• Anti-Money Laundering Subject Matter Expert (SME)…

    Capital One (Mclean, VA)
    …(19050), United States of America, McLean, Virginia Anti-Money Laundering Subject Matter Expert (SME) - Special Investigations Unit ( SIU ) The Special ... Investigations Unit in the AML Department performs specialized investigations to assess risks presented in particular circumstances. A Subject Matter Expert… more
    Capital One (12/09/24)
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  • Part Time Private Investigator - Special

    The Robison Group (St. Louis, MO)
    …searches, and other investigative tasks. This is a remote opportunity for part-time employment in our Special Investigations Unit ( SIU ). As an SIU ... are interested in utilizing their investigative skills to conduct a variety of investigations on insurance related matters; such as auto and property theft, fire… more
    The Robison Group (01/03/25)
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  • Certified Professional Coder, Special

    CVS Health (Columbus, OH)
    …The Certified Professional Coder (CPC) will perform medical claim reviews to ensure compliance with coding practices through a comprehensive record review for ... Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world.… more
    CVS Health (01/04/25)
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  • Manager, Fraud and Waste * Special

    Humana (Columbus, OH)
    …enforcement authorities to coordinate investigations and supervises the activities of the Special Investigations Unit ( SIU ) to ensure accurate and ... put health first** The Manager, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The...field or equivalent. 7+ years of related compliance and/or special investigation experience in managed care or CMS. +… more
    Humana (12/19/24)
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  • Student Intern ( Special

    LA Care Health Plan (Los Angeles, CA)
    Student Intern ( Special Investigations Unit ) Job Category: Administrative, HR, Business Professionals Department: Talent Strategy & HR Technology Location: ... Additional Information + Provide analytical support to active Healthcare Fraud investigations . + Conduct case intake from various sources including hotline… more
    LA Care Health Plan (12/07/24)
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  • Senior Fraud and Waste Investigator,…

    Humana (Indianapolis, IN)
    …Program Integrity (OMPP PI) and other agencies such as the Medicaid Fraud Control Unit (MFCU) and coordinate all aspects of FWA activities in Ohio to increase ... to encourage sensible and culturally-competent business standards + Oversee internal investigations of FWA compliance issues + Work with the Contract Compliance… more
    Humana (12/19/24)
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  • SIU Investigator - Part-Time

    Allied Universal (Rutland, VT)
    …plans, employee assistance programs, and exclusive perks. Allied Universal(R) is hiring a Special Investigations Unit ( SIU ) Investigator. Special ... designated regional area. + Proficient in utilizing laptop computers and cell phones. + Special Investigative Unit ( SIU ) Compliance knowledge + Ability to… more
    Allied Universal (01/09/25)
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  • Director, SIU / Fraud Waste and Abuse…

    Molina Healthcare (AZ)
    **Knowledge/Skills/Abilities** Acts as liaison between Special Investigations Unit ( SIU ) operations and contracted vendor(s) to assure a smooth workflow ... Associate Vice President of Fraud, Waste and Abuse (FWA) and Associate Vice President of Special Investigations Unit ( SIU ) to oversee the special more
    Molina Healthcare (01/04/25)
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  • Investigator, SIU -Miami, Florida

    Molina Healthcare (Miami, FL)
    **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit ( SIU ) Investigator is responsible for supporting the prevention, detection, investigation, ... review audits that may also include coding and billing reviews. The SIU Investigator is responsible for reviewing and analyzing information to draw conclusions… more
    Molina Healthcare (12/15/24)
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  • Senior Healthcare Fraud Investigator (Aetna…

    CVS Health (Tallahassee, FL)
    …are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU ). In this role, you will manage ... fraud, waste and abuse (FWA). **Key Responsibilities** + Conduct high level, complex investigations of known or suspected acts of healthcare fraud, waste and abuse.… more
    CVS Health (11/21/24)
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  • Special Investigation Unit Reporting…

