- Humana (Columbus, OH)
- …enforcement authorities to coordinate investigations and supervises the activities of the Special Investigations Unit ( SIU ) to ensure accurate and ... caring community and help us put health first** The Manager , Fraud and Waste conducts investigations of...field or equivalent. 7+ years of related compliance and/or special investigation experience in managed care or CMS. +… more
- CVS Health (Columbus, OH)
- …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… more
- 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
- Elevance Health (Washington, DC)
- …questions as necessary to aid in investigations . + Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern. ... **Nurse and CPC - Clinical Fraud Investigator II - SIU Fraud & Abuse** **Location:** This position will work...clinical evaluation of the collected data. + Performs in-depth investigations on identified providers as warranted. + Examines claims… more
- CVS Health (Hartford, CT)
- …current skills and development needs. + Assess training needs and collaborate with the SIU Sr. Manager to create development plans for team members. + Develop ... for ensuring the quality and integrity of healthcare fraud and abuse investigations . This role involves overseeing the training and development of team members,… more
- Centene Corporation (New York, NY)
- …As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. **Position Purpose:** ... Plan, organize, monitor, and oversee programs utilizing cross functional teams to deliver defined requirements and meet business needs and strategic objectives. + Support business department initiatives that promote, quality, safety and cost of care… more
- CVS Health (Albany, NY)
- …the United States **Preferred Qualifications** + Experience In Medicaid Compliance, Medicaid Investigations , MCO Medicaid FWA Unit in the following States: ... Coordinate with department leaders to fulfill the requirements of the program integrity unit + Comply with all program integrity related requests, both internal and… more
- American Family Insurance - Corporate (Sacramento, CA)
- …internal and external partners, agents and customers. You will report to a Senior Special Investigations Manager . In this primarily home-based role, you will ... involving multi-line claims, develop meaningful industry social network and assist special investigations leadership in promoting fraud awareness and detection… more
- Magellan Health Services (San Diego, CA)
- …the local compliance committee meetings. + Coordinates activities with the Internal Audit and Special Investigations Unit ( SIU ) on compliance matters ... Submits reports to the Quality Improvement Committee (QIC), Compliance Committee, Business Unit Manager , and the corporate Compliance Department as appropriate.… more
- RELX INC (Concord, NH)
- …relationships with internal and external customers to raise brand awareness of the Special Investigations Unit . + Other duties as assigned. Qualifications ... Risk at the link below. https://risk.lexisnexis.com/government About our Team The Public Safety Special Investigative Unit ( SIU ) is comprised of former law… more
- Aflac (Windsor, CT)
- Case Verification Manager The Company: CAIC PFML The Location: Windsor, CT, US, 06095 The Division: PLADS Job Id: 7164 Salary Range: $31,200 - $71,000 Job Posting ... enhance our controls. * Refer all suspicious claims to SIU for official investigation, and review final reports to...to all appropriate business partners; CT Authority, Aflac privacy, SIU , Accounting, etc. * Serve as the point of… more
- Fallon Health (Worcester, MA)
- …training to SIU staff related to clinical topics as neededFWA Manager will oversees the day-to-day operations over investigations and allegations into ... of purpose:** Under the general direction of the Senior Internal Audit Manager , theAnalyze and interpret patient medical records pertaining to FWA investigations… more
- Travelers Insurance Company (Manassas, VA)
- …internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit . + ... Identifies and refers claims with Major Case Unit exposure to the manager . + Performs administrative functions such as expense accounts, time off reporting, etc.… more
- Travelers Insurance Company (Washington, DC)
- …internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit . + ... Identifies and refers claims with Major Case Unit exposure to the manager . + Performs administrative functions such as expense accounts, time off reporting, etc.… more
- Highmark Health (Buffalo, NY)
- …and provides supporting documentation. *Identifies potential fraud cases and forwards to Special Investigations Unit . E5. Adjusts claims: *Performs online ... and external customers; processes and adjusts claims. This is a bargaining unit position. The collective bargaining agreement for this position requires that… more
- CVS Health (Tallahassee, FL)
- …health care more personal, convenient and affordable. **Position Summary** The Sr. Manager Medicaid Value Based Care (VBC) FL manages and oversees compliance with ... based contracting to meet state contract and product requirements. + The State Network Manager will assist in the recruitment of new value based providers as needed… more
- Kemper (Downers Grove, IL)
- …outlining basis for settlement + Determine subrogation or fraud potential and refer to SIU unit when potential exists or handle to conclusion + May handle ... summarize claims in excess of authority and submit to manager for approval + Evaluate settlement alternatives by reviewing...High School and/or GED required. + Complex liability and/or SIU experience a plus. + 1+ years of experience… more
- Sysco (Wilsonville, OR)
- …maintenance under the guidance of fleet technician II & III or fleet manager on vehicles and equipment to maximize the safety, reliability, and cost efficiency ... fleet technician II & III or fleet supervisor or manager in accordance with all federal, state and local...manufacturers + Apprentice will be required to complete Sysco SIU training modules for safety and other required courses.… more
- Flynn Restaurant Group (Independence, OH)
- …such as chairs, stools, rugs and other materials promptly. + Request authority from manager by writing up special and general damages with liability explanation ... or court appointed liens and incorporate in settlements correctly. + Updating Manager timely when new information is received throughout investigation with to ensure… more
- Customs and Border Protection (Santee, CA)
- …US Border Patrol, San Diego Sector, Targeting & Intelligence Division, Sector Intelligence Unit ( SIU ) in Santee, CA. Additional selections may be made beyond ... 5 USC 8331 (6c) and 8412 (d). Duties and responsibilities include: Leading a unit or team of Border Patrol Agents capable of anticipating, targeting, detecting, and… more