- Kaleida Health (Buffalo, NY)
- …and consistent with the Mission, Vision and Values of Kaleida Health. The Sr . HR Investigator will be responsible for reviewing complaints and planning, ... to conduct investigations in a thorough and objective manner to provide recommendations. The Sr . HR Investigator will partner with the VP Labor & Employment… more
- CareFirst (Columbia, MD)
- **Resp & Qualifications** **PURPOSE:** The role of the Special Investigations Unit (SIU) Investigator , Sr . is to assist in the reduction and recuperation of ... of audits of financial business records, provider and subscriber medical data, claims , systems? reports, medical...result in an overall achievement of unit goals. + Investigator , Sr . will develop documentation that supports… more
- Elevance Health (Columbus, GA)
- ** Senior Investigator ( Investigator Sr )** _Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 ... Integrity, is determined to recover, eliminate, and prevent unnecessary medical -expense spending. The ** Senior Investigator **...to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim… more
- EFI Global (Denver, CO)
- …buildings or residences. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** **Investigates assigned claims suspected of insurance fraud, this includes large loss, large ... fire loss, and multiple claims .** **Ensures that assigned cases are investigated and reported back to the requesting party in adherence to best practices.… more
- Elevance Health (MI)
- …formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The ** Investigator Senior ** is responsible ... ** Investigator Senior ** **Supports the Payment Integrity...to recover corporate and client funds paid on fraudulent claims . Health insurance experience required with understanding of health… more
- Clark County, NV (Las Vegas, NV)
- SENIOR MANAGEMENT ANALYST (DIVERSITY AND EEO INVESTIGATOR ) Print (https://www.governmentjobs.com/careers/clarkcounty/jobs/newprint/4696407) Apply SENIOR ... Diversity is seeking qualified candidates to apply for the Senior Management Analyst (Diversity and EEO Investigator )...printed materials and a computer screen; and hearing and speech to communicate in person or over the telephone.… more
- USAA (Houston, TX)
- …of what makes us so special! **The Opportunity** As a dedicated SIU field investigator , within defined guidelines and framework, you will help protect USAA and our ... members from potential fraudulent claims by investigating complex fraud investigations with significant financial...state laws and regulations. + Must be a skilled investigator with experience taking sophisticated statements from multiple parties… more
- EFI Global (Sacramento, CA)
- …buildings or residences. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Investigates assigned claims suspected of insurance fraud, this includes large loss, large ... fire loss, and multiple claims . + Ensures that assigned cases are investigated and...ethical manner. + May provide investigative guidance to Fire Investigator team members. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs… more
- Humana (Indianapolis, IN)
- **Become a part of our caring community and help us put health first** This Senior Fraud and Waste Investigator will serve as Humana's Program Integrity Officer, ... outcomes; work closely with internal and external auditors, financial investigators, and claims processing areas + Adequately staff and manage the program integrity … more
- Elevance Health (Nashville, TN)
- …Payment Integrity, is determined to recover, eliminate, and prevent unnecessary medical -expense spending. ** Investigator II** is responsible for the ... ** Investigator II - Carelon Payment Integrity** **Location** :...to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim… more
- Elevance Health (Houston, TX)
- …formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The ** Investigator II** is responsible for the ... ** Investigator II** **Supporting the Payment Integrity line of...to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim… more
- RTX Corporation (East Hartford, CT)
- …go beyond? We have an exciting hybrid opportunity for a Global Ethics and Compliance Investigator to join our team! What You Will Do: P&W is looking for an ... experienced investigator who will provide critical support to the Lead...travel in support of investigations. + Experience with briefing senior leadership on investigative findings. + Experience with creating… more
- Lilly (IN)
- …matters may include FDA and global regulatory clinical development, medical affairs, product manufacture and distribution, reimbursement, the Anti-kickback Statute ... and its safe harbors, the False Claims Act, antitrust, commercial law, and business transactions. In this role, you will advise on legal strategy to a fast-paced and… more
- Abbott (St. Paul, MN)
- …spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 114,000 colleagues ... serve people in more than 160 countries. ** Senior Principal Clinical Scientist** **Working at Abbott** At Abbott,...can grow the career you dream of. . Free medical coverage for employees* via the Health Investment Plan… more
- CVS Health (Wellesley, MA)
- …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...investigation, or auditing + In-depth knowledge of healthcare systems, claims processing, and regulatory requirements related to healthcare fraud.… more
- Mount Sinai Health System (New York, NY)
- …of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek's "The ... Description** Responsible for ensuring that unpaid and partially paid claims are resolved in an efficient and timely manner....Sinai Health System is one of the largest academic medical systems in the New York metro area, with… more
- Mount Sinai Health System (New York, NY)
- …of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek's "The ... Description** Responsible for ensuring that unpaid and partially paid claims are resolved in an efficient and timely manner....Sinai Health System is one of the largest academic medical systems in the New York metro area, with… more
- Mount Sinai Health System (New York, NY)
- …**Qualifications** + HS/GED; Associates Degree is preferred + 3+ years of experience in medical billing or health claims , with experience in billing systems in a ... **Job Description** ** Senior Biller-Oncology Billing Corporate East 42nd Street Full-Time...and in the 99th percentile in research dollars per investigator according to the Association of American Medical… more
- Mount Sinai Health System (New York, NY)
- …high school diploma/GED plus 3 years of relevant experience + 3 years experience in medical billing or health claims , with experience in IDX billing systems in a ... **Job Description** The Senior Billing Coordinator (Generalist) is responsible for multiple...and in the 99th percentile in research dollars per investigator according to the Association of American Medical… more
- UPMC (Pittsburgh, PA)
- …potential and current claims with relevant internal departments and UHCIP claims investigator and make appropriate recommendations to Director for approval ... UPMC Corporate is hiring a Senior Risk Management Specialist to join our team!...is systematic management of potential as well as actual claims . Clinical data will by analyzed to determine areas… more