- 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 ... utilizing their investigative skills to conduct a variety of investigations on insurance related matters; such as auto and...+ Make sound judgments during the course of the investigation . + Provide timely progress updates. + Complete detailed… more
- CVS Health (Richmond, VA)
- …experience with medical record review within a healthcare insurance company. - Prior special investigation unit experience. - Excellent analytical skills. - ... Excellent communication skills. **Education** - GED or equivalent - AAPC Certified Professional Coder Certification (CPC) **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $43,888.00 - $102,081.00… 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...Medicaid and Medicare programs - Familiarity with state-specific fraud investigation protocols (eg, Texas OIG, Florida AHCA) - Prior… more
- Molina Healthcare (Lexington, KY)
- **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit ( SIU ) Investigator is responsible for supporting the prevention, detection, ... SIU related requirements. Prepares detailed preliminary and extensive investigation referrals to state and/or federal regulatory and/or law enforcement agencies… more
- CVS Health (Albany, NY)
- …Senior Healthcare Fraud Investigator to join our Dental/Pharmacy/Broker Investigative Team within Aetna's Special Investigations Unit . In this role, you will ... fraud, waste and abuse (FWA). **Key Responsibilities** + Conduct high level, complex investigations of known or suspected acts of healthcare fraud, waste and abuse.… 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 ... directs the prevention, detection and investigation of anti-fraud, waste and abuse (FWA)program processes and...Job Duties + Provides leadership and strategic direction of Special Investigations and Program Integrity units spanning… more
- CVS Health (Harrisburg, PA)
- …**Position Summary** **Position Summary** TThe SIU Investigator conducts investigations to effectively pursue the prevention, investigation and prosecution ... in identifying resources and best course of action on investigations . - Cooperates with federal, state, and local law...federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud and abuse matters.… more
- CVS Health (Hartford, CT)
- …be flexible to work EDT hours (8:00 am - 5 pm EDT) Conducts investigations to effectively pursue the prevention, detection, investigation and prosecution of ... agencies as required by law and regulation. **Fundamental Components:** - Conducts investigations of known or suspected acts of healthcare fraud, waste, and abuse… more
- Molina Healthcare (Covington, KY)
- … investigations . **KNOWLEDGE/SKILLS/ABILITIES** + Provides oversight and review of the SIU referral intake and investigation process while giving guidance and ... direction to team on case investigation steps and actions. + Works with leadership to maintain and revise policies and procedures, fraud, waste, and abuse plans,… 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 ... ensuring thorough documentation and effective communication with clients and their Special Investigation Unit Supervisor **QUALIFICATIONS (MUST HAVE):**… 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 ... investigator and work closely with other members of the SIU . Reviews are fast-paced and require the investigator to...summaries of findings, supported by evidence collected in the investigation Assisting in the preparing fraud referrals to other… 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 ... **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
- 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 ... Bachelor Apprenticeship Program - Claims Fraud Investigation - Schaumburg (January 2026) 126569 Have you...fraud indicators and recommend cases for referral to ZCIS investigations . + Partner with investigators to collect additional insights,… 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 ... position reports to the Director of the Consumer Services Unit , which is responsible for ensuring that consumers are...information from all parties as appropriate to complete an investigation and communicate their findings to complainants and DOI… 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
- Sedgwick (Irving, TX)
- …changes with internal departments. + Provides referrals to legal, utilization review, pharmacy, and Special Investigations Unit ( SIU ) as appropriate and ... communication skills + PC literate, including Microsoft Office products + Strong investigation and organizational skills + Good interpersonal skills + Ability to… more
- Travelers Insurance Company (West Hollywood, CA)
- …internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit . + ... handling throughout the claim life cycle (customer contacts, coverage, investigation , evaluation, reserving, negotiation and resolution) including maintaining full… more