- Premera Blue Cross (Mountlake Terrace, WA)
- …and communicate audit results and will collaborate with internal teams including the Special Investigation Unit and Payment Integrity Specialists. This role ... + Collaborate with internal teams (eg, claims processing, provider relations, special investigations unit ). + Utilize auditing software and systems to… more
- USAA (New York, NY)
- …us special and impactful. **The Opportunity** We are looking for a Manager, SIU ( Special Investigations Unit ) within P&C. Responsible for operational ... and decisions to carry out proactive claim's projects and investigations . + Reviews and evaluates investigation recommendations...risks. + 4+ years of progressive experience within a Special Investigations Unit ( SIU… more
- Capital One (Richmond, VA)
- AML Sr. Investigator I - Special Investigations Unit **AML Sr. Investigator I - Special Investigations Unit ** The Anti-Money Laundering (AML) Sr. ... Supervisors and Managers to perform other critical functions. The Special Investigations Unit conducts suspicious...+ Self-manage a queue of alerts, cases, and closing investigations + Helps maintain operations of a SIU… 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
- Providence (Oakland, CA)
- **Description** **Investigator External Audit Special Investigations Unit \*Remote The SIU Audit Investigator supports the compliance related activities ... of the Special Investigations Unit ( SIU...activities at the Health Plan. This includes the identification, investigation and correction of fraudulent and/or abusive billing and… more
- Elevance Health (Cleveland, OH)
- …recover, eliminate and prevent unnecessary medical-expense spending. **Staff Vice President (VP), Special Investigations Unit ( SIU )** **Location:** May ... the national SIU . + Functions within the SIU include investigations , case intake and assignment,...administration, or related field and minimum of 10 years investigation , prosecution, or healthcare experience; or any combination of… more
- CVS Health (Hartford, CT)
- …we do it all with heart, each and every day. The **Senior RFI Analyst** within the Special Investigations Unit ( SIU ) plays a key role in supporting ... fraud, waste, and abuse investigations by managing and responding to Requests for Information...Medicaid and Medicare programs - Familiarity with state-specific fraud investigation protocols (eg, Texas OIG, Florida AHCA) - Prior… more
- Molina Healthcare (AZ)
- **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit ( SIU ) Investigator is responsible for supporting the prevention, detection, ... SIU related requirements. Prepares detailed preliminary and extensive investigation referrals to state and/or federal regulatory and/or law enforcement agencies… more
- CVS Health (Olympia, WA)
- …The Certified Professional Coder (CPC) will perform medical claim reviews to ensure compliance with coding practices through a comprehensive record review for ... medical, behavioral, transportation and other healthcare providers. The CPC must have the ability to determine correct coding and appropriate documentation during the review of medical records. The CPC must also ensure that the state, federal and company… more
- Geisinger (Danville, PA)
- …Responsible for the strategic direction, planning, oversight, and operation of the Special Investigations ("SI") and Program Integrity ("PI") teams. Develops and ... directs the prevention, detection and investigation of anti-fraud, waste and abuse (FWA)program processes and...Job Duties + Provides leadership and strategic direction of Special Investigations and Program Integrity units spanning… more
- Centene Corporation (Jefferson City, MO)
- …correcting fraud, waste, and abuse ("FWA") in healthcare billing through investigation and coordination with internal and external stakeholders. Responsible for ... and executing strategies that ensure high-quality, timely, value-generating FWA investigations in compliance with legal, regulatory, and contractual requirements.… more
- Molina Healthcare (Milwaukee, WI)
- …hospital, clinic settings) or 5+ years of experience working in a FWA / SIU or Fraud investigations + Thorough knowledge of PC based software including ... **JOB DESCRIPTION** **Job Summary** The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical… more
- Molina Healthcare (Louisville, KY)
- … investigations . **KNOWLEDGE/SKILLS/ABILITIES** + Provides oversight and review of the SIU referral intake and investigation process while giving guidance and ... direction to team on case investigation steps and actions. + Works with leadership to maintain and revise policies and procedures, fraud, waste, and abuse plans,… more
- Allied Universal (Batavia, NY)
- …best, explore a career with us and make a difference. Allied Universal(R) 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
- Capital One (Mclean, VA)
- AML Sr Investigator II- SIU Subject Matter Expert (SME) **The Special Investigations Unit in the AML Department** performs specialized investigations ... (SME)** will work closely with key stakeholders in the SIU and outside of the SIU when...+ Collaborating with investigators and people leaders on complex investigations and/or special projects, often functioning in… more
- U-Haul (Phoenix, AZ)
- …+ Strong Communication Skills + Claims knowledge Work Status: Full-time U-Haul offers its Special Investigation Unit : + Full Medical coverage + Prescription ... Regional Claims Manager, Repwest Insurance Company, responsible for the identification, investigation , and prosecution of fraudulent intent by all persons directed… more
- BlueCross BlueShield of North Carolina (NC)
- **Job Description** The Special Investigations Unit ( SIU ) Investigator is responsible to conduct timely and thorough health care fraud investigations ... - $111,800.00 **Skills** Depositions, Evidence Collection, Forensic Accounting, Fraud Investigations , Investigation Techniques, Investigative Analysis, Job Interviews,… more
- Louisiana Department of State Civil Service (Breaux Bridge, LA)
- … Division is comprised of and responsible for the following sections/units/programs: + Special Investigations Unit This section comprises of the following ... + Description + Benefits + Questions About this Job Special Investigations Division The Special ...state and local law enforcement agencies in Louisiana. + Special Victims Unit Rescue and seek justice… more
- CVS Health (Phoenix, AZ)
- …parties including CVS Health corporate security, pharmacy audit and network teams, the client's special investigations unit ( SIU ), and Federal, State, ... we do it all with heart, each and every day. The Advisor- Investigations /Compliance provides expert healthcare fraud, waste, and abuse investigative expertise in… more
- RELX INC (Washington, DC)
- …and production outcome as a subject matter expert on LexisNexis Risk Solutions within the Special Investigations Unit ( SIU ). This is a remote/ home-based ... Risk at the link below. https://risk.lexisnexis.com/government About the TeamThe Public Safety Special Investigative Unit ( SIU ) is comprised of former… more
