- 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
- Allied Universal (Boise, ID)
- …+ One or more of the following professional industry certifications: + Certified Fraud Investigator (CFE) + Certified Insurance Fraud Investigator ... compliance and investigation jobs! Allied Universal(R) is hiring a Claims / SIU Investigator . Claims ...extensive knowledge of Insurance policies and the components of fraud to determine If claims warrant reporting… 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
- Elevance Health (Indianapolis, IN)
- …**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
- The Hartford (Chicago, IL)
- …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
- 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
- USAA (San Antonio, TX)
- …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
- MyFlorida (Miami, 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 - 41000982 Date: Jun 17, 2024...Annually Position Summary: This position is in the Medicaid Fraud Unit in Miami, Florida. The Attorney General's Medicaid… 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
- 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
- National General Insurance Company (TX)
- …multi-discipline coverage and claims that have been referred to the special investigation unit (SIU) for potential fraud . This role typically handles ... National General is seeking an SIU Field Investigator for the San Antonio, or Austin, TX...a combination of complex attorney represented and unrepresented claims and moderate to complex losses, in which suspicious… 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
- US Agency for International Development (Washington, DC)
- …submit your application package. OIG is responsible for preventing and detecting fraud , waste, abuse, and violations of law, and for promoting economy, efficiency, ... and Millennium Challenge Corporation (MCC). Responsibilities As a GS-13 Criminal Investigator you will: Conduct complex and large-scale criminal, civil, and… more
- Centene Corporation (Springfield, IL)
- …United States.** **Position Purpose:** Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and executing ... claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse. + Conduct investigations of potential waste, abuse, and… 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
- American Family Insurance - Corporate (Madison, WI)
- … schemes and associated indicators. + Demonstrated experience investigating suspected insurance fraud activity involving multi-line auto and property claims . + ... participating in special investigation industry associations and collaborating with special investigation industry peers to combat insurance fraud activity.… more
- CareFirst (Baltimore, MD)
- …Qualifications:** Credentials as Certified Fraud Examiner (CFE), Accredited Health Fraud Investigator (AHFI), RN/LPN, or Certified Professional Coder (CPC). ... and external data bases and systems to support leads. Analyzes detailed claims files and performs financial calculations to assess financial impact of potential… more
- New York State Civil Service (Albany, 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...an Investigative Officer 1 (SL) in the Office of Special Investigations, under the general direction of an Investigative… more
- Architect of the Capitol (Washington, DC)
- …, Waste and Abuse Investigations: Provide oversight, supervision and direction to subordinate special agents involved with allegations of fraud , waste and abuse ... and operations, as well as to prevent and detect fraud , waste and abuse. Responsibilities Law enforcement retirement is...alleged cause of personal on-the-job injuries and worker's compensation claims and any and all relevant matters of importance… 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