- CVS Health (Wellesley, MA)
- …solutions to make health care more personal, convenient and affordable. **Position Summary** The Special Investigations Unit is seeking a Sr. Manager to lead ... our new ASO investigations team. The Healthcare Fraud Senior Manager...eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long… more
- Manulife (Boston, MA)
- …+ Ability to apply a working knowledge of state laws and regulations related to insurance fraud and SIU requirements **What motivates you?** + You obsess ... build their JH careers. We are looking for a candidate with experience in insurance , Medicare, Long-Term Care or Disability fraud with expertise assessing and… more
- CVS Health (Columbus, OH)
- …high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high profile, those ... or an additional 5 years of working health care fraud , waste and abuse investigations . **Pay Range**...eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long… more
- Allied Universal (St. Paul, MN)
- …plans, employee assistance programs, and exclusive perks. 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
- USAA (Colorado Springs, CO)
- … experience working in diverse teams across multiple functions within SIU + SIU , Fraud Investigations , Military or Law Enforcement experience + Validated ... Come be a part of what makes us so special ! **The Opportunity** As a dedicated SIU ...investigating questionable, suspect claims activity in compliance with state insurance fraud -related laws and regulations and policies… more
- USAA (Orlando, FL)
- …+ Leads high exposure, high profile and critical work assignments, and special investigations involving sophisticated niche fraud referrals, (examples: ... Come be a part of what makes us so special ! **The Opportunity** As a dedicated SIU ...our members from potential fraudulent claims by investigating complex fraud investigations with significant financial impact to… more
- ICW Group (Sacramento, CA)
- …opportunities to contribute, develop, and belong. **PURPOSE OF THE JOB** The purpose of the Special Investigations Unit ( SIU ) Coordinator is to provide ... The SIU Coordinator will regularly communicate with Department of Insurance (DOI) personnel, District Attorney Offices, Private Investigations (PI) partners,… more
- Humana (Indianapolis, IN)
- …**Required Qualifications** + Bachelor's degree + At least 2 years of healthcare fraud investigations and auditing experience + Knowledge of healthcare payment ... (OMPP PI) and other agencies such as the Medicaid Fraud Control Unit (MFCU) and coordinate all...encourage sensible and culturally-competent business standards + Oversee internal investigations of FWA compliance issues + Work with the… more
- Elevance Health (Los Angeles, CA)
- …questions as necessary to aid in investigations . + Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern. ... CPC - Clinical Fraud Investigator II - SIU Fraud & Abuse** **Location:** This position...clinical evaluation of the collected data. + Performs in-depth investigations on identified providers as warranted. + Examines claims… more
- NJM Insurance (Trenton, NJ)
- NJM is considering 2025 summer interns for our Special Investigations Unit , ( SIU ). Interns for the summer season will assist the SIU in anti- fraud ... and leveraging internal and external data sources to support SIU 's policy and claim investigations . The ...Attend virtual industry meetings to broaden exposure to the insurance industry. Qualifications and Required Skills: + Math, Statistics,… more
- Molina Healthcare (KY)
- …(surgical, hospital, clinic settings) or 5+ years of experience working in a FWA / SIU or Fraud investigations role for New Jersey/New York location + ... **JOB DESCRIPTION** **Job Summary** The SIU Coding Investigator is responsible for investigating and...State & Federal laws and regulations pertaining to health insurance , investigations & legal processes (Commercial … more
- CareFirst (Columbia, MD)
- **Resp & Qualifications** **PURPOSE:** The role of the Special Investigations Unit ( SIU ) Investigator, Sr. is to assist in the reduction and recuperation ... State/Federal criminal statutes and criminal and civil law impacting insurance fraud /abuse investigations to preserve...assigned by management to meet the needs of the Special Investigations Unit . **QUALIFICATIONS:** **Education… more
- Centene Corporation (Sacramento, CA)
- … investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse. + Conduct investigations of potential waste, abuse, and ... abuse, and fraud + Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions… more
- CVS Health (Columbus, OH)
- …high level, complex investigations of known or suspected acts of healthcare fraud , waste and abuse. + Conduct Investigations to prevent payment of suspect ... Facilitates the recovery of company and customer money lost as a result of fraud , waste and abuse. + Cooperates with federal, state, and local law enforcement… more
- Allied Universal (Billings, MT)
- …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
- Fallon Health (Worcester, MA)
- …clinical background. + Strong attention to detail with the ability to identify fraud , assess the impact, resolve investigations , mitigate risk, and capture ... we strive to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for… more
- Centene Corporation (Austin, TX)
- …potential FWA, including the coordination of internal investigations with the Special Investigations Unit and the development of appropriate corrective ... and implementation of Corrective Action Plans + Coordinating potential fraud investigations and referrals from and with the SIU , where applicable, and… more
- NJM Insurance (Trenton, NJ)
- … fraud and promptly notify the supervisor if a case warrants investigation by the Special Investigations Unit ( SIU ). + Prepare and issue monthly audit ... assignments for NJM auditors and independent audit vendors. Include relevant policy information and instructions as required to ensure efficient audit processing. + Identify and process estimated audits for policyholders who are noncompliant with mail audit… more
- Magellan Health Services (San Diego, CA)
- …with the Internal Audit and Special Investigations Unit ( SIU ) on compliance matters including fraud , waste, and abuse auditing and monitoring, as ... of or support of the SBU and/or Corporate Compliance Program, Health Insurance Portability and Accountability Act (HIPAA) compliance, including audits and the… more
- Point32Health (Canton, MA)
- …the effectiveness of corrective action plans. + ** Fraud Prevention:** Work with the Fraud Special Investigations Unit to ensure compliance with CMS ... issues and requirements. + **Administrative Management:** Oversee the compliance unit 's administrative tasks, including document organization, report preparation, and… more