- USAA (San Antonio, TX)
- …of 10 consecutive business days each calendar year. As a dedicated with **Director, Special Investigations Unit ( SIU ),** you will be responsible ... fraud investigation programs and management of the Life Special Investigation Unit ( SIU ) staff....broad understanding of procedures related to SIU investigations . + Knowledge and experience in fraud … more
- USAA (Atlanta, GA)
- …+ 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
- 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
- Allied Universal (Rochester, NY)
- …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
- 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
- Travelers Insurance Company (Franklin, TN)
- …obtain assistance in conducting investigations . + Identifies cases for potential insurance fraud prosecution and submits questionable claims to the National ... into actionable investigative strategies including the identification of complex case investigations . + Conducts insurance investigations including… 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 (Woburn, MA)
- …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 - SIU Fraud & Abuse** **Location:** This...clinical evaluation of the collected data. + Performs in-depth investigations on identified providers as warranted. + Examines claims… more
- Elevance Health (Manchester, NH)
- …and billing issues, trends, and changes in laws/regulations. + Collaborates with the Special Investigation Unit and other internal areas on matters of mutual ... for identifying issues and/or entities that may pose potential risks associated with fraud and abuse. **How you will make an impact:** + Examines claims for… more
- Molina Healthcare (IA)
- …(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
- Centene Corporation (New York, NY)
- …workplace flexibility. **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
- 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
- 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
- Allied Universal (Charleston, WV)
- …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
- 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
- Magellan Health Services (Honolulu, HI)
- …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
- Humana (Richmond, VA)
- …necessary. + Coordinate with the Special Investigations Unit ( SIU ) to operate and effective fraud , waste and abuse program integrity program. **Use ... Experience working with regulatory agencies, including state departments of health insurance and/or CMS + Knowledgeable in process improvement **Scheduled Weekly… 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