• Healthcare Fraud Senior Manager,…

    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
    CVS Health (11/02/24)
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  • LTC Fraud Investigator

    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
    Manulife (10/31/24)
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  • Special Investigations Unit

    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
    CVS Health (11/10/24)
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  • SIU Investigator - Part-Time

    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
    Allied Universal (11/14/24)
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  • Mid-Level Field SIU Investigator

    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 (11/13/24)
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  • Senior SIU Investigator - major case field…

    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
    USAA (11/08/24)
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  • Special Investigations Unit

    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
    ICW Group (11/01/24)
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  • Senior Fraud and Waste Investigator,…

    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
    Humana (11/07/24)
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  • Nurse and CPC - Clinical Fraud Investigator…

    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
    Elevance Health (10/01/24)
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  • SIU Analyst Intern - Summer

    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
    NJM Insurance (11/12/24)
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  • Investigator, Coding SIU (Remote)

    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
    Molina Healthcare (11/06/24)
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  • Senior Investigator (Hybrid)

    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
    CareFirst (10/28/24)
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  • SIU Investigator

    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
    Centene Corporation (10/06/24)
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  • SIU Senior Investigator (Fully Remote)

    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
    CVS Health (11/09/24)
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  • Surveillance / Claims Investigator

    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
    Allied Universal (11/14/24)
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  • Fraud Waste and Abuse (FWA) Audit Manager

    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
    Fallon Health (11/09/24)
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  • Medicare Compliance Officer

    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
    Centene Corporation (09/20/24)
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  • Premium Audit Reviewer

    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
    NJM Insurance (11/14/24)
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  • Compliance Manager - Must Reside in California

    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
    Magellan Health Services (11/15/24)
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  • Senior Manager, Compliance

    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
    Point32Health (10/29/24)
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