- Molina Healthcare (Louisville, KY)
- **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
- Command Investigations (Louisville, KY)
- …for investigative excellence. What you'll get: + A dedicated position as a surveillance investigator on a part-time to a full-time basis. + A steppingstone into the ... surveillance + Be able to hold a valid Private Investigator license/PERC card - where applicable. + Possession of...damages. What a day in the life of an investigator looks like: + Surveillance involves monitoring, tracking, and… more
- Elevance Health (Louisville, KY)
- **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 days ... eliminate and prevent unnecessary medical-expense spending. The **Clinical Fraud Investigator II** is responsible for identifying issues and/or entities that… more
- Humana (Frankfort, KY)
- …PREFERRED:** Prior Law enforcement experience at a detective or investigator level. + **STRONGLY PREFERRED:** Experience with internal/employee investigations. + ... Bilingual (Spanish) + Graduate degree and/or certifications (MBA, JD, MSN, Clinical Certifications, CPC, CCS, CFE, AHFI). + Understanding of healthcare industry, claims processing and investigative process development. + Experience in a corporate environment… more
- Highmark Health (Frankfort, KY)
- …Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of provider facility payment ... methodology, claims processing systems and coding and billing proficiency + Must have understanding of technical and financial aspects of the health insurance industry + Strong personal computer skills, along with the ability to use fraud/abuse data mining… more
- Meta (Frankfort, KY)
- …activities related to insider threats. **Required Skills:** Security Engineer Investigator , Insider Trust Responsibilities: 1. Perform analysis, and threat hunting ... from a variety of log sources (eg, individual host logs, network traffic logs) to identify potential insider threats 2. Create workflows and automations to streamline signal detection, threat hunts, and investigative processes 3. Collaborate with software and… more
- USAA (Louisville, KY)
- …special and impactful. **The Opportunity** We are looking for a SIU Investigator (mid-level). **This is a "Desk" position.** Within defined guidelines and framework, ... protects USAA and our members from potential fraudulent claims by investigating questionable, suspect claims activity in compliance with state insurance fraud-related laws and regulations and policies and procedures. **This role is remote eligible. However,… more
- Molina Healthcare (Louisville, KY)
- **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
- Command Investigations (Louisville, KY)
- …Visit our website and find out why at www.GoCommand.com . The Claims Investigator should demonstrate proficiency in the following areas: + AOE/COE, Auto, or ... Homeowners Investigations. + Writing accurate, detailed reports + Strong initiative, integrity, and work ethic + Securing written/recorded statements + Accident scene investigations + Possession of a valid driver's license + Ability to prioritize and organize… more
- Humana (Frankfort, KY)
- …- What it takes to Succeed** + Bachelor's degree or equivalent work experience + Minimum 2 years of investigative and/or claims experience + Knowledge of healthcare ... payment methodologies + Strong organizational, interpersonal, and communication skills + Inquisitive nature with ability to analyze data to metrics + Computer literate (MS Word, Excel, Access) + Strong personal and professional ethics + Ability to travel up to… more
- Humana (Frankfort, KY)
- …+ Bachelor's Degree or equivalent years of relevant work experience in Fraud & Abuse Investigations required + At least 2 years of healthcare fraud investigations and ... **Become a part of our caring community and help us put health first** The Senior Fraud and Waste Professional (Program Integrity Lead) is responsible for overseeing the monitoring and enforcement of the Fraud, Waste, and Abuse (FWA) program. This role aims to… more
- Parexel (Frankfort, KY)
- …CTA templates, Fallback languages, Site Contract Plan, etc. + Advise on investigator grant budgets/parameters in collaboration with a global team of Grant Strategy ... and Investigator fees + Ensuring that all terms and conditions...to cross-functional teams including Start up, Global Clinical Operations, Investigator Payments, Business Development and Feasibility + Provide regular… more
- Humana (Frankfort, KY)
- …and help us put health first** The Manager, Fraud and Waste Investigator : Nurse Audit/Review performs clinical audit/validation processes to ensure that medical ... approach, resources, schedules and goals. The Manager, Fraud and Waste Investigator : Nurse Audit/Review validates and interprets medical documentation to ensure… more
- Parexel (Frankfort, KY)
- …with feasibility leaders, solution consultants + Participate in team project and investigator meetings + Provide training of study teams on TA indication and ... preferred *Experienced as a Physician in Industry or as a clinical trial investigator with significant clinical research experience The ability to travel 15-20% is… more
- Sumitomo Pharma (Frankfort, KY)
- …CMC documentation (eg nonclinical study reports, clinical protocols/study reports, investigator brochures, CMC information/data) and contributes to content as needed ... CMC documentation (eg nonclinical study reports, clinical protocols/study reports, investigator brochures, CMC information/data) and contribute to content as needed… more
- Sumitomo Pharma (Frankfort, KY)
- …writing of clinical study reports + Contributes to the preparation of Investigator Brochures, annual reports, data collection systems and final reports in compliance ... globally + Contributes to the development of presentation materials for investigator meetings, health authority meetings, scientific advisory board meetings, and… more
- Sumitomo Pharma (Frankfort, KY)
- …CMC documentation (eg nonclinical study reports, clinical protocols/study reports, investigator brochures, CMC information/data) and contributes to content as needed ... CMC documentation (eg nonclinical study reports, clinical protocols/study reports, investigator brochures, CMC information/data) and contribute to content as needed… more
- Norstella (Frankfort, KY)
- …development planning and forecasting + Protocol Design, Country, Site and Investigator Feasibility + Clinical trials operations, cost benchmarking & landscapes + ... Performance monitoring/optimization & acceleration + Diversity planning and execution + Competitor trial monitoring & analytics **Requirements** + Deep knowledge and expertise of the pharma strategic Clinical trial landscape (Clin Dev/Ops, clinical development… more
- Merck (Frankfort, KY)
- …(BI), Clinical Development, Decision Making, Interpersonal Relationships, Investigator -Initiated Studies (IIS), Leadership, Management Process, Medical Affairs, ... Medical Care, Medical Teaching, Medical Writing, Multidisciplinary Collaboration, Mycology, Operational Excellence, Ophthalmology, Pharmaceutical Development, Pharmaceutical Management, Pharmaceutical Medical Affairs, Pharmacology, Policy Development, Product… more
- Pacific Northwest National Laboratory (Frankfort, KY)
- …human-in-the-loop decision-making for grid operators. + Serve as the principal investigator (PI) on multi-disciplinary research projects funded by DOE, ARPA-E, ... utilities, and other stakeholders. Define project vision, build teams, and oversee successful execution. + Collaborate across different components of the organization supplying domain expertise to AI/ML experts in other areas. + Mentor and coach other… more