• Healthcare Fraud Senior Manager

    CVS Health (Wellesley, MA)
    …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 is responsible for overseeing and managing fraud detection, investigation, and prevention efforts to… more
    CVS Health (11/02/24)
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  • Area Program Manager - Special

    State of Massachusetts (Boston, MA)
    …mission-driven individual to fill the role of Area Program Manager (APM) for the Special Investigations Unit ( SIU ). The Special Investigations ... DCF employees and specific community stakeholders. The Area Program Manager is a member of the SIU ...& Families* **Title:** *Area Program Manager - Special Investigations Unit * **Location:** *Massachusetts-Boston-600… more
    State of Massachusetts (09/14/24)
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  • Clinical Fraud Investigator II - SIU Fraud…

    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 position will...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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  • Clinical Provider Auditor I - SIU Fraud…

    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 ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
    Elevance Health (11/02/24)
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  • Compliance Manager HMSA

    Magellan Health Services (Honolulu, HI)
    …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
    Magellan Health Services (10/16/24)
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  • RN Clinical Provider Post Service Review…

    Blue Cross Blue Shield of Massachusetts (Hingham, MA)
    …health and medical management, network management, business operations, payment policy, legal, special investigations unit , audit and risk management, ... Federal Employee Program (FEP) Department is a full business unit comprised of approximately 140 associates. It encompasses a...Position Summary: The RN Clinical Provider Post Service Review Manager , led by a Registered Nurse, is responsible… more
    Blue Cross Blue Shield of Massachusetts (10/23/24)
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  • Senior Manager , Compliance

    Point32Health (Canton, MA)
    …effectiveness of corrective action plans. + **Fraud Prevention:** Work with the Fraud Special Investigations Unit to ensure compliance with CMS requirements. ... click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Compliance Senior Manager will report to the Government Programs Compliance Officer. This… more
    Point32Health (10/29/24)
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  • Claims TPA Regulatory Governance and Performance…

    AIG (Atlanta, GA)
    …to manage risk. Join us as a Claims TPA Regulatory Governance and Performance Manager to play your part in that transformation. It's an opportunity to grow your ... for General Insurance. Your Contribution at AIG as a TPA State Regulatory Performance Manager : As a Leader within the TPA Claims Governance team and an influencer at… more
    AIG (08/13/24)
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  • Special Investigations

    CareFirst (Baltimore, MD)
    …(all benefits/incentives are subject to eligibility requirements). **Department** SIU Investigations **Equal Employment Opportunity** CareFirst BlueCross ... BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age,… more
    CareFirst (10/26/24)
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  • Catastrophe Outside Property Claim Professional…

    Travelers Insurance Company (Columbus, OH)
    …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 (10/01/24)
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  • Claim Representative Trainee, Outside Property

    Travelers Insurance Company (Morristown, NJ)
    …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 (11/07/24)
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  • Outside Property Claim Representative

    Travelers Insurance Company (Spokane Valley, WA)
    …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 (11/06/24)
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  • Legal Compliance Advisor- Medicare Part C Risk…

    The Cigna Group (Bluffton, SC)
    …Guidance and ICD-10 coding guidelines; *Collaborates with all areas of compliance, the special investigations unit , and business owners to drive process ... business units. + Reports to the Part C Legal Compliance Manager ;*Monitors transactions and business processes associated with reconciling ICD-9/ICD-10 codes… more
    The Cigna Group (09/24/24)
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  • Diesel Fleet Mechanic Technician I

    Sysco (Selma, NC)
    …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
    Sysco (10/31/24)
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  • Pediatric Dietitian

    Compass Group, North America (Springfield, IL)
    …Experienced Dietitians with relocation assistance if needed Reports To: Clinical Nutrition Manager Location: HSHS St John's Details: We are seeking a full-time ... Level III NICU. As a teaching medical center, we work in partnership with SIU Medicine, offering a rich environment for professional growth. In this role, the… more
    Compass Group, North America (11/07/24)
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  • Auto Claim Representative Trainee

    Travelers Insurance Company (Diamond Bar, CA)
    …in on-going training sessions for the inside auto business. + Works closely with Unit Manager or mentor to promptly resolve assigned claim. + Customer ... and forwards appropriate files to subject matter experts (ie, Subrogation, SIU , Property, Adverse Subrogation, etc.). + Reserving: + Establishes timely and… more
    Travelers Insurance Company (11/06/24)
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  • Surveillance Investigator

    The Robison Group (Kansas City, MO)
    …with education and experience. OPPORTUNITIES FOR GROWTH WITHIN THE COMPANY INCLUDE: SIU work, Field Supervisor, Field Operations Manager , Case Management, etc. ... Individuals selected for the position will be expected to perform investigations of workers compensation claims, liability investigations , multi-line insurance… more
    The Robison Group (10/24/24)
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  • Energy Communities VISTA: Community Development…

    Conservation Legacy (Carbondale, IL)
    …including the Shawnee National Forest and award-winning Shawnee Hills Wine Trail, home to SIU Carbondale - a major research university, and is within a day's drive ... interviewing, and/or onboarding process, please send your request to the hiring manager in your preferred method of communication. Required Skills Preferred Skills… more
    Conservation Legacy (08/15/24)
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