- CVS Health (Atlanta, GA)
- …all with heart, each and every day. **Position Summary** - Conducts investigations to effectively pursue the prevention, investigation and prosecution of healthcare ... to comply with state regulations mandating fraud plans and practices. - Conducts investigations of known or suspected acts of healthcare fraud and abuse. -… more
- UPMC (Pittsburgh, PA)
- …is a remote position. Under the direction of the manager, the Special Investigations Unit ( SIU ) Investigator is responsible for investigating ... UPMC Health Plan has an exciting opportunity for a Special Investigations Unit Investigator...supporting current SIU staff and manager with investigations and special projects. Responsibilities: + Maintain… more
- Centene Corporation (Frankfort, KY)
- …Position acts as a subject matter expert for the Contractor's Program Integrity unit to reduce Fraud, Waste and Abuse of Medicaid services within Kentucky. Provides ... + Manage and coordinate cases being investigated by the SIU + Maintain all vendor cases + Assist with...Maintain all vendor cases + Assist with conducting complex investigations , including on-site investigations , review, complete and… more
- CVS Health (Columbus, OH)
- …do it all with heart, each and every day. **Position Summary** As a Senior Investigator you will conduct high level, complex investigations of known or suspected ... in identifying resources and best course of action on investigations + Serves as back up to the manager...waste and abuse matters. + Working knowledge of medical coding ; CPT, HCPCS, ICD10 + Proficiency in Microsoft Office… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …OMIG's minimum investigator requirements as follows: Persons employed by the SIU as investigators shall be qualified by education or experience, which shall ... criminal justice or related field; or employment as an investigator in the SIU on or before...and supporting systems. (BREADTH). + Expertise in complex clinical coding /reviewing assignments, difficult investigations and highly visible… more
- MVP Health Care (Tarrytown, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Clinical Investigator ** to join #TeamMVP. This is the opportunity for you if you have ... a passion for problem solving and investigations , commitment to compliance and ethical standards and dedication...involving economic or insurance related matters. + A clinical investigator must have in addition to the above requirements:… more
- Point32Health (Canton, MA)
- …an essential team member of the Special Investigation Unit (" SIU ") responsible for leading complex provider investigations related to fraud, waste, and ... **Job Summary** The Investigator I is...for conducting high-volume Pre-Payment Fraud Waste & Abuse ("FWA") investigations under the direction of the Manager, FWA Prepayment… more
- Molina Healthcare (Covington, KY)
- **JOB DESCRIPTION** **Job Summary** Under direct supervision of the Manager, SIU , the Team Lead is responsible to lead a small team of investigators and provide ... on daily investigative activities as a back-up to the SIU Manager. This position will be accountable for tracking...Manager. This position will be accountable for tracking on investigations conducted by his/her team and will provide oversight… more
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