- Usaa (Washington, DC)
- …What sets you apart: SIU experience conducting low to complex PNC fraud investigations OR a combination of Claims and Law Enforcement Investigations ... claims by investigating questionable, suspect claims activity in compliance with state insurance fraud -related laws and regulations and policies and procedures.… more
- Usaa (Seattle, WA)
- …policy provisions. Reviews claims/suppliers for fraud indicators and refers to Special Investigations Unit for handling, if applicable. Maintains ... we treat each other and our members. Be part of what truly makes us special and impactful. The Opportunity We are hiring an Auto Appraiser for the Washington State… more
- Allied Universal (Winchester, VA)
- …best, explore a career with us and make a difference. Allied Universal(R) is hiring a Special Investigations Unit ( SIU ) Investigator. Special ... SIU Specialist must use their extensive knowledge of Insurance policies and the components of fraud ...Proficient in utilizing laptop computers and cell phones. + Special Investigative Unit ( SIU ) Compliance… more
- Philadelphia Insurance Companies (Ewing, NJ)
- … investigations of suspect insurance claims and policy applications. Conduct insurance fraud investigations in accordance with applicable law and ... to join our team! Summary : Evaluate referred insurance claims for potential insurance fraud...applications referred to the SIU for possible fraud . Conduct database investigations , including use of… more
- USAA (Auburn, ME)
- …**What sets you apart:** + SIU experience conducting low to complex PNC fraud investigations OR a combination of Claims and Law Enforcement Investigations ... claims by investigating questionable, suspect claims activity in compliance with state insurance fraud -related laws and regulations and policies and procedures.… more
- Kemper (Doral, FL)
- …coordinate investigations with outside SIU contacts, the Department of Insurance Fraud Division, NICB, and various law enforcement agencies. A laptop ... claims referred to and accepted for investigation by the Special Investigative Unit . Our Special ...Fraud Claims Law Associate (FCLA) designations and Certified Insurance Fraud Investigator (CIFI) or Certified … more
- Elevance Health (Seattle, WA)
- …questions as necessary to aid in investigations . + Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern. ... **Clinical Fraud Investigator II - Registered Nurse and CPC...- Registered Nurse and CPC - Calrelon Payment Integrity SIU ** **Location:** This role enables associates to work virtually… more
- Centene Corporation (Frankfort, KY)
- …Purpose:** Position acts as a subject matter expert for the Contractor's Program Integrity unit to reduce Fraud , Waste and Abuse of Medicaid services within ... + Manage and coordinate cases being investigated by the SIU + Maintain all vendor cases + Assist with...the Bachelors Degree . 5+ years of management experience Investigations and healthcare fraud -related investigations … more
- Centene Corporation (Tallahassee, FL)
- …of Florida. **Position Purpose:** Oversee a full range of waste, abuse and fraud investigations , audits and medical code editing scenarios. Ensure all audits ... adhere to federal and state Medicaid fraud , waste and abuse guidelines. + Oversee the activities...and abuse guidelines. + Oversee the activities of the SIU for accurate and timely operational reviews and final… more
- Point32Health (Canton, MA)
- …individuals to join our organization as a Fraud Operations Specialist within our Special Investigations Unit (" SIU "). The Fraud Operations ... regulators and other parties with direct interaction with the SIU . The Sr. Fraud Operations specialist will...groups, and committees. + Responsible for leading complex provider investigations related to fraud , waste and abuse,… more
- Allied Universal (Schenectady, NY)
- …standards in their home state and within their designated region of the country + Special Investigative Unit ( SIU ) Compliance knowledge + Ability to type 40+ ... of four (4) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims +...+ Certified Fraud Investigator (CFE) + Certified Insurance Fraud Investigator (CIFI) + Fraud… more
- Iowa Department of Administrative Services (Des Moines, IA)
- …- Investigator (ICA-I) have many of the same skills that an insurance company Special Investigations Unit ( SIU ) or similar investigators have and ... vital role in identifying and mitigating risks associated with fraud and misconduct in the Insurance Industry...that would assist an applicant would be: + Private investigations . + Insurance company ( SIU )… more
- Point32Health (Canton, MA)
- …is an essential team member of the Special Investigation Unit (" SIU ") responsible for leading complex provider investigations related to fraud , ... criminal justice Experience + Required (minimum): 1-3 years' related experience in health insurance fraud investigations . + Preferred: Related experience in… more
- Humana (Oklahoma City, OK)
- …caring community and help us put health first** Humana's Special Investigations Unit is seeking a Senior Fraud & Waste Investigator to join the Oklahoma ... for OHCA and other agencies such as the Medicaid Fraud Control Unit (MFCU) and coordinate all...be an Oklahoma resident** + 2+ years of healthcare fraud investigations and auditing experience + Knowledge… more
- MVP Health Care (Tarrytown, NY)
- …RN. + New York State Nursing license required (RN preferred). Experience in health insurance fraud investigations preferred. + Obtain CPC and/or COC ... if you have a passion for problem solving and investigations , commitment to compliance and ethical standards and dedication... conducted by government agencies, law enforcement, and other insurance company SIU staff. + Make recommendations… more
- Elevance Health (Costa Mesa, CA)
- …office. **Position Overview:** Responsible for providing leadership and guidance to the Special Investigations Unit **Pharmacy** team in investigating, ... the team manager with the administration and operational activities occurring within the Special Investigations Unit for **pharmacy Investigations ** ;… more
- NJM Insurance (Trenton, NJ)
- …every 60-90 days for status; and assist GC Legal in reviewing the NJM Special Investigations Unit ( SIU ) fraud investigations . + Prepare annual ... using data provided from various sources including financial metrics databases, the NJM SIU , the GC Subrogation Department, GC Legal Staff, and GC Staff. + Review… more
- Point32Health (Canton, MA)
- …to join our organization as an Analytics & Triage Fraud Analyst within our Special Investigations Unit (" SIU "). The Analytics & Triage Fraud ... Analyst is an essential team member of the SIU , responsible for analyzing claim trends, patterns and outliers, developing and refining queries to detect potentially… more
- TEKsystems (Austin, TX)
- Investigator, Special Investigations Unit The position of Investigator within the SIU -FIU will be an individual contributor role responsible for ... example: * Emerging Threats * Terrorist Financing * Internal Investigations and Referrals * Large Fraud Rings...- Pre-tax and Roth post-tax contributions available * Life Insurance (Voluntary Life & AD&D for the employee and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …+ Prepares recommendations on preventive/corrective measures for the deterrent of future fraud . + Supports other SIU investigators and analysts with their ... apply! Job Description: Summary: Under the guidance of the SIU Management, this position is responsible for the accurate...five years in the healthcare field working in FWA investigations and audits; or five years of insurance… more
