- 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 ... and motivating direct reports. Duties Leadership and Program Oversight: Lead LA Care's Special Investigations Unit ( SIU ) in overseeing the internal and… 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 ... 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
- 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, ... assets and reduce healthcare costs. This requires demonstrating vision in positioning the SIU with the right skill sets, cutting edge analytics tools, and robust… more
- City of New York (New York, NY)
- …and enforcing child support orders. Within the OCSS Division of Enforcement Operations, the Special Investigations Unit ( SIU ) is responsible for ... denial, property executions against any financial institutions, and garnishment of wages. Special Investigations is charged with locating absent parents and… more
- New York State Civil Service (Buffalo, NY)
- …include answering, phones, photocopying, and other tasks, as needed. DCI is NYSIF's special investigations unit for the detection, investigation, and ... HELP No Agency Insurance Fund, State Title Department of Confidential Investigations Intern Occupational Category Other Professional Careers Salary Grade NS… more
- Allied Universal (Burlington, VT)
- …best, explore a career with us and make a difference. 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
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The role of the Special Investigations Unit ( SIU ) Investigator is to assist in the reduction and recuperation of ... special projects as assigned by management to meet the needs of the Special Investigations Unit . **SUPERVISORY RESPONSIBILITY:** Position does not have… more
- Command Investigations (Detroit, MI)
- … Investigations ) is seeking qualified, driven, and experienced candidates to join our special investigations unit as an ACP Investigator. SuperiorX ... demand for quality investigations to gather critical information, conduct special investigations , examine coverage/loss, and combat fraud, one case at… more
- City of New York (New York, NY)
- …Counsel, the Family Court, other OCSS divisions, OTDA, and other jurisdictions. The Special Investigations Unit ( SIU ) identifies and investigates ... senior management oversight and direction for OCSS' Administrative Enforcement, Interstate, Special Investigations and Employment Services Units. The incumbent… more
- Centene Corporation (Tallahassee, FL)
- …Florida. **Position Purpose:** Oversee a full range of waste, abuse and fraud investigations , audits and medical code editing scenarios. Ensure all audits adhere to ... and abuse guidelines. + Oversee the activities of the SIU for accurate and timely operational reviews and final...or equivalent + 7+ years of related compliance and/or special investigation experience in managed care or CMS Pay… more
- City of La Mesa, CA (La Mesa, CA)
- …patrol, field training officer, investigations , motor officer, school resource officer, special investigations unit , street team, honor guard and the ... type calls that are non-criminal in nature. + Conduct investigations at scenes of incidents to which summoned or...other potentially hostile situations. + Direct traffic at fires, special events, and other emergency situations; provide traffic and… more
- Elevance Health (Costa Mesa, CA)
- …law. **Position Overview:** Responsible for providing leadership and guidance to the Special Investigations Unit **Pharmacy** team in investigating, ... with the administration and operational activities occurring within the Special Investigations Unit for **pharmacy...research findings + Provides guidance to investigators and other SIU staff in the development of criminal and recovery… more
- CareFirst (Baltimore, MD)
- …+ Perform special projects to meet the objectives of the Special Investigations Unit . **QUALIFICATIONS:** **Education Level:** Bachelor's Degree OR ... to the SI team to support both prepayment reviews and/or post-payment investigations . **ESSENTIAL FUNCTIONS:** + Review of medical records and claims. Investigate… more
- Kemper (Doral, FL)
- …investigations of insurance claims referred to and accepted for investigation by the Special Investigative Unit . Our Special Investigator will function as ... and conducting and/or directing Examinations Under Oath. This investigator will coordinate investigations with outside SIU contacts, the Department of Insurance… more
- Kemper (San Bernardino, CA)
- …and conducting and/or directing Examinations Under Oath. This investigator will coordinate investigations with outside SIU contacts, the Department of Insurance ... SIU Manager and provide work direction to other Special Investigators on a temporary basis. A laptop computer,...management. + Responsible for communicating critical situations to the Special Investigation Unit and field managers. +… more
- Humana (Oklahoma City, OK)
- **Become a part of our caring community and help us put health first** Humana's Special Investigations Unit is seeking a Senior Fraud & Waste Investigator to ... the Oklahoma Medicaid Team. This team of Investigators conducts investigations into allegations of fraud, waste, and abuse involving...and other agencies such as the Medicaid Fraud Control Unit (MFCU) and coordinate all aspects of FWA activities… 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 ... + Manage and coordinate cases being investigated by the SIU + Maintain all vendor cases + Assist with...Maintain all vendor cases + Assist with conducting complex investigations , including on-site investigations , review, complete and… more
- UPMC (Pittsburgh, PA)
- …Auditor/Analyst Intermediate! The Clinical Auditor/Analyst Intermediate is an integral part of the Special Investigations Unit ( SIU ) and is responsible ... and health plan business rules. + Provide a clinical opinion for special projects or various issues including appropriate utilization of controlled substances,… more
- Point32Health (Canton, MA)
- …report on the effectiveness of corrective action plans. + Collaborate with the Fraud special investigations unit to ensure program meets CMS requirements. + ... in a lawful and ethical manner. + Manage the compliance unit 's administrative duties, including organizing and maintaining relevant documents; preparing necessary… more
- Dignity Health (Phoenix, AZ)
- …FWA reporting mechanism and collaborate closely with the Internal Audit Department and the Special Investigations Unit ( SIU ), as applicable. + Exercise ... Medicare fraud, waste, or abuse, (FWA) including coordinating internal investigations and developing appropriate corrective or disciplinary actions when necessary.… more