    CVS Health (Columbus, OH)
    …to make health care more personal, convenient and affordable. **Position Summary** The Aetna Special Investigations Unit ( SIU ) Data Analytics team is ... looking for a data-driven individual that can analyze big data and create a story through data aggregation and reporting. The ideal candidate would have a solid understanding of medical claim data, experience with data analysis & visualization and… more
    CVS Health (01/05/25)
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  • SIU Investigator

    NJM Insurance (Parsippany, NJ)
    NJM's SIU is seeking a Special Investigator to join our team. The candidate will primarily be responsible for investigative duties surrounding claims and ... policies of all lines of business referred to the SIU to determine if there is a reasonable suspicion...experience strongly preferred. + Subject matter expertise in insurance investigations is preferred. + Experience in working with the… more
    NJM Insurance (01/10/25)
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  • Investigator ( SIU )

    City of New York (New York, NY)
    …The New York City Department of Correction seeks to recruit Investigators for the Special Investigation Unit ( SIU )- PREA Team. The Prison Rape Elimination ... environment, engaged in the performance of confidential, highly complex, and/or special investigations involving surveillance, interrogation of subjects and… more
    City of New York (12/12/24)
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  • SIU Specialist Investigator

    Kemper (Miami, FL)
    …experience to our stakeholders that delivers on our promises._ **Position Summary:** The SIU Investigator will conduct field and desk investigations of insurance ... claims referred to and accepted for investigation by the Special Investigative Unit . Our Special ...and/or directing Examinations Under Oath. This investigator will coordinate investigations with outside SIU contacts, the Department… more
    Kemper (01/09/25)
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  • Experienced SIU /Insurance Investigator

    Command Investigations (Orlando, FL)
    …an insurance Investigator is required. Must have background in handling multi-lines investigations and some SIU experience. Must have reliable transportation, ... Seeking a full-time experienced SIU /Insurance investigator. A minimum of 3 years' experience...should demonstrate proficiency in the following areas: + Multi-lines investigations + Writing accurate and detailed reports + Strong… more
    Command Investigations (11/29/24)
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  • Experienced SIU Investigator

    Command Investigations (Ventura County, CA)
    Experienced SIU Investigator A minimum of 5 years' SIU experience is required. Must have background in handling P&C investigations . Candidates who do not ... staff. This is a W-2 role; subcontractors will not be considered. The SIU /Insurance Investigator should demonstrate proficiency in the following areas: + P&C … more
    Command Investigations (11/21/24)
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  • SIU Investigator

    Command Investigations (San Diego, CA)
    SIU INVESTIGATOR A minimum of 5 years' SIU experience is required. Must have experience in Commercial and P&C investigations . * Candidates who do not have ... assignments. This is a W-2 role; subcontractors will not be considered. The SIU Investigator should demonstrate proficiency in the following areas: + P&C … more
    Command Investigations (11/06/24)
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  • Special Investigation Unit Manager…

    CVS Health (Columbus, OH)
    …innovate and deliver solutions to make health care more personal, convenient and affordable. The Special Investigations Unit is seeking a Manager to lead our ... team of Certified Professional Coders (CPC). The Manager is responsible for overseeing and managing coding reviews for fraud detection, investigation, and prevention efforts to safeguard the organization's resources and reduce healthcare costs. This role… more
    CVS Health (12/25/24)
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  • Investigator, SIU RN

    Molina Healthcare (Meridian, ID)
    **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit ( SIU ) Investigator is responsible for supporting the prevention, detection, investigation, ... medical review audits that may also include coding and billing reviews. The SIU Investigator is responsible for reviewing and analyzing information to make medical… more
    Molina Healthcare (01/04/25)
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  • Investigator, SIU RN-Must reside…

    Molina Healthcare (KY)
    **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit ( SIU ) Investigator is responsible for supporting the prevention, detection, investigation, ... medical review audits that may also include coding and billing reviews. The SIU Investigator is responsible for reviewing and analyzing information to make medical… more
    Molina Healthcare (12/04/24)
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