- CVS Health (Lincoln, NE)
- …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 (Omaha, NE)
- …makes us special and impactful. **The Opportunity** We are looking for a SIU Investigator (mid-level). This is a Desk position. Within defined guidelines and ... (GED). + 2+ years claims adjusting experience, or P&C SIU /Fraud Investigation experience OR 4+ years prior investigative law...SIU experience conducting low to complex PNC fraud investigations OR a combination of Claims and Law Enforcement… more
- Centene Corporation (Lincoln, NE)
- …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 (Omaha, NE)
- **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
- Molina Healthcare (Omaha, NE)
- **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 (Omaha, NE)
- **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
- The Robison Group (Omaha, NE)
- Individuals selected for the position will be expected to perform investigations of workers compensation claims, liability investigations , multi-line insurance ... We are looking for people who are enthusiastic about investigations , those who thrive in a diverse work environment,...POSITION QUALIFICATIONS: + A current and valid Nebraska Private Investigator license is highly preferred. Ability to obtain an… more