- Elevance Health (Richmond, VA)
- Anticipated End Date: 2025-07-31 Position Title: Clinical Fraud Investigator II - Registered Nurse and CPC - Carelon Payment Integrity SIU Job Description: Clinical ... Fraud Investigator II - Registered Nurse and CPC - Calrelon...Performs in-depth investigations on identified providers as warranted. Examines claims for compliance with relevant billing and processing guidelines… more
- Schneider Electric (Boston, MA)
- …a Experienced Certified Fraud Examiner in Boston, MA. The Central Investigator plays a critical role in ensuring thorough and effective investigations of Trust ... part of your role, you may conduct the investigation with another central investigator or with an external consultant (outsourced investigation). What will you do?… more
- Allied Universal (Butte, MT)
- …Investigator 's license** **required** **prior to applying** Allied Universal(R) is hiring a Claims Investigator . Claim Investigators validate the facts of ... Investigator (CFE) + Certified Insurance Fraud Investigator (CIFI) + Fraud Claim Law Associate...+ Fraud Claim Law Specialist (FCLS) + Certified Protection Professional (CPP) + Associate in Claims… more
- Allied Universal (Las Vegas, NV)
- …+ Certified Fraud Investigator (CFE) + Certified Insurance Fraud Investigator (CIFI) + Fraud Claim Law Associate (FCLA) + Fraud Claim Law ... full schedule** Allied Universal(R) is hiring a SIU / Claims Investigator . SIU / Claims ... Certified Protection Professional (CPP) + Associate in Claims (AIC) + Chartered Property Casualty Underwriter (CPCU) **BENEFITS:**… more
- CareFirst (Baltimore, MD)
- …Unit. **QUALIFICATIONS:** **Education Level:** Bachelor's Degree **Licenses/Certifications Preferred:** + Certified Insurance Fraud Investigator (CIFI) + ... & Qualifications** **PURPOSE:** The role of the Special Investigations Unit (SIU) Senior Investigator is to assist in the reduction and recuperation of losses to… more
- Molina Healthcare (St. Petersburg, FL)
- …: + Health Care Anti-Fraud Associate (HCAFA). + Accredited Health Care Fraud Investigator (AHFI). + Certified Fraud Examiner (CFE). To all current Molina ... **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation,… more
- Constructive Partnerships Unlimited (Manhattan, NY)
- …C. REQUIREMENTS: 1. Minimum BA/BS in related Human Services Field. 2. Must be a certified investigator or be able to pass the certification course within 60 days ... Incident Management Investigator Type of Position Full time Search Location(s)...the Social Services Law), Protection of Individual in Programs certified by OPWDD (Part 633 regulations), and the Justice… more
- State of Arkansas (Little Rock, AR)
- …compliance, internal audit, or a similar investigative role. Specialized certifications (eg, Certified Fraud Examiner, Certified Forensic Investigator ) may ... *Presenting evidence * Interviewing witnesses Job Summary: Review Incident and Accident claims as assigned by the lead investigator Perform a thorough… more
- EFI Global (Detroit, MI)
- …Licensing** Bachelor's degree from an accredited college or university preferred. IAAI Certified Fire Investigator (IAAI-CFI) certification or Certified Fire ... buildings or residences. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Investigates assigned claims suspected of insurance fraud, this includes large loss, large… more
- EFI Global (Los Angeles, CA)
- …expectations-anytime, anywhere. Click here to learn more about EFI Global. Seeking a certified fire investigator in the greater Los Angeles area. Must hold ... buildings or residences. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Investigates assigned claims suspected of insurance fraud, this includes large loss, large… more
- State of Colorado (CO)
- …Information This position is open only to Colorado state residents. THIS FINANCIAL CRIMINAL INVESTIGATOR REQUIRES YOU TO BE COLORADO POST CERTIFIED AND HAVE A ... Financial Investigator (Criminal Investigator IV) - Division...entity to identify all parties who may have a claim to the company's assets, including those whose ownership… more
- Compass Strategy Solutions (Washington, DC)
- …Compass Strategy Solutions, LLC, is seeking a highly qualified Background Investigator to conduct full-scope background investigations as a contract employee for ... We are an Equal Employment Opportunity employer. JOB DESCRIPTION The Field Investigator will be assigned background investigation cases by a senior official of… more
- Kemper (Doral, FL)
- …Law Specialist (FCLS) or Fraud Claims Law Associate (FCLA) designations and Certified Insurance Fraud Investigator (CIFI) or Certified Fraud Examiner ... reports for potential fraud + Completion of the NICB Basic and/or Analytics Academies are desirable. + Certified Insurance Fraud Analyst (CIFA), Fraud Claims … more
- Sedgwick (Salt Lake City, UT)
- …Marine Investigator **PRIMARY PURPOSE** **:** To perform detailed admiralty claims investigation and analysis through examination of the loss, collection of ... achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work(R) Fortune Best Workplaces in… more
- Elevance Health (Norfolk, VA)
- **Clinical Fraud Investigator Senior** **Location:** _Hybrid1:_ This role requires associates be in the office 1-2 days per week, fostering collaboration and ... adaptable workplace. Alternate locations may be considered. The **Clinical Fraud Investigator Senior** is responsible for identifying issues and/or entities that may… more
- Constructive Partnerships Unlimited (Manhattan, NY)
- Incident Management Investigator Specialist Type of Position Full time Search Location(s) Manhattan, NY Apply Now ... (https://phe.tbe.taleo.net/phe03/ats/careers/v2/applyRequisition?org=CPOFNYS&cws=37&rid=6481) Job Brief Assists the Incident Management Investigator with conducting investigations into situations, which may violate… more
- Constructive Partnerships Unlimited (Manhattan, NY)
- Incident Management Investigator Type of Position Per Diem Search Location(s) Manhattan, NY Apply Now ... investigations. 6. In conjunction with the assigned Incident Management Investigator Specialist, prepares investigative reports and forwards completed reports to… more
- Highmark Health (Dover, DE)
- …+ Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of provider facility payment methodology, ... **Required** + None **Preferred** (any of the following) + Certified Fraud Examiner (CFE) + Certified Professional... claims processing systems and coding and billing proficiency +… more
- CVS Health (Carson City, NV)
- …it all with heart, each and every day. The SIU Senior Investigator conducts complex investigations to effectively pursue the prevention, investigation and ... in a prepayment environment - Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc. - Researches and prepares cases… more
- CVS Health (Hartford, CT)
- …every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU). In this role, ... abuse. + Conduct Investigations to prevent payment of suspect or fraudulent claims submitted by insured's, providers, claimants, and customers. + Researches and… more
