- MTA (Brooklyn, NY)
- Claims Fraud Investigator ( Special Investigations) Job ID: 7127 Business Unit: MABSTOA Location: Brooklyn, NY, United States Regular/Temporary: Regular ... Date of Filing: 05/11/2024 Authority: OA/TA Department: Law Division/Unit: Special Investigation Unit Reports to: Director, Special ...claims fraud . Education and Experience Claim Fraud Investigator + Bachelor's degree in a… 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 (Pittsburgh, PA)
- …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 (Beckley, 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
- The Hartford (NJ)
- …too. Join our team as we help shape the future. We are seeking a talented Special Investigator to join our Special Investigations Unit (SIU). This position ... The mission of the SIU is to contribute to claims accuracy by building fraud awareness and...will require 50%+ travel within the assigned territory. The Special Investigator for this opportunity will be… 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
- 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
- Office of the Inspector General (Billings, MT)
- …and program reviews in support of the unit's mission. As a Criminal Investigator ( Special Agent) you will conduct complex and difficult, highly visible ... a wide range of complex criminal, civil and administrative investigative techniques, complex fraud schemes, civil false claims and allegations of DOI violations… more
- CVS Health (Columbus, OH)
- …investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with state ... regulations mandating fraud plans and practices. + Conducts investigations of known... cases + Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, customer members, etc.… more
- MyFlorida (Fort Lauderdale, 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 - 41001279 Date: May 8, 2024...Annually Position Summary: This position is in the Medicaid Fraud Unit. The Attorney General's Medicaid Fraud … more
- USAA (San Jose, CA)
- …to how we treat each other. Come be a part of what makes us so special ! **The Opportunity** As a dedicated SIU investigator , you will protect USAA and our ... members from potential fraudulent claims by investigating questionable, suspect claims activity in compliance with state insurance fraud -related laws and… 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
- Customs and Border Protection (Washington, DC)
- …collusion, conspiracy, forgery, bribery, embezzlement, theft, Procurement Integrity Act, False Claims Act, and fraud . Leading and conducting sensitive and ... Border Protection, Office of Professional Responsibility, Investigative Operations Division, Procurement Fraud Program, Washington, DC.. This is a Direct Hire Public… more
- Premera Blue Cross (Mountlake Terrace, 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
- National General Insurance Company (Uniondale, NY)
- …multi-discipline coverage and claims that have been referred to the special investigation unit(SIU) for potential fraud . This role typically handles a ... ** This role is a field Investigator role where the investigator would...The Bronx, Queens and Staten Island NY. Previous SIU claims and/or law enforcement investigation experience preferred** Job Summary:… more
- Highmark Health (Harrisburg, PA)
- …Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of provider ... investigative work necessary to complete a review of a special project, potential fraud , waste and abuse...facility payment methodology, claims processing systems and coding and billing proficiency +… more
- National Science Foundation (IN)
- …complex investigations of sexual assault and/or stalking, as well as allegations of fraud , bribery, misuse of funds, false claims , mismanagement, conflicts of ... Summary This position is that of a Criminal Investigator in the Office of Investigations (OI), Office...a national investigative program with minimal oversight from the Special Agent in Charge or the Assistant Special… 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
- 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
- MyFlorida (Jacksonville, FL)
- LAW ENFORCEMENT INVESTIGATOR II - 79001415 Date: May 3, 2024 Location: JACKSONVILLE, FL, US, 32202 JACKSONVILLE, FL, US, 32209 JACKSONVILLE, FL, US, 32221 ... No: 828733 Agency: Business and Professional Regulations Working Title: LAW ENFORCEMENT INVESTIGATOR II - 79001415 Pay Plan: Career Service Position Number: 79001415… more