- MultiPlan (Atlanta, GA)
- …and coordination of benefit techniques to analyze and audit hospital and physician claims to identify errant claim payments. JOB ROLES AND RESPONSIBILITIES: 1. ... positive change. You can be part of an established company with a 40-year legacy that helps our customers...to shine! JOB SUMMARY: This role reviews medical paid claims against provider contracts and policies to ensure medical… more
- Dexian - DISYS (Baltimore, MD)
- …result in an overall achievement of unit goals. Investigator researches and analyzes claims data using company anti-fraud software, Excel, and other tools to ... Job Description: Job Duties: The role of the Special Investigations Unit (SIU) Investigator is to assist in the reduction and recuperation of losses through the… more
- nTech Solutions, Inc. (Baltimore, MD)
- …effective and result in an overall achievement of unit goals. Researches and analyzes claims data using company anti-fraud software, Excel, and other tools to ... of financial business records, provider and subscriber medical data, claims , systems' reports, medical records, analysis of contract documents, provider/subscriber… 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 ... Universal(R) Compliance and Investigations, North America's leading expert insurance claim investigations, compliance and corporate governance company , provides… more
- Allied Solutions (Plano, TX)
- …all established recovery and claim service standards and benchmarks for a Claims Investigator . + Promptly and effectively respond to both carrier and lender ... is responsible for the initial setup and investigation of claims prior to the assignment of the claim...database information found in systems such as Unitrac, insurance company websites, Lexis Nexis, ISO, and other automobile databases… more
- Allied Universal (Crossville, TN)
- …Universal(R) Compliance and Investigations, North America's leading expert insurance claim investigations, compliance and corporate governance company , provides ... jobs! Allied Universal(R) is hiring a Special Investigations Unit (SIU) Investigator . Special Investigations Unit (SIU) Specialists investigate claims with… more
- Xcel Energy (Denver, CO)
- …payment is received for damage claims , and pursue delinquent damage claim accounts. Mediate between customer and company contractors. Provide guidance and ... on determination of appropriate reserve funding. + Public and Company Claims and Settlement Payment - Determine... claims -related exp., including 3 years gas/electric Utility Claims Investigator exp. or equivalent. - Advanced… more
- The Hartford (NJ)
- …timely, efficient and impartial investigations to support the accurate resolution of insurance claims by the Company . Key responsibilities of the role include: + ... claim staff, or losses reviewed by the field investigator proactively which may be appropriate for SIU involvement....group benefit claims . + Provide support to claims partners and other departments within the Company… more
- Travelers Insurance Company (Brookfield, WI)
- …Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is ... - $109,700.00 **Target Openings** 1 **What Is the Opportunity?** This SIU Investigator is responsible for conducting field investigations in a dynamic fast paced… more
- Elevance Health (Columbus, OH)
- …paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use ... **Senior Investigator ( Investigator Sr)** _Location: This position will work...of proprietary data and claim systems for review of facility, professional… more
- Elevance Health (Columbus, OH)
- …paid on fraudulent claims . **How will you make an impact:** + Claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use ... ** Investigator Senior** **Supports the Payment Integrity line of business**...of proprietary data and claim systems for review of facility,… more
- Allied Universal (Coventry, RI)
- …Universal(R) Compliance and Investigations, North America's leading expert insurance claim investigations, compliance and corporate governance company , provides ... and vision coverage, life insurance, retirement plan, employee assistance programs, company discounts, perks and more for most full-time compliance and investigation… more
- Travelers Insurance Company (Los Angeles, CA)
- …Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is ... that have complex allegations and/or significantly financial impact to multiple claims and/or organized ring activity spanning across multiple lines of business… more
- Elevance Health (Chicago, IL)
- …paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use ... ** Investigator II** **Location** : This position will work a hybrid model...of proprietary data and claim systems for review of facility, professional and… more
- Elevance Health (West Des Moines, IA)
- …paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use ... ** Investigator II** **Schedule** : 1-2 days per week in the office...of proprietary data and claim systems for review of facility, professional and… more
- NANA Regional Corporation (Washington, DC)
- **Overview** **Work Where it Matters** Suvi, an Akima company , is not just another federal mission services contractor. As an Alaska Native Corporation (ANC), our ... join our team in Washington, DC, as a Field Investigator , working in support of a Law Enforcement Agency....service and acting as a liaison to insurance companies claim services, claimants, policyholders, agents, counterparts in other departments,… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …. As a member of Premera's Special Investigations Unit (SIU), the ** Investigator III** will be responsible for investigating allegations of external fraud, waste, ... miles north of Seattle, Washington.** **What you'll do:** + Analyze healthcare claim data and vet referrals to detect fraudulent activity and independently determine… more
- Independent Health (Buffalo, NY)
- …benefits and commitment to diversity and inclusion. **Overview** The Fraud Investigator develops, implements and administers the IH anti-fraud program, including a ... from computerized fraud system and make determination to pay or deny claims . **Qualifications** + Bachelor's degree in criminal justice or related field required.… more
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- Lead Special Investigator (General) Hybrid Recruitment # 240411-7771AR-002 Location Hartford, CT Date Opened 5/9/2024 12:00:00 AM Salary $72,926* - $94,374/year ... a qualified individual for the position of Lead Special Investigator (PCN 100208) to join our team. This position...You'd be able to work for a Forbes top company : 'Forbes' State of Connecticut Ranked One of the… 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 work ... services. Discover more about us at www.amerihealthcaritas.com. **Responsibilities:** The Investigator is responsible for conducting comprehensive investigations of reported,… more
