- CVS Health (Topeka, KS)
- …United States. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU), ... plan sponsor. In this role, you will manage complex investigations into suspected and known acts of healthcare fraud,...claimants, and customers. + Research and prepare cases for clinical and legal review. + Document all appropriate case… 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 ... to encourage sensible and culturally-competent business standards + Oversee internal investigations of FWA compliance issues + Work with the Contract Compliance… more
- CVS Health (St. Paul, MN)
- …it all with heart, each and every day. **Position Summary** - Conducts investigations to effectively pursue the prevention, investigation and prosecution of ... state regulations mandating fraud plans and practices. - Conducts investigations of known or suspected acts of healthcare fraud...fraud and abuse. - Researches and prepares cases for clinical and legal review. - Documents all appropriate case… more
- AmeriHealth Caritas (Columbia, SC)
- …Accountabilities:** + Ensures compliance with all requirements related to Special Investigation Units and fraud, waste and abuse investigations . + Conducts ... administrative services. Discover more about us at www.amerihealthcaritas.com. The Investigator is responsible for conducting comprehensive investigations of… more
- MVP Health Care (Tarrytown, NY)
- …innovative 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 a passion for problem solving and investigations , commitment to compliance and ethical standards and dedication...experience involving economic or insurance related matters. + A clinical investigator must have in addition to… more
- Sanford Health (Fargo, ND)
- …analytics, investigation , claim auditing and other areas related to Special Investigations . Completes reports of investigative findings and recommends ... investigation /audit. Master's Degree preferred Accredited Health Care Fraud Investigator (AHFI) certification or Certified Fraud Examiner (CFE) preferred Nursing… more
- Stony Brook University (Stony Brook, NY)
- …issues related to Title VI, Title VII and/or Title IX. Experience conducting investigations using the Civil Rights model of investigation or certification for ... EEO Investigator **Required Qualifications (as evidenced by an attached resume):** Bachelor's degree (foreign equivalent or higher). Five (5) years of full-time… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …of the SIU Management, this position is responsible for the accurate and thorough clinical investigation of potential fraud, waste and abuse (FWA) for all lines ... Operations) and supporting systems. (BREADTH). + Expertise in complex clinical coding/reviewing assignments, difficult investigations and highly visible… more
- Lane County (OR)
- …typically require): + Seven years of education and/or experience in medical investigation , similar investigations , biology, chemistry, pharmacology, or a related ... Medical-Legal Death Investigator , Senior Print (https://www.governmentjobs.com/careers/lanecountyor/jobs/newprint/5155373) Apply Medical-Legal Death … more
- Molina Healthcare (Ann Arbor, MI)
- **JOB DESCRIPTION** **Job Summary** The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical ... records to document relevant findings of a post pay clinical review. This position manages documents and prioritizes case...experience working in a FWA / SIU or Fraud investigations + Thorough knowledge of PC based software including… more
- Deschutes County (Bend, OR)
- …Health Specialist II, Civil Commitment Investigator /Monitor Print (https://www.governmentjobs.com/careers/deschutes/jobs/newprint/5158351) Apply Behavioral Health ... Specialist II, Civil Commitment Investigator /Monitor Salary $6,004.15 - $8,448.45 Monthly Location Bend, OR...Community Mental Health Program providing safety net and core clinical services for community members in Deschutes County dealing… more
- Point32Health (Canton, MA)
- …Summary** The Investigator I is an essential team member of the Special Investigation Unit ("SIU") responsible for leading complex provider investigations ... for conducting high-volume Pre-Payment Fraud Waste & Abuse ("FWA") investigations under the direction of the Manager, FWA Prepayment...the direction of the Manager, FWA Prepayment Review. The Investigator I works closely with other members of the… more
- University of Utah (Salt Lake City, UT)
- …+ Established track record of research accomplishments with a focus on clinical investigation and/or health services research + Eligibility for licensure ... Position Information **Position/Rank** General Internal Medicine Clinician Investigator **Department** 00232 - General Internal Medicine **City** Salt Lake City, UT… more
- Humana (Oklahoma City, OK)
- **Become a part of our caring community and help us put health first** Humana's Special Investigations Unit is seeking a Senior Fraud & Waste Investigator to ... join the Oklahoma Medicaid Team. This team of Investigators conducts investigations into allegations of fraud, waste, and abuse involving providers who submit claims… more
- US Capitol Police (Washington, DC)
- …of the ID; Prepare and disseminate written reports including reports of investigation , various investigative assessments, and investigations bulletins; Perform a ... mitigation, Member protection, and enforcement strategies. Specialty Units include Investigations , Intelligence and Interagency Coordination, and Dignitary Protection. A… more
- US Capitol Police (Washington, DC)
- …of the ID; Prepare and disseminate written reports including reports of investigation , various investigative assessments, and investigations bulletins; Perform a ... risk mitigation, Member protection, and enforcement strategies. Specialty Units include Investigations and Dignitary Protection. A United States Capitol Police … more
- University of Pennsylvania (Philadelphia, PA)
- …members + Promote good clinical practice in the conduct of clinical investigations , included possessing an in-depth knowledge of the federal regulations ... needed and monitor results. Responsible for study coordination for investigator -initiated studies, multi-center research studies, and patient-oriented clinical … more
- University of Pennsylvania (Philadelphia, PA)
- …members + Promote good clinical practice in the conduct of clinical investigations , included possessing an in-depth knowledge of the federal regulations ... needed and monitor results. Responsible for study coordination for investigator -initiated studies, multi-center research studies, and patient-oriented clinical … more
- University of Pennsylvania (Philadelphia, PA)
- …and translational research projects. Job Description Job Responsibilities + Conduct clinical investigation utilizing GCP, which includes possessing and ... needed and monitor results. Responsible for study coordination for investigator -initiated studies, multi-center research studies, and patient-oriented clinical … more
- Stony Brook University (Stony Brook, NY)
- …University's Renaissance School of Medicine (RSOM) is seeking applications for a clinical pathology faculty member at the Assistant, Associate, or Full Professor ... (Clinician Educator track) to provide laboratory director oversight for the clinical microbiology laboratory section of the Stony Brook University Hospital's… more