- Usaa (Parkersburg, WV)
- …us special and impactful. The Opportunity We are looking for a SIU Investigator (mid-level). This is a desk position. Within defined guidelines and framework, ... protects USAA and our members from potential fraudulent claims by investigating questionable, suspect claims activity...position. Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain… more
- USAA (San Antonio, TX)
- …us special and impactful. **The Opportunity** We are looking for a SIU Investigator (mid-level). **This is a "Desk" position.** **Besides solid experience as an SIU ... Investigator within P&C, you will have strong underwriting skillset...framework, protects USAA and our members from potential fraudulent claims by investigating questionable, suspect claims activity… more
- MyFlorida (Pensacola, FL)
- LAW ENFORCEMENT INVESTIGATOR II - 41001250 1 Date: Dec 10, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... No: 866581 Agency: Office of the Attorney General Working Title: LAW ENFORCEMENT INVESTIGATOR II - 41001250 1 Pay Plan: Career Service Position Number: 41001250… more
- Centene Corporation (Frankfort, KY)
- …response to Department requests for information + Serve as a lead for the Kentucky market + Manage and coordinate cases being investigated by the SIU + Maintain all ... teams as needed. + Supports the provider escalation project team to resolve claims and payment issues. + Identifies root-cause issues to ensure enterprise solutions… more
- Humana (Oklahoma City, OK)
- …first** Humana's Special Investigations Unit is seeking a Senior Fraud & Waste Investigator to join the Oklahoma Medicaid Team. This team of Investigators conducts ... of fraud, waste, and abuse involving providers who submit claims to Humana's Oklahoma Medicaid line of business. As...line of business. As the Senior Fraud and Waste Investigator , you will serve as Humana's Program Integrity Officer,… more
- Elevance Health (Seattle, WA)
- **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role enables associates to work virtually ... eliminate and prevent unnecessary medical-expense spending. The **Clinical Fraud Investigator II** is responsible for identifying issues and/or entities that… more
- Humana (Santa Fe, NM)
- …help us put health first** Humana is looking for an experienced Healthcare Investigator to join its industry leading Special Investigations Unit. Do you enjoy ... an in-depth evaluation of variable factors. The Fraud and Waste Investigator collaborates in investigations with law enforcement authorities. Assembles evidence and… more
- Elevance Health (Atlanta, GA)
- …in order to recover corporate and client funds paid on fraudulent Medicaid claims . **How You Will Make an Impact:** + Responsible for identifying and developing ... more than one company health plan, line of business and/or state + Claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and… more
- Highmark Health (Harrisburg, PA)
- …Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of provider facility payment ... methodology, claims processing systems and coding and billing proficiency +...and expected contributions, as well as internal peer equity, market , and business considerations. The displayed salary range does… more
- MyFlorida (Tallahassee, FL)
- …and enforces cases under state and federal antitrust laws, Florida False Claims Act, Florida securities law, Civil Racketeering and as needed civil complex ... federal antitrust laws may have occurred. Interview fact witnesses and/or direct an investigator in conducting such interviews. Obtain evidence in the form of sworn… more
- Travelers Insurance Company (Hartford, CT)
- …Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The hourly salary range provided for this position is a ... nationwide market range and represents a broad range of salaries...receiving valuable on-the-job training, and learns about the Fire Investigator professions available at Travelers. Interns receive challenging work… more
- J&J Family of Companies (Irvine, CA)
- …of evidence generation and dissemination activities that support product approvals, claims development, and product adoption and lifecycle management, and work ... data analysis, publication support and collection of data for supporting platform claims . + Contribute to the development and execution of product and/or procedural… more
- Mount Sinai Health System (New York, NY)
- …models and perform data analysis across finance and strategic business needs (eg, market sizing), and healthcare topics (eg, claims analysis) with guidance from ... roles ? Advanced analytical capabilities required, experience with healthcare claims analysis and clinical quality measures highly preferred ? Experience… more
- J&J Family of Companies (Irvine, CA)
- …(eg study protocol, informed consents, CRF, monitoring plan, study manual, investigator brochure, annual reports); + Ensures applicable trial registration (eg on ... Associates (CRAs); + Oversees and supports the development and execution of Investigator agreements and trial payments. + Is responsible for clinical data review… more
- Otsuka America Pharmaceutical Inc. (Sacramento, CA)
- …creates a unified focus among account management, medical, patient access and market access to engage local healthcare systems and identify opportunities to improve ... Leads are led by Regional Leads with significant autonomy to assess unique market priorities and customize decisions that reflect local customer needs. In the… more
- Mount Sinai Health System (New York, NY)
- …for operations, budgeting, auditing, forecasting, accounting, AR and reserve analysis, market analysis, staffing, and financial reporting. + Strong leadership skills ... workflows align with revenue cycle best practices to reduce claim denials, improve cash collections and enhance clean ...and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges.… more
- Mount Sinai Health System (New York, NY)
- …for operations, budgeting, auditing, forecasting, accounting, AR and reserve analysis, market analysis, staffing, and financial reporting. + Strong leadership skills ... workflows align with revenue cycle best practices to reduce claim denials, improve cash collections, and enhance clean ...and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges.… more
- Oracle (Pierre, SD)
- …studies (eg, patient survey studies, large database studies electronic health records, claims , etc.) and provide research consultation to both internal and external ... clients to understand patients, physicians and payers, bring products to market quickly, navigate the regulatory pathway and negotiate payer reimbursement and… more
- University of Southern California (Los Angeles, CA)
- …lead programmer and technical specialist on research projects that use administrative healthcare claims data. SAS is required. The programmer is an integral part of ... the research team and works closely with the principal investigator and a multidisciplinary research team. The key role of the programmer is to develop a plan to… more
- Highmark Health (Harrisburg, PA)
- …for overall category or function. Plans will include current and future market environment, market conditions, health system strategic plan, time-frames, and ... ensure a successful execution of the strategic plan. + Serve as principal investigator , assist in project management and serve as contractual expert on specific… more
