- CVS Health (Sacramento, CA)
- …and more compassionate. And we do it all with heart, each and every day. Medical Director - SIU ( Special Investigations Unit ) CVS Health - Special ... **This is a remote based, work from home role.** Key Responsibilities: The Special Investigations Unit ( SIU ) Medical Director will be responsible for… more
- The Robison Group (Fort Myers, FL)
- …searches, and other investigative tasks. This is a remote opportunity for part-time employment in our Special Investigations Unit ( SIU ). As an SIU ... are interested in utilizing their investigative skills to conduct a variety of investigations on insurance related matters; such as auto and property theft, fire… more
- CVS Health (Springfield, IL)
- …with heart, each and every day. Come work for Aetna Better Health of Illinois and the Special Investigations Unit ( SIU )! **Position Summary** The SIU ... in identifying resources and best course of action on investigations . - Cooperates with federal, state, and local law...experience working on health care fraud, waste, and abuse investigations and audits required or equivalent investigations … more
- CVS Health (Pierre, SD)
- …The Certified Professional Coder (CPC) will perform medical claim reviews to ensure compliance with coding practices through a comprehensive record review for ... medical, behavioral, transportation and other healthcare providers. The CPC must have the ability to determine correct coding and appropriate documentation during the review of medical records. The CPC must also ensure that the state, federal and company… more
- Allied Universal (Orange, CA)
- …plans, employee assistance programs, and exclusive perks. Allied Universal(R) is hiring a Special Investigations Unit ( SIU ) Investigator. Special ... designated regional area. + Proficient in utilizing laptop computers and cell phones. + Special Investigative Unit ( SIU ) Compliance knowledge + Ability to… more
- JPMorgan Chase (Jersey City, NJ)
- …security solutions, ensuring a safer and more secure future for all. As a Special Investigations Unit Investigator within the Global Security team, you ... will be responsible for conducting complex and sensitive investigations involving Code of Conduct violations in both North America and Latin America and coordinate… more
- LA Care Health Plan (Los Angeles, CA)
- Student Intern ( Special Investigations Unit ) Job Category: Administrative, HR, Business Professionals Department: Talent Strategy & HR Technology Location: ... Additional Information "Provide analytical support to active Healthcare Fraud investigations . Conduct case intake from various sources including hotline complaints,… more
- City of New York (New York, NY)
- …seeks to recruit a SIU Data Analyst (community coordinator) to work on its Special Investigations Unit , PREA Investigations team. Under the direction ... of a Deputy Director for the SIU PREA Team and with latitude to exercise independent...will be responsible to work closely with the PREA Investigations Supervisors and Investigators to assist in the accurate… more
- Command Investigations (Orlando, FL)
- …an insurance Investigator is required. Must have background in handling multi-lines investigations and some SIU experience. Must have reliable transportation, ... Seeking a full-time experienced SIU /Insurance investigator. A minimum of 3 years' experience...should demonstrate proficiency in the following areas: + Multi-lines investigations + Writing accurate and detailed reports + Strong… more
- Command Investigations (Ventura County, CA)
- Experienced SIU Investigator A minimum of 5 years' SIU experience is required. Must have background in handling P&C investigations . Candidates who do not ... staff. This is a W-2 role; subcontractors will not be considered. The SIU /Insurance Investigator should demonstrate proficiency in the following areas: + P&C … more
- Command Investigations (San Diego, CA)
- SIU INVESTIGATOR A minimum of 5 years' SIU experience is required. Must have experience in Commercial and P&C investigations . * Candidates who do not have ... assignments. This is a W-2 role; subcontractors will not be considered. The SIU Investigator should demonstrate proficiency in the following areas: + P&C … more
- Molina Healthcare (Bellevue, WA)
- …(surgical, hospital, clinic settings) or 5+ years of experience working in a FWA / SIU or Fraud investigations role for New Jersey/New York location + Thorough ... **JOB DESCRIPTION** **Job Summary** The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical… more
- Travelers Insurance Company (Walnut Creek, CA)
- … SIU Specialized Investigator, you will lead complex, multi-claim investigations with regional and national impact-often involving potential litigation. This role ... accelerate case development, and support data-driven strategies in major case investigations . **What Will You Do?** + Proactively analyzes highly technical… more
- Travelers Insurance Company (Philadelphia, PA)
- …expertise to identify potential risks and combat fraudulent practices. As an SIU Investigator, you will analyze, summarize and prioritize information to uncover ... all lines of business. The investigator will conduct thorough and comprehensive investigations in a dynamic, fast paced environment. This position may include a… more
- Kemper (Henderson, NV)
- …by law and management. + Responsible for communicating critical situations to the Special Investigation Unit and field managers. + Develops and maintains ... to our stakeholders that delivers on our promises._ **Position Summary** : The SIU Desk Investigator I is responsible for the investigation of simple claims that… more
- BlueCross BlueShield of North Carolina (NC)
- **Job Description** The Special Investigations Unit ( SIU ) Investigator is responsible to conduct timely and thorough health care fraud investigations ... Investigations are confidential and are conducted in accordance with SIU Policies and Procedures, contractual obligation and in accordance with applicable state… more
- Sedgwick (Irving, TX)
- …changes with internal departments. + Provides referrals to legal, utilization review, pharmacy, and Special Investigations Unit ( SIU ) as appropriate and ... coordinates independent medical examinations. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). **QUALIFICATIONS** **Education & Licensing** High school diploma or GED required.… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …as a liaison for activity generated by Customer Advocacy (CAU), Customer Service (CS), Special Investigations Unit ( SIU ), Provider Relations (PR), or ... Sales & Marketing. + Ensuring all regulatory requirements are being met, such as NYS DOH, CMS, NCQA, and HEDIS, serving as internal auditor within the group. + Responsible for all aspects of the Case Management department functions including quality,… more
- Humana (Oklahoma City, OK)
- **Become a part of our caring community and help us put health first** Humana's Special Investigations Unit is seeking a Senior Fraud & Waste Investigator to ... the Oklahoma Medicaid Team. This team of Investigators conducts investigations into allegations of fraud, waste, and abuse involving...and other agencies such as the Medicaid Fraud Control Unit (MFCU) and coordinate all aspects of FWA activities… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …agencies (eg APS/CPS) as needed, and any suspected/possible Medicaid fraud to the Special Investigations Unit ( SIU ) or designated internal/external ... entity.* Communicates with all internal and external stakeholders to obtain the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members.* Adheres to all Corporate and Departmental policies… more
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