- 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 (Oklahoma City, OK)
- …searches, and other investigative tasks. This is a remote opportunity for part-time employment in our Special Investigations Unit ( SIU ). As an SIU ... are interested in utilizing their investigative skills to conduct a variety of investigations on insurance related matters; such as auto and property theft, fire… more
- USAA (Seattle, WA)
- …truly makes us special and impactful. **The Opportunity** As a dedicated **Manager, Special Investigations Unit for Property & Casualty** , you will be ... of investigative tools and techniques to guide and coach special investigators. + Proven ability to build and maintain...to demonstrate monthly productivity and cycle time outcomes from investigations assigned to the SIU team. +… 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 ... by the enterprise. Job Duties + Provides leadership and strategic direction of Special Investigations and Program Integrity units spanning all lines of business.… more
- CVS Health (Hartford, CT)
- …flexible to work EDT hours (8:00 am - 5 pm EDT) Conducts investigations to effectively pursue the prevention, detection, investigation and prosecution of healthcare ... agencies as required by law and regulation. **Fundamental Components:** - Conducts investigations of known or suspected acts of healthcare fraud, waste, and abuse… 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...Texas OIG, Florida AHCA) - Prior experience in a SIU or regulatory response role - Knowledge of claims… more
- Allied Universal (Palm Coast, FL)
- …on the position and eligibility. **Job Description:** Allied Universal(R) is hiring a Special Investigations Unit ( SIU ) Investigator. Special ... designated regional area. + Proficient in utilizing laptop computers and cell phones. + Special Investigative Unit ( SIU ) Compliance knowledge + Ability to… 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
- CVS Health (Hartford, CT)
- …Summary** We are seeking a skilled and proactive **QuickBase Developer** to support the Special Investigations Unit ( SIU ) by designing, developing, and ... and support monitoring and reporting needs. This role also includes managing SIU digital assets, conducting user access reviews, and supporting SharePoint site… more
- NTT DATA North America (Boston, MA)
- …strategy. NTT DATA's Client is seeking a Investigator for Health Plan Special Investigations Unit ( " SIU ) REMOTE EAST COAST The Investigator will ... experienced pre-payment review investigator and work closely with other members of the SIU . Reviews are fast-paced and require the investigator to be organized and… more
- Command Investigations (Detroit, MI)
- … Investigations ) is seeking qualified, driven, and experienced candidates to join our special investigations unit as an ACP Investigator. SuperiorX ... demand for quality investigations to gather critical information, conduct special investigations , examine coverage/loss, and combat fraud, one case at… more
- Elevance Health (Richmond, VA)
- …questions as necessary to aid in investigations . + Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern. ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU ** **Location:** This role requires associates to be in-office 1 - 2 days… more
- State of Massachusetts (Boston, MA)
- …and others with insurance laws, rules, regulations and administrative bulletins (ie, referral to Special Investigations Unit ). * Participate on special ... Insurance Examiner II position reports to the Director of the Consumer Services Unit , which is responsible for ensuring that consumers are informed of their rights… more
- M. C. Dean (Vienna, VA)
- …coverage; review the established reserve requirements, identified claims for subrogation and/or Special Investigations Unit as appropriate. + Assesses actual ... regulatory issues and available resources. + Plans and conducts investigations of claims to confirm coverage and to determine...Knowledge and abilities of Microsoft suite of applications with special emphasis on excel and the ability to pivot… more
- Zurich NA (Overland Park, KS)
- …+ Participate in National Insurance Crime Bureau (NICB) and International Association of Special Investigations Unit (IASIU) meetings to stay informed on ... for potential fraud indicators and recommend cases for referral to ZCIS investigations . + Partner with investigators to collect additional insights, utilizing social… more
- Travelers Insurance Company (Upper Marlboro, MD)
- …internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit . + ... Identifies and refers claims with Major Case Unit exposure to the manager. + Performs administrative functions such as expense accounts, time off reporting, etc. as… more
- Travelers Insurance Company (Toledo, OH)
- …internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit . + ... Identifies and refers claims with Major Case Unit exposure to the manager. + Performs administrative functions such as expense accounts, time off reporting, etc. as… more
- Zurich NA (Schaumburg, IL)
- …Assist in the identification of fraudulent billings by reporting suspicious activity to Special Investigations Unit . + Resolve escalated issues by exercising ... or more years of experience in the Critical Care Unit or Emergency Room or Medical Surgical Facility or...or more years of experience in the Critical Care Unit or Emergency Room or Medical Surgical Facility or… more
- Sedgwick (Knoxville, TN)
- …changes with internal departments. + Provides referrals to legal, utilization review, pharmacy, and Special Investigations Unit ( SIU ) as appropriate and ... coordinates independent medical examinations. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). **QUALIFICATIONS** **Education & Licensing** High school diploma or GED required.… more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …as a liaison for activity generated by Customer Advocacy (CAU), Customer Service (CS), Special Investigations Unit ( SIU ), Provider Relations (PR), or ... Sales & Marketing. + Ensuring all regulatory requirements are being met, such as NYS DOH, CMS, NCQA, and HEDIS, serving as internal auditor within the group. + Responsible for all aspects of the Case Management department functions including quality,… more