- Independent Health (Buffalo, NY)
- …first-class perks, benefits and commitment to diversity and inclusion. **Overview** The Fraud Investigator develops, implements and administers the IH anti- ... fraud program, including a regular fraud risk assessment, and project managing the program, facilitating... system and make determination to pay or deny claims . **Qualifications** + Bachelor's degree in criminal justice or… more
- SGI Global, LLC (Raleigh, NC)
- SGI Global is seeking a Civil Investigator (Healthcare Fraud and Opioid Matters) to support Affirmative Civil Enforcement ("ACE") Program for the United States ... Office for the Eastern District of North Carolina. The investigator will be assigned cases and matters that vary...data relating to suspected civil violations, such as healthcare fraud or other violations or offenses of special… more
- Allied Universal (Crossville, TN)
- …compliance and investigation jobs! Allied Universal(R) is hiring a SIU / Claims Investigator . Special Investigations Unit (SIU) Specialists investigate ... extensive knowledge of Insurance policies and the components of fraud to determine If claims warrant reporting...more of the following professional industry certifications: + Certified Fraud Investigator (CFE) + Certified Insurance … more
- Allied Universal (Charleston, WV)
- …for most full-time compliance and investigation jobs! Allied Universal(R) is hiring a Claims Investigator . Claim Investigators validate the facts of loss for ... + One or more of the following professional industry certifications + Certified Fraud Investigator (CFE) + Certified Insurance Fraud Investigator… more
- CDPHP (Albany, NY)
- …will be responsible for investigating complex insurance cases to detect internal and external fraud and abuse. The Special Investigator will research and ... Federal laws pertaining to the health care industry. The Special Investigator will coordinate referrals of suspicious...experience required. + Designation as an Accredited Health Care Fraud Investigator preferred. + Incumbent must meet… more
- AmeriHealth Caritas (Washington, DC)
- ** Special Investigator Managed Care - DMV Counties only** Location: Washington, DC Primary Job Function: Compliance ID**: 29509 **Job Brief** This position will ... (ACFC). Major Accountabilities: + Ensures compliance with all requirements related to Special Investigation Units and fraud , waste and abuse investigations. +… more
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- Special Investigator (General) Hybrid Recruitment # 240516-7804AR-001 Location Hartford, CT Date Opened 5/16/2024 3:18:00 PM Salary $70,983* - $89,640/year ... currently accepting applications for an exciting opportunity as a Special Investigator (General) (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=7804AR&R1=&R3=) . WHAT WE… more
- CVS Health (Springfield, IL)
- …care more personal, convenient and affordable. Position Summary: As a Senior Investigator you will conduct high level, complex investigations of known or suspected ... acts of healthcare fraud and abuse. Routinely handles cases that are sensitive... schemes * Investigates to prevent payment of fraudulent claims submitted to the Medicaid lines of business *… more
- MyFlorida (Orlando, FL)
- …in 409.920, Florida Statutes. These matters include but are not limited to fraud against the Medicaid Program, false claims against the Medicaid program, ... LAW ENFORCEMENT INVESTIGATOR II - 41001050 Date: May 15, 2024...Annually Position Summary: This position is in the Medicaid Fraud Unit. The Attorney General's Medicaid Fraud … more
- Molina Healthcare (Omaha, NE)
- …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
- Premera Blue Cross (Spokane, WA)
- …Professional Coder (CPC), Certified Fraud Examiner (CFE), or Accredited Health Care Fraud Investigator (AHFI) preferred. + (2) years of active experience in ... through our Healthsource blog: https://healthsource.premera.com . As a member of Premera's Special Investigations Unit (SIU), the ** Investigator III** will be… 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
- Aflac (GA)
- …Preferred + Beginning progress toward one or more of the following designations/certifications: Fraud Claims Law Specialist (FCLS), Health Care Anti- Fraud ... Associate (HCAFA), or Certified Insurance Fraud Investigator (CIFI) + Ability to proficiently read and write both English and Spanish Travel Less than or equal… more
- Manulife (Boston, MA)
- …Machine Learning /AI techniques and solutions to detect, capture and proactively prevent fraud /abuse within the LTC claims experience. You will partner with all ... squads to drive savings associated with fraud , waste & abuse. The Senior LTC ...+ Regularly communicates findings and investigation status + Completes special projects individually or as a team member +… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Associate Investigator works with a growing team conducting and managing Health Care Fraud , Waste and Abuse ... interviews and data analysis to identify, evaluate and measure potential healthcare fraud and abuse to determine valid cases for appropriate action. + Document… more
- Headquarters, NASA (Kennedy Space Center, FL)
- …of law, including bribery, larceny, embezzlement, collusion, conflict of interest, procurement fraud , false statements, false claims and other Federal statutes. ... and investigations of NASA programs and operations to prevent and detect fraud , waste, abuse, and mismanagement. The Office of Investigations (OI) investigates… more
- Universal Health Services (Reno, NV)
- …analytics or related field + The following certifications are preferred: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), and ... patient experience. Learn more at: https://prominence-health.com/ Job Summary: The Special Investigations Unit is responsible for investigating and resolving high… more
- System One (Baltimore, MD)
- ALTA IT is hiring an Associate Investigator to support a leading health insurance customer. The individual will work with the Special Investigations Unit (SIU) ... and recuperation of losses. You will research and analyze data using company anti- fraud software, Excel, and other tools to proactively identify new potential cases.… more
- Commonwealth of Pennsylvania (PA)
- …to identify potential fraud , which will be documented and reported to the SWIF fraud investigator and supervisor. Apply today to become part of our team as ... State Workers' Insurance Fund Claims Adjuster Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/4500736) Apply State Workers' Insurance Fund … more
- Commonwealth of Pennsylvania (PA)
- … fraud , which will be documented and reported to the SWIF fraud investigator and supervisor. Interested in learning more? Additional details regarding ... State Workers' Insurance Fund Claims Adjuster Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/4500414) Apply State Workers' Insurance Fund … more