- CVS Health (Columbus, OH)
- …an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU ), dedicated to a specific self-funded plan ... sponsor. In this role, you will manage complex investigations into suspected and known acts of healthcare fraud,...abuse (FWA). **Key Responsibilities** + Conduct high level, complex investigations of known or suspected acts of healthcare fraud,… more
- USAA (Columbus, OH)
- …truly makes us special and impactful. **The Opportunity** As a dedicated **Manager, Special Investigations Unit for Property & Casualty** , you will be ... to demonstrate monthly productivity and cycle time outcomes from investigations assigned to the SIU team. +...teams. **What sets you apart:** + 2+ years of SIU investigator experience. + Current or prior… more
- Humana (Dublin, OH)
- …community and help us put health first** This Senior Fraud and Waste Investigator will serve as Humana's Program Integrity Officer, who will oversee the monitoring ... Department of Medicaid (ODM) and other agencies such as the Medicaid Fraud Control Unit (MFCU) and coordinate all aspects of FWA activities in Ohio to increase… more
- CVS Health (Columbus, OH)
- …every day. **Position Summary** **WEST VIRGINIA RESIDENCY** **REQUIRED** As a Senior Investigator you will conduct high level, complex investigations of known ... in identifying resources and best course of action on investigations + Serves as back up to the Team...years of working health care fraud, waste and abuse investigations ). **Anticipated Weekly Hours** 40 **Time Type** Full time… more
- Centene Corporation (Columbus, OH)
- …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 fraud + Document...referral to Federal and State agencies + Complete various special projects and audits + Performs other duties as… more
- Molina Healthcare (Columbus, OH)
- **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
- AmeriHealth Caritas (Columbus, OH)
- … investigations . + Performs necessary functions to support all aspects of SIU investigations and responsibilities to include, but not limited to: Intake; ... Special Investigation Units and fraud, waste and abuse investigations . + Conducts investigations of potential; fraud,...in lieu of formal educational requirements for the Lead SIU Investigator position may be considered.; +… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** **Job Summary** Under direct supervision of the Manager, SIU , the Team Lead is responsible to lead a small team of investigators and provide ... on daily investigative activities as a back-up to the SIU Manager. This position will be accountable for tracking...Manager. This position will be accountable for tracking on investigations conducted by his/her team and will provide oversight… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** **Job Summary** The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical ... settings) or 5+ years of experience working in a FWA / SIU or Fraud investigations + Thorough knowledge of PC based software including Microsoft Word (edit/save… more