- AIG (Atlanta, GA)
- …and reporting on findings. The investigator will provide assistance to the claims adjuster in progressing the claim and will leverage knowledge and expertise ... customers to manage risk. Join us as a Principal Claims Investigator to play your part in...business involving claimants, brokers, lawyers, medical providers, etc., to support the Claims organization. + Obtain and… more
- State of Colorado (Lakewood, CO)
- Criminal Investigator III - Lottery Divsion Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5150451) Apply Criminal Investigator III - ... quality customer service, innovation, and collaboration. We celebrate diversity and support an equitable and inclusive culture. We embrace our differences because… more
- Elevance Health (Indianapolis, IN)
- …eliminate and prevent unnecessary medical-expense spending. **Title:** Sr Investigator **Locations:** Indianapolis, IN, Columbus, OH, Nashville, TN **Hybrid:** ... week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …in a clear and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. + Manages cases as assigned, ... All Levels + Must meet the NYS DFS's and the NYS OMIG's minimum investigator requirements as follows: Persons employed by the SIU as investigators shall be qualified… more
- Prime Therapeutics (Salem, OR)
- …of pharmacy with us. **Job Posting Title** Special Investigations Unit (SIU) Investigator - Remote **Job Description** The Special Investigations Unit (SIU) ... Investigator is responsible for conducting standard investigations of potential...prescriber fraud, waste and abuse (FWA). This position conducts claims data mining, fraud analysis and auditing/monitoring activities and… more
- MVP Health Care (Tarrytown, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Clinical Investigator ** to join #TeamMVP. This is the opportunity for you if you have ... justice or a related field, and minimum of five years of insurance claims investigation experience; or five years of professional investigation experience with law… more
- UPMC (Pittsburgh, PA)
- …UPMC Health Plan has an exciting opportunity for a Special Investigations Unit Investigator position. This is a temporary position working Monday through Friday 8:00 ... direction of the manager, the Special Investigations Unit (SIU) Investigator is responsible for investigating assigned fraud, waste and...abuse (FWA) cases, as well as researching and analyzing claims data in order to identify potential FWA. The… more
- USAA (Cheyenne, WY)
- …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 in compliance with state insurance… more
- State of Michigan (Detroit, MI)
- Civil Rights Investigator - Detroit Print (https://www.governmentjobs.com/careers/michigan/jobs/newprint/5142643) Apply Civil Rights Investigator - Detroit ... and education, and community engagement. In this important role, an investigator is responsible for investigation and/or resolution of complaints of unlawful… more
- AmeriHealth Caritas (Columbia, SC)
- …services. Discover more about us at www.amerihealthcaritas.com. The Investigator is responsible for conducting comprehensive investigations of reported, ... Proactively performs research using the Internet, data analysis tools, etc., to analyze aberrant; claims billing and practice patterns. + Analyzes data as part of the… more
- Humana (Dayton, OH)
- …community and help us put health first** This Senior Fraud and Waste Investigator will serve as Humana's Program Integrity Officer, who will oversee the monitoring ... outcomes; work closely with internal and external auditors, financial investigators, and claims processing areas + Adequately staff and manage the program integrity … more
- Idaho Division of Human Resources (Lewiston, ID)
- Senior Agricultural Investigator - Lewiston or Post Falls Posting Begin Date: 2025/09/09 Posting End Date: 2025/12/11 Category: Agriculture Sub Category: Natural ... The Idaho Department of Agriculture is currently recruiting for an Agriculture Investigator Senior in the division of Agriculture Resources located in Lewiston or… more
- Point32Health (Canton, MA)
- …about who we are at Point32Health (https://www.point32health.org/) . **Job Summary** The Investigator I is an essential team member of the Special Investigation Unit ... ("FWA") investigations under the direction of the Manager, FWA Prepayment Review. The Investigator I works closely with other members of the SIU to set investigative… more
- Ally (Austin, TX)
- …be, too? **The Opportunity** The primary role of the Senior Bank Fraud Investigator to investigate and deter fraud against Ally Bank. This role requires the ... in bank fraud investigations of all types of forgery claims and schemes (ie, kite schemes, counterfeit checks, forgeries,...- extends beyond your paycheck and is designed to support and enrich your personal and professional life, including:… more
- Elevance Health (St. Louis, MO)
- …week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office ... recover corporate and client funds paid on fraudulent Medicaid claims . **How You Will Make an Impact:** + Responsible...company health plan, line of business and/or state + Claim reviews for appropriate coding, data mining, entity review,… more
- CVS Health (Topeka, KS)
- …States. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU), dedicated to a ... abuse. + Conduct Investigations to prevent payment of suspect or fraudulent claims submitted by insured's, providers, claimants, and customers. + Research and… more
- Marshfield Clinic (Marshfield, WI)
- **Come work at a place where innovation and teamwork come together to support the most exciting missions in the world!** **Job Title:** Subrogation Investigator ... Required: Two years previous work experience in collections, legal, claims processing, or subrogation related field. Preferred/Optional Experience: Qualified… more
- Highmark Health (Pittsburgh, PA)
- …or alleged fraud/waste and abuse cases or special projects. + Provides advisory support as needed to internal and external law enforcement and regulatory agencies, ... Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of provider facility payment… more
- City and County of San Francisco (San Francisco, CA)
- …and submission of claims to the California Victim Compensation and Government Claims Board, and monitor claim progress and payment. 5. Assist with the ... the criminal justice system humane and accessible by providing support and assistance to victims and their families in...losses when possible, and, in general, works tirelessly to support victims regain control over their lives. The Victim… more
- The Boeing Company (Ridley Park, PA)
- …NTSB, the FAA, and other foreign and domestic government agencies + Support the identification and mitigation of airplane related risks (design, maintenance, ... processes and initiatives. + Participates in the discussion of legal cases and claims with in-house and outside counsel. + Researches, acquires and provides specific… more