- Parexel (Columbus, OH)
- …to design, development and implementation of major business initiatives or special projects. Applies technical skills and discipline knowledge to contribute to ... achievement of client business objectives **Compliance with Parexel standards** + Complies with required training curriculum + Completes timesheets accurately as required + Submits expense reports as required + Updates CV as required + Maintains a working… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, ... review audits that may also include coding and billing reviews. The SIU Investigator is responsible for reviewing and analyzing information to draw conclusions on… more
- CVS Health (Columbus, OH)
- …States. **Position Summary** We are seeking 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, waste and abuse (FWA). **Key Responsibilities** + Conduct high level, complex investigations of known or suspected… more
- AmeriHealth Caritas (Columbus, OH)
- …services. Discover more about us at www.amerihealthcaritas.com. The Investigator is responsible for conducting comprehensive investigations of reported, ... **Major Accountabilities:** + Ensures compliance with all requirements related to Special Investigation Units and fraud, waste and abuse investigations. + Conducts… 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 ... and claims processing areas + Adequately staff and manage the program integrity investigator (s) responsible for all FWA detection programs and activities + Assist in… more
- Molina Healthcare (Columbus, OH)
- …**Job Summary** Under direct supervision of the Manager, SIU, the Team Lead is responsible to lead a small team of investigators and provide oversight on daily ... investigative activities as a back-up to the SIU Manager. This position will be accountable for tracking on investigations conducted by his/her team and will provide oversight and guidance throughout the life of an investigation as well as QA reviews and… 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 ... providers. This position uses information from a tip, member benefits, and medical records to document relevant findings of a post pay clinical review. This position manages documents and prioritizes case load to ensure timely turn around. This position… more
- Family Dollar (Marysville, OH)
- General Summary: The Market Investigator is responsible for confirming that the market's stores operations and daily functions comply with Company programs and ... suspected fraudulent activity to Loss Prevention Business Partners. + Assist with special projects that impact given market (ie Target Program and Shrink Impact… more
- Centene Corporation (Columbus, OH)
- …investigative findings for referral to Federal and State agencies + Complete various special projects and audits + Performs other duties as assigned + Complies with ... all policies and standards **Education/Experience:** Bachelor's Degree in Business, Criminal Justice, Healthcare, related field or equivalent experience. 1+ years of medical claim investigation, medical claim audit, medical claim analysis, or fraud… more
- USAA (Columbus, OH)
- …treat each other and our members. Be part of what truly makes us special and impactful. **The Opportunity** As a dedicated **Manager, Special Investigations Unit ... of investigative tools and techniques to guide and coach special investigators. + Proven ability to build and maintain...**What sets you apart:** + 2+ years of SIU investigator experience. + Current or prior SIU leadership experience… more
- Pfizer (Columbus, OH)
- …researchers as appropriate + Appropriately provide medical support throughout the Investigator Sponsored Research (ISR) process + Cultivate research and therapeutic ... - Onboarding partner, ad board and study lead mentor. + Participate in special projects as needed **BASIC QUALIFICATIONS** + Candidate demonstrates a breadth of… more
