- USAA (San Antonio, TX)
- …be a part of what makes us so special ! **The Opportunity** As a dedicated ** Director , Special Investigations Unit for P&C** , you will be responsible ... of insurance policies and broad understanding of procedures related to SIU investigations . + Capability to analyze data, conduct root causes analysis, identify… more
- State of Massachusetts (Boston, MA)
- …highly organized, mission-driven individual to fill the role of Area Program Manager (APM) for the Special Investigations Unit ( SIU ). The Special ... activities of the clinical staff, and reports to the Special Investigations Director . The selected...of Children & Families* **Title:** *Area Program Manager - Special Investigations Unit * **Location:** *Massachusetts-Boston-600… more
- Centene Corporation (New York, NY)
- …**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...field or equivalent. 7+ years of related compliance and/or special investigation experience in managed care or CMS. **Please… more
- UCLA Health (Los Angeles, CA)
- …responsibilities include: + Oversee aspects of the Medicare Advantage Prescription Drug Anti-Fraud, Special Investigations Unit ( SIU ), and Audit Programs ... Description As the Assistant Director of Medicare Advantage Audit and Fraud Compliance,...compliance with regulatory requirements related to non-compliance, FWA, and SIU . + Guide strategic goals to manage health plan… more
- DCCA (Columbia, MD)
- Project Director Location Columbia, MD Job Code 2245 # of...skills Desired Skills : . Healthcare Fraud Programs . Special Investigations Unit ( SIU ) ... a competitive compensation and benefits package. Visit our website at: www.dcca.com Project Director Candidate must have or be willing to obtain a Public Trust… more
- Providence (OR)
- …will:** + Support timely completion of compliance related audits and investigations of the Special Investigations Unit ( SIU ) at the Health Plan + ... cases and audits simultaneously + May assist Senior Investigator or SIU Director in developing, implementing and performing compliance related auditing and… more
- 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, ... Summary: The Federal Employee Program (FEP) Department is a full business unit comprised of approximately 140 associates. It encompasses a member and provider… more
- Commonwealth Care Alliance (Boston, MA)
- …Coder Sr. Associate is an integral part of the Fraud, Waste & Abuse (FWA) Special Investigation Unit ( SIU ). The position reports directly to the Sr. ... and industry requirements to the different benefits and products within investigations . + Proactively seek out and develop leads, resources, and opportunities… more
- AIG (Atlanta, GA)
- …must have significant experience with Workers' Compensation as a Claims Manager/ Director (managing a team of Claims Professionals with wide-ranging state ... as State Regulatory projects (ie State Regulatory Audits, California SIU /Fraud Audits, Workers' Compensation post project/handling reviews, etc.) must be… more
- GuideOne Insurance (Charlotte, NC)
- …you. Responsibilities: + This position handles Commercial General Liability, Director 's & Officer Liability, Employment Practices Liability, Commercial Auto ... claim. + Recognizes and pursues recovery opportunities and prepares submissions to SIU when indicated. + Assigns and supervises field examiners and vendor resources,… more
- Salt Lake City Corporation (Salt Lake City, UT)
- …management outlining the basis for inclusion or omission of a given SIU in the Pretreatment Program. + Prepare correspondence between the Pretreatment Program ... from citizens, industrial users, and other regulatory agencies. Conduct on-site investigations when noncompliance or illicit discharges are suspected or identified,… more