• Senior Fraud and Waste Investigator

    Humana (Indianapolis, IN)
    …(as much as 3 days/week, as needed) for meetings + Experience in healthcare , healthcare investigations , and/or risk management **Preferred Qualifications** + ... us put health first** This Senior Fraud and Waste Investigator will serve as Humana's Program Integrity Officer, who...and other agencies such as the Medicaid Fraud Control Unit (MFCU) and coordinate all aspects of FWA activities… more
    Humana (03/06/24)
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  • Special Investigations Unit

    CVS Health (Springfield, IL)
    …Summary: As a Senior Investigator you will conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely ... multi-lines of business, or cases involving multipleperpetrators or intricate healthcare fraud schemes * Investigates to prevent payment of...in identifying resources and best course of action on investigations * Serves as back up to the Team… more
    CVS Health (03/23/24)
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  • Investigator , SIU ( New Mexico)

    Molina Healthcare (Albuquerque, NM)
    **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit ( SIU ) Investigator is responsible for supporting the prevention, detection, ... that may also include coding and billing reviews. The SIU Investigator is responsible for reviewing and...assessments of FWA allegations, and end to end full investigations , including but not limited to witness interviews, background… more
    Molina Healthcare (03/21/24)
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  • SIU Senior Investigator

    CVS Health (Hartford, CT)
    …- Exhibits behaviors outlined in Employee Competencies. - Exhibits behaviors outlined in SIU Investigator Competencies. - May include travel to testify in court ... plans. Fundamental Components: - Conducts more high level, complex investigations of known or suspected acts of healthcare... investigations of known or suspected acts of healthcare fraud and abuse. - Routinely handles cases that… more
    CVS Health (03/17/24)
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  • SIU Senior Investigator (Must reside…

    CVS Health (Tallahassee, FL)
    …and to comply with state regulations mandating fraud plans and practices.- Conducts investigations of known or suspected acts of healthcare fraud and abuse.- ... in healthcare field working in fraud, waste and abuse investigations and audits.- Strong analytical and research skills.- Proficient in researching information… more
    CVS Health (03/06/24)
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  • Investigator III

    Premera Blue Cross (Mountlake Terrace, WA)
    …https://healthsource.premera.com . As a member of Premera's Special Investigations Unit ( SIU ), the ** Investigator III** will be responsible for ... Lives** Our purpose, to improve customers' lives by making healthcare work better, is far from ordinary. And so...+ (3) years of experience in fraud investigation, a special investigation unit , or a related field.… more
    Premera Blue Cross (03/02/24)
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  • Senior Pre-Payment External Auditor, Finance…

    Providence (Beaverton, OR)
    …Pre-Payment External Auditor, Finance who will:** + Support the compliance related activities of the Special Investigations Unit ( SIU ) at the Health Plan ... tracking of prepay audit operations (ie. live claims queue, SIU claims workflow, claims review history) and audit documentation...and effective manner + Current certification as an Accredited Healthcare Fraud Investigator (ie, AHFI, CFI) +… more
    Providence (02/15/24)
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  • Analyst, Special Investigation Unit

    CVS Health (Hartford, CT)
    …- Exhibits behaviors outlined in Employee Competencies - Exhibits behaviors outlined in SIU Investigator Competencies - May include travel to testify in court ... required by law and regulation. Fundamental Components: - Conducts investigations of known or suspected acts of healthcare... investigations of known or suspected acts of healthcare fraud, waste, and abuse - Communicates with federal,… more
    CVS Health (03/06/24)
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