- CVS Health (Hartford, CT)
- …(CPC) will perform medical claim reviews for the Special Investigations Unit ( SIU ) to ensure compliance with coding practices through a comprehensive ... Including but not limited to claim reviews for legal, compliance or rework projects. + Provide detailed written summary...Collaboration with investigators, data analytics and plan leadership on SIU schemes. + Act as management back-up and supports… more
- CVS Health (Columbus, OH)
- …deliver solutions to make health care more personal, convenient and affordable. The Special Investigations Unit is seeking a Manager to lead our team of ... working closely with internal and external stakeholders and ensuring compliance with regulatory requirements. The Manager develops...for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed… more
- CVS Health (Hartford, CT)
- …of five years of experience managing healthcare fraud, waste, and abuse investigations , Compliance Auditing, Program Integrity, Regulatory Oversight, ... personal, convenient and affordable. As the Manger of Business Compliance of Quality Review, Training, and Program ...needs. + Assess training needs and collaborate with the SIU Sr. Manager to create development plans… more
- CVS Health (Albany, NY)
- …States **Preferred Qualifications** + Experience In Medicaid Compliance , Medicaid Investigations , MCO Medicaid FWA Unit in the following States: Florida, ... with department leaders to fulfill the requirements of the program integrity unit + Comply with all...Special Investigation or Medicaid / Medicare / Commercial Compliance role + Ability to travel up to 10%… more
- CVS Health (Hartford, CT)
- …environment. + Direct and oversee all fraud detection activities and investigations , ensuring alignment with organizational objectives and compliance standards. ... convenient and affordable. **Position Summary** We are seeking an experienced Healthcare Fraud Manager to lead and oversee a team of investigators in our efforts to… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …serve through our Healthsource blog: https://healthsource.premera.com/ . As a member of Premera's Special Investigations Unit ( SIU ), the **Investigator ... SIU budget, performance metrics, and data analysis for SIU compliance /performance audits, to be delivered to...required. + Assist in developing, planning, and reporting the SIU budget. + Participate in special projects,… more
- RELX INC (Concord, NH)
- …relationships with internal and external customers to raise brand awareness of the Special Investigations Unit . + Other duties as assigned. Qualifications ... Risk at the link below. https://risk.lexisnexis.com/government About our Team The Public Safety Special Investigative Unit ( SIU ) is comprised of former law… more
- VNS Health (Manhattan, NY)
- …parties that support the Health Plans and Provider Services. Special Investigation Unit ( SIU ) Only: + Conducts investigations of allegations or reports ... OverviewManages the activities of the Compliance Program for one or more... and legal counsel leadership, as appropriate. Assists in SIU related investigations . + Manages the Sanctions… more
- Travelers Insurance Company (Lake Oswego, OR)
- …internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit . + ... employment. As part of our comprehensive compensation and benefits program , employees are also eligible for performance-based cash incentive...Identifies and refers claims with Major Case Unit exposure to the manager . + Performs… more
- Travelers Insurance Company (Phoenix, AZ)
- …internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit . + ... employment. As part of our comprehensive compensation and benefits program , employees are also eligible for performance-based cash incentive...Identifies and refers claims with Major Case Unit exposure to the manager . + Performs… more
- Fallon Health (Worcester, MA)
- …training to SIU staff related to clinical topics as neededFWA Manager will oversees the day-to-day operations over investigations and allegations into ... theAnalyze and interpret patient medical records pertaining to FWA investigations Compare to information submitted on the claims in...their leadership of the Fraud, Waste and Abuse (FWA) program . The FWA Manager will be responsiblefor… more
- Kemper (Lake Mary, FL)
- …wage and other expense claim investigation forms and form letters. Compliance with Standard Operating Procedures, Regulatory and Statutory requirements and/or Best ... coverage issues identified during the coverage investigation. Conduct liability investigations utilizing investigative tools and processes to include obtaining… more
- Humana (Indianapolis, IN)
- …accurate and timely encounter submissions. + Works with the Special Investigation Unit ( SIU ) Manager to assure that service billing and utilization ... help us put health first** Humana Healthy Horizons in Indiana is seeking a Manager , Claims Research & Resolution, who leads a team that focuses on supporting… more
- Travelers Insurance Company (Downers Grove, IL)
- …in on-going training sessions for the inside auto business. + Works closely with Unit Manager or mentor to promptly resolve assigned claim. + Customer ... of employment. As part of our comprehensive compensation and benefits program , employees are also eligible for performance-based cash incentive awards. **Salary… more