- 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
- Elevance Health (New York, NY)
- …**Hybrid Workplace Strategy:** 1-2 days in office per week The **Clinical Fraid Investigator II** is responsible for identifying issues and/or entities that may pose ... potential risk associated with fraud and abuse. **How you will make an impact:**...in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines… more
- Allied Universal (Queens, NY)
- …is hiring a Special Investigations Unit (SIU) Investigator . Special Investigations Unit (SIU) Specialists investigate claims with red flags that ... 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
- CDPHP (Albany, NY)
- …Certified Outpatient Coder (COC) Certification is preferred. + Accredited Health Care Fraud Investigator (AHFI(R)) accreditation to be obtained once the required ... values and invites you to be a part of that experience. The Special Investigative Analyst will be responsible for researching, investigating, and resolving instances… more
- Highmark Health (Albany, NY)
- …Professional Coder- Hospital(CPC-H) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of ... recover identified overpayments, performing a follow-up review to ensure that the claims were adjusted correctly, resulting in expected recovery/savings. + Perform … more
- New York State Civil Service (White Plains, NY)
- …considered qualifying: Experience in such positions as police detective, insurance investigator , licensed and registered private investigator , federal ... investigator , state investigator , municipal investigator , child protective services investigator , in an...As an Investigative Officer 1 in the Office of Special Investigations, under the general direction of an Investigative… more
- City of New York (New York, NY)
- …FOR 6.1.9 TITLE CHANGE. BFI is mandated to detect and deter Public Assistance fraud and misuse by conducting investigations of individuals and groups that attempt to ... other means for referral to the Supplemental Nutrition Assistance Program- Claims and Recovery (SNAP CR). - Review claims...and make determination of whether to re-budget, return to Investigator or refer to SNAP-CR. - Assess the continued… more