full-time experience as an investigator as described in "1" above; or 3. A… more
- CVS Health (Charleston, WV)
- …make health care more personal, convenient and affordable. **Position Summary** As a Senior Investigator you will conduct high level, complex investigations of ... or intricate healthcare fraud schemes. + Investigates to prevent payment of fraudulent claims submitted to the Medicaid lines of business + Researches and prepares… more
- CVS Health (Trenton, NJ)
- …work from home anywhere in the United States. We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna ... abuse. + Conduct Investigations to prevent payment of suspect or fraudulent claims submitted by insured's, providers, claimants, and customers. + Researches and… more
- EFI Global (Sacramento, CA)
- …buildings or residences. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Investigates assigned claims suspected of insurance fraud, this includes large loss, large ... fire loss, and multiple claims . + Ensures that assigned cases are investigated and...ethical manner. + May provide investigative guidance to Fire Investigator team members. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs… more
- 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
- CVS Health (Providence, RI)
- …convenient and affordable. Kentucky Resident is preferred The SIU Investigator conducts complex investigations to effectively pursue the prevention, investigation ... in a prepayment environment - Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc. - Researches and prepares cases… more
- OneMain Financial (Baltimore, MD)
- …. Judgmental skills necessary to escalate high-risk matters to Fraud Manager, Senior Investigator and/or management. . Motivated and results oriented with ... The Claims Analyst/ Investigator has an above...and aptitude related to personal loan and credit card claim /chargeback processing, lending, collections, or fraud investigations with the… more
- EFI Global (Salt Lake City, UT)
- …RESPONSIBILITIES** + Accepts assignments from customers for investigation of losses or claims and pursues investigation in accordance with the specific needs of the ... assignment. + Determines the origin and cause of the loss/ claim under investigation and identifies any potential third-party responsibility for subrogation… more
- Allied Solutions (Plano, TX)
- …all established recovery and claim service standards and benchmarks for a Claims Investigator . + Promptly and effectively respond to both carrier and lender ... is responsible for the initial setup and investigation of claims prior to the assignment of the claim...Total Losses ; refer timely and accurately to more senior level adjusting staff for adjudication and collection; +… more
- ICW Group (Sacramento, CA)
- …The purpose of this job is to detect, prevent, and investigate suspected fraudulent claims for all lines of insurance, with heavy emphasis on Workers' Compensation ... claims . This position exists in order to protect company...agencies. + Prepares and presents completed investigations to appropriate senior staff and/or criminal justice personnel in a highly… more
- Elevance Health (Charleston, WV)
- …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**...of proprietary data and claim systems for review of facility,… more
- University of Rochester (Rochester, NY)
- …the University community and meet the University's legal obligations to address claims of discrimination and harassment. Makes and documents findings that serve as ... agency investigations and lawsuits. The Equal Employment Opportunity and Title IX Investigator (EEO/Title IX Investigator ) serves as part of a team… more
- San Jose State University (San Jose, CA)
- … Investigator Apply now (https://secure.dc4.pageuppeople.com/apply/873/gateway/default.aspx?c=apply&lJobID=544207&lJobSourceTypeID=837&sLanguage=en-us) Job no: 544207 ... MPP, At-Will, Compliance/Legal, Full Time Job Summary The Civil Rights Investigator is responsible for conducting investigations pertaining to protected status… more
- HCA Healthcare (Charleston, SC)
- …We care like family! Jump-start your career as a Research Outcomes Investigator Jr today with Trident Medical Center. **Benefits** Trident Medical Center, offers ... location._** Come join our team as a Research Outcomes Investigator Jr. We care for our community! Just last...to help achieve the company's vision. * Collaborate with Senior Management on strategic planning; provide effective leadership in… more
- Constructive Partnerships Unlimited (Manhattan, NY)
- Incident Management Investigator Specialist Type of Position Full time Search Location(s) Manhattan, NY Apply Now ... (https://phe.tbe.taleo.net/phe03/ats/careers/v2/applyRequisition?org=CPOFNYS&cws=37&rid=6380) Job Brief Assists the Incident Management Investigator with conducting investigations into situations, which may violate… more
- Kanaan Communications, LLC (Palm Beach Gardens, FL)
- …memberships, pet insurance, and much more! What you'll do as a Sr Investigator + Conduct investigations into claims of potential harassment, discrimination, ... Discover a more connected Sr Investigator career At Dycom Industries, Inc as a...investigation results + Provide investigations, findings and summaries to senior leadership + Conduct various data analysis on complaints… more
- Constructive Partnerships Unlimited (Manhattan, NY)
- Incident Management Investigator Type of Position Full time Search Location(s) Manhattan, NY Apply Now ... recommendations. 5. In conjunction with the assigned Incident Management Investigator Specialist, prepares investigative reports and forwards completed reports to… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …. As a member of Premera's Special Investigations Unit (SIU), the ** Investigator II** is responsible for developing, collecting, and evaluating information and data, ... as a fraud investigation. + Compile, manipulate, interpret, and document complex claims payment data to determine the company's potential financial exposure to a… more