- CVS Health (Atlanta, GA)
- …do it all with heart, each and every day. Position Summary Conducts investigations to effectively pursue the prevention, investigation and prosecution of ... to comply with state regulations mandating fraud plans and practices. Conducts investigations of known or suspected acts of healthcare fraud and abuse. Communicates… more
- Humana (Dayton, OH)
- …Department of Medicaid (ODM) 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
- Molina Healthcare (Louisville, KY)
- JOB DESCRIPTION Job Summary Under direct supervision of the Manager, SIU , the Team Lead is responsible to lead a small team of investigators and provide oversight on ... daily investigative activities as a back-up to the SIU Manager. This position will be accountable for tracking...Manager. This position will be accountable for tracking on investigations conducted by his/her team and will provide oversight… more
- Molina Healthcare (Phoenix, AZ)
- …hospital, clinic settings) or 5+ years of experience working in a FWA / SIU or Fraud investigations Thorough knowledge of PC based software including Microsoft ... JOB DESCRIPTION Job Summary The SIU Coding Investigator is responsible for investigating and...& Federal laws and regulations pertaining to health insurance, investigations & legal processes (Commercial insurance, Medicare, Medicare Advantage,… more
- Allied Universal (Cleveland, TN)
- …best, explore a career with us and make a difference. Allied Universal is hiring a Special Investigations Unit ( SIU ) Investigator. Special ... ensuring thorough documentation and effective communication with clients and their Special Investigation Unit Supervisor QUALIFICATIONS (MUST HAVE):… more
- CVS Health (San Antonio, TX)
- …A minimum 3 years of experience in a Healthcare Program Integrity, Medicaid Special Investigation or Medicaid / Medicare / Commercial Compliance role Strong ... each and every day. Position Summary Direct oversight of SIU and Fraud, Waste and Abuse activities related to...Anti-Fraud Association (AHFI) - Experience In Medicaid Compliance, Medicaid Investigations , TX MCO Medicaid FWA Unit -… more
- Centene Corporation (Frankfort, KY)
- …Position acts as a subject matter expert for the Contractor's Program Integrity unit to reduce Fraud, Waste and Abuse of Medicaid services within Kentucky. Provides ... for the Kentucky market Manage and coordinate cases being investigated by the SIU Maintain all vendor cases Assist with conducting complex investigations ,… more
- UnitedHealth Group (Tampa, FL)
- …Caring. Connecting. Growing together. Work at home! The Medical Director for UnitedHealthcare's Investigations Unit (UHC IU) is a valuable national leader for ... findings, actions and outcomes to be relied on in investigations of fraud, waste, and abuse cases in accordance...task forces Develop quality audit practices to ensure UHC SIU 's Medical Record Review Team is adhering to proper… 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 . ... handling throughout the claim life cycle (customer contacts, coverage, investigation , evaluation, reserving, negotiation and resolution) including maintaining full… more
- Travelers Insurance Company (Redlands, CA)
- …internal and external customers/business partners. Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit . ... handling throughout the claim life cycle (customer contacts, coverage, investigation , evaluation, reserving, negotiation and resolution) including maintaining full… more
- Travelers Insurance Company (Richmond, VA)
- …other internal and external customers/business partners. Recognizes when to refer claims to Special Investigations Unit and/or Subrogation Unit . Performs ... handling throughout the claim life cycle (customer contacts, coverage, investigation , evaluation, reserving, negotiation and resolution) including maintaining full… more
- UnitedHealth Group (Minneapolis, MN)
- …four days per week. Primary Responsibilities: Provide legal counsel to the UnitedHealthcare Special Investigations Unit regarding fraud, waste, and abuse and ... including, but not limited to: fraud, waste and abuse, payment integrity, special investigations , litigation support, claim payment strategy and policy… more
- USAA (Colorado Springs, CO)
- …adverse carrier). Identifies coverage concerns, reviews prior loss history, determines, and creates Special Investigation Unit ( SIU ) referrals, when ... we treat each other and our members. Be part of what truly makes us special and impactful. The Opportunity As a dedicated Auto Adjuster you will manage file… more
- USAA (Springfield, MA)
- …characteristics. Identifies coverage concerns, reviews prior loss history, determines and creates Special Investigation Unit ( SIU ) referrals, when ... we treat each other and our members. Be part of what truly makes us special and impactful. The Opportunity As a dedicated Property Adjuster Specialist, you will work… more
- RELX INC (Atlanta, GA)
- …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 ... data offerings to provide real-time investigative insights for LexisNexis customers. The SIU team aids law enforcement during critical incidents and major … more
- State of Massachusetts (Boston, MA)
- …seeking an experienced and dedicated individual to fill the role of Director for the Special Investigations Unit . In this role, the Director will be ... and monitoring all clinical and administrative operations of the Special Investigations Unit . This specialized...and regulations are known and practiced appropriately by all SIU staff. * Direct the monitoring and implementation of… more
- LA Care Health Plan (Los Angeles, CA)
- …Fraud, Waste and Abuse (FWA) is responsible for directing LA Care Health Plan's enterprise special investigations unit ( SIU ) and FWA program. The ... disciplining, and motivating direct reports. Duties Leadership and Program Oversight: Lead LA Care's Special Investigations Unit ( SIU ) in overseeing the… more
- City of New York (New York, NY)
- …criminal and/or non-criminal, unique, highly confidential and sensitive investigations . The Special Investigation Unit ( SIU ) is responsible for ... of Correction seeks to recruit Deputy Directors for the Special Investigation Unit ( SIU...engaged in the performance of confidential, highly complex, and/or special investigations involving surveillances, interrogation of subjects… more
- UPMC (Pittsburgh, PA)
- …4:30 pm This is a remote position. Under the direction of the manager, the Special Investigations Unit ( SIU ) Investigator is responsible for ... UPMC Health Plan has an exciting opportunity for a Special Investigations Unit Investigator position....supporting current SIU staff and manager with investigations and special projects. Responsibilities: + Maintain… more
- The Robison Group (Brooklyn, NY)
- …writing, reading and speaking Spanish. This is a remote opportunity for part-time employment in our Special Investigations Unit ( SIU ). As an SIU ... 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
