- Kelsey-Seybold Clinic (Pearland, TX)
- **Responsibilities** The Sr. Fraud Investigator SIU ( Special Investigations Unit) assists in the implementation and daily operation of the organization's ... Health Care Fraud Investigator (AHFI), OR CFE - Certified Fraud Examiner credential ** Special Skills** Required: Knowledge of Managed Care payment… more
- Allied Universal (Durango, CO)
- …+ One or more of the following professional industry certifications: + Certified Fraud Investigator (CFE) + Certified Insurance Fraud Investigator ... programs, and exclusive perks. Allied Universal(R) is hiring a Claims / SIU Investigator . Claims ...extensive knowledge of Insurance policies and the components of fraud to determine If claims warrant reporting… more
- Allied Universal (Billings, MT)
- …programs, and exclusive perks. Allied Universal(R) is hiring a Surveillance / Claims Investigator . Surveillance / Claims Investigators validate the ... + One or more of the following professional industry certifications + Certified Fraud Investigator (CFE) + Certified Insurance Fraud Investigator… more
- Elevance Health (Cincinnati, OH)
- …**Hybrid Workplace Strategy:** 1-2 days in office per week The **Clinical Fraud Investigator II** is responsible for identifying issues and/or entities ... that may pose potential risk associated with fraud and abuse. **How you will make an impact:**...in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines… more
- Providence (OR)
- …in health care fraud investigation, such as Accredited Healthcare Fraud Investigator (AHFI), Certification as an Internal Auditor (CIA), Healthcare ... must empower them._** **Providence Health Plan is calling an Investigator , Special Investigation Unit who will:** +...+ Proactively learns and applies data analysis related to fraud risk identification and prevention + Able to manage… more
- AmeriHealth Caritas (Dublin, OH)
- ** Special Investigator - Ohio resident** Location: Dublin, OH Primary Job Function: Compliance ID**: 34748 **Job Brief** This position is remote based but will ... Ohio.** **Major Accountabilities:** + Ensures compliance with all requirements related to Special Investigation Units and fraud , waste and abuse investigations.… more
- Department of State - Agency Wide (Washington, DC)
- …and policies relating to Department/USAGM/USIBWC programs and operations, such as: procurement fraud , grant fraud , false claims , public corruption, conflicts ... for conducting and reporting on inspections, evaluations, investigations, audits, and special inquiries involving all overseas and domestic Department programs and… more
- CVS Health (Des Moines, IA)
- …to effectively pursue the prevention, detection, investigation and prosecution of healthcare fraud , waste, and abuse. Also reports suspected fraud , waste, and ... will do:** + Investigates to prevent payment of fraudulent claims submitted to the Medicaid lines of business +...company and customer money lost as a result of fraud matters + Provides on the job training to… more
- USAA (Fayetteville, NC)
- …to how we treat each other. Come be a part of what makes us so special ! **The Opportunity** As a dedicated SIU investigator , you will protect USAA and our ... members from potential fraudulent claims by investigating questionable, suspect claims activity in compliance with state insurance fraud -related laws and… more
- Molina Healthcare (New York, NY)
- …ASSOCIATION** : + Health Care Anti- Fraud Associate (HCAFA). + Accredited Health Care Fraud Investigator (AHFI). + Certified Fraud Examiner (CFE). To all ... **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit (SIU) Investigator is...when appropriate, recovery of money related to health care fraud , waste, and abuse. Duties include performing accurate and… more
- Commonwealth Care Alliance (Boston, MA)
- …The FWA Investigator Coder Sr. Associate is an integral part of the Fraud , Waste & Abuse (FWA) Special Investigation Unit (SIU). The position reports ... directly to the Sr. Director, Fraud , Waste & Abuse. This position utilizes a variety...related to review processes and results. Sr Associate, FWA Investigator Coder utilizes claim analysis, document review, coding knowledge… more
- US Agency for International Development (Washington, DC)
- …The Office of Inspector General (OIG) is committed to detecting and preventing fraud , waste, and abuse within the U. S. Agency for International Development (USAID). ... Foundation (IAF), and the Millennium Challenge Corporation (MCC). Responsibilities As the Special Agent in Charge (SAC), OIG, Office of Investigations, you will… more
- US Agency for International Development (Washington, DC)
- …submit your application package. OIG is responsible for preventing and detecting fraud , waste, abuse, and violations of law, and for promoting economy, efficiency, ... and Millennium Challenge Corporation (MCC). Responsibilities As a GS-13 Criminal Investigator you will: Conduct complex and large-scale criminal, civil, and… more
- US Agency for International Development (Washington, DC)
- Summary OIG is responsible for preventing and detecting fraud , waste, abuse, and violations of law, and for promoting economy, efficiency, and effectiveness of USAID ... at the time of appointment. Applicants that have no prior series 1811 criminal investigator experience must meet the maximum age for entry into a covered position… more
- Centene Corporation (Oklahoma City, OK)
- …workplace flexibility. **Position Purpose:** Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and executing ... claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse. + Conduct investigations of potential waste, abuse, and… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …Nursing, Criminal Justice, or similar field of study preferred. + Accredited Healthcare Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE) ... or Registered Nurse (RN) preferred. + Experience creating and implementing a healthcare anti- fraud program. + Knowledge of healthcare claims and anti- fraud … more
- USAA (San Diego, CA)
- …for Property & Casualty** , you will be responsible for operational management of Claims fraud investigative teams. Directs staff in the investigation of cases ... Come be a part of what makes us so special ! **The Opportunity** As a dedicated **Manager, Special...+ Extensive knowledge and experience in all levels of claims investigation or fraud investigation and regulatory… more
- New York State Civil Service (New York, NY)
- …Business Office staff to ensure optimal attention to potential signs or "Red Flags" of claims fraud , policy fraud and medical provider fraud . Interacts ... criminal justice or related field, OR* Five years of insurance claims investigation experience or professional investigation experience with law enforcement… more
- City of New York (New York, NY)
- …FOR 6.1.9 TITLE CHANGE. BFI is mandated to detect and deter Public Assistance fraud and misuse by conducting investigations of individuals and groups that attempt to ... other means for referral to the Supplemental Nutrition Assistance Program- Claims and Recovery (SNAP CR). - Review claims...and make determination of whether to re-budget, return to Investigator or refer to SNAP-CR. - Assess the continued… more