- Novo Nordisk Inc. (Plainsboro, NJ)
- …Strategic Market Intelligence group. Working relationships with pipeline business unit partners across the organization and close collaboration commercial insights ... / Analytics in support of market insights Conducts hypothesis-driven investigations into detailed physician-level, patient-level and transactional-level data, to… more
- MTA (New York, NY)
- … Conditions Unit DEPT/DIV: MTA PD/ Investigative Services Bureau, Special investigation Division SUPERVISOR: Detective/Lieutenant, Special ... who are interested in being assigned to Special Investigations Division, Special Conditions Unit . RESPONSIBILITIES: . Targeting crime patterns and… more
- Bassett Healthcare (Cooperstown, NY)
- …and enjoy the best quality of life possible. About the department Bassett Medical Center's Special Care Unit is a 24-bed intermediate care unit , serving as ... to meet the needs of our rural community. The Special Care unit is consistently hiring for...by managerial observation Helps to identify clinical problems requiring investigation as measured by co-worker feedback and managerial observation.… more
- The Hartford (GA)
- …shape the future. We are seeking a talented Special Investigator to join our Special Investigations Unit (SIU). This position will be based out of the ... QUALIFICATIONS: + Bachelor's Degree preferred. + Minimum of 3 years special investigation insurance experience and/or investigative law enforcement experience… more
- McLaren Health Care (Indianapolis, IN)
- …assigned Plan. Ensures compliance with all requirements related to Special Investigation Units and fraud, waste and abuse investigations . **This position is ... We are looking for a Special Investigative Unit Auditor to join...Inc. at https://www.mdwise.org/ **Position Summary:** Responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving the… more
- BlueCross BlueShield of North Carolina (NC)
- **Job Description** The AVP Special Investigations Unit (SIU) is responsible for overseeing and managing fraud, waste, and abuse (FWA) detection, ... law enforcement agencies, regulatory bodies, and external partners during investigations . + Prepare comprehensive reports summarizing investigation outcomes,… more
- The Robison Group (Brooklyn, NY)
- …other investigative tasks. This is a remote opportunity for part-time employment in our Special Investigations Unit (SIU). As an SIU Investigator, you will ... utilizing their investigative skills to conduct a variety of investigations on insurance related matters; such as auto and...+ Make sound judgments during the course of the investigation . + Provide timely progress updates. + Complete detailed… more
- 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
- 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 ... responsible for overseeing and managing coding reviews for fraud detection, investigation , and prevention efforts to safeguard the organization's resources and… more
- CVS Health (Trenton, NJ)
- …United States. We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU). In this role, you will ... manage complex investigations into suspected and known acts of healthcare fraud,...federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud. + Demonstrates high… more
- CVS Health (Columbus, OH)
- …Must be flexible to work EDT hours (8:00 am - 5 pm EDT) The Special Investigations Unit (SIU) is looking for an analytically driven individual who is skilled ... billing patterns and reviewing incoming referrals to determine if additional investigations are warranted. **Fundamental Components:** -Research and ad hoc report… more
- CVS Health (Albany, NY)
- …education may substitute) + Experience in a Healthcare Program Integrity, Medicaid Special Investigation or Medicaid / Medicare / Commercial Compliance role ... the United States **Preferred Qualifications** + Experience In Medicaid Compliance, Medicaid Investigations , MCO Medicaid FWA Unit in the following States:… more
- 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
- 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 (Baton Rouge, LA)
- …is a remote position but Louisiana residency is required. + Conducts investigations to effectively pursue the prevention, detection, investigation and ... in identifying resources and best course of action on investigations + Serves as back up to the Team...federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud and abuse matters.… more
- CVS Health (Columbus, OH)
- …RN and certified coder Responsible for the review and evaluation of clinical information and documentation related to SIU flagged providers. Reviews documentation and ... interprets data obtained from clinical records or systems and uses clinical decision-making to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider claims. Independently coordinates… more
- CVS Health (Raleigh, NC)
- …be flexible to work EDT hours (8:00 am - 5 pm EDT) Conducts investigations to effectively pursue the prevention, detection, investigation and prosecution of ... agencies as required by law and regulation. **Fundamental Components:** - Conducts investigations of known or suspected acts of healthcare fraud, waste, and abuse… more
- State of Colorado (Denver, CO)
- …fraud, and other crimes appropriate for investigation and prosecution by the Special Prosecutions Unit . As such, this position has the authority to partner ... Section is seeking an experienced investigator to join the Special Prosecutions Unit . In this role, you'll...with and assist any law enforcement agency with investigations and enforcement of laws related to all crimes… more
- US Secret Service (Washington, DC)
- …here. Responsibilities SPECIAL AGENTS During the course of their careers, Special Agents carry out assignments in both investigations and protection and ... team member (in a non-support or administrative role) in a Department of Defense special operations unit Served as a military member possessing direct combat… more
- Leidos (Clovis, NM)
- …SOIS and SMS.Serves as primary or alternate Contingency Operations Manager for Special Operations unit . Serves as an alternate Emergency Management ... you how to unleash your potential. Leidos has an exciting opportunity for a Unit Deployment Manager (UDM). The selected candidate will provide a full range of… more
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