- City of New York (New York, NY)
- …stipulated in their agreement to repay. Claims &Collection is recruiting for (4) four Fraud Investigator II to function as a Senior Fraud Investigator ... Job Description Claims and Collections pursues monetary recoveries owed to...discuss their cases and obtain additional information (if necessary) FRAUD INVESTIGATOR - 31113 Qualifications 1. A… more
- USAA (San Antonio, TX)
- …moderately complex investigations for life, health, and annuity products for potential claims fraud . + Gathers evidence through interviews, searches of ... to review, analyze, and investigate life, health, and annuity claims to ensure claim validity and to protect the...other agencies as appropriate. As a Mid-Level Life SIU Investigator for **Medicare Supplement Fraud , Waste, and… more
- Elevance Health (Norfolk, VA)
- **Clinical Fraud Investigator II** **Location** : _Hybrid1:_ This role requires associates be in the office 1-2 days per week, fostering collaboration and ... dynamic and adaptable workplace. Alternate locations may be considered. The **Clinical Fraud Investigator II** is responsible for identifying issues and/or… more
- Allied Universal (Salt Lake City, UT)
- …+ One or more of the following professional industry certifications: + Certified Fraud Investigator (CFE) + Certified Insurance Fraud Investigator ... perks. Allied Universal(R) is hiring a Special Investigations Unit (SIU) Investigator . Special Investigations Unit (SIU) Specialists investigate claims with… more
- Allied Universal (Butte, MT)
- …plans, employee assistance programs, and exclusive perks. Allied Universal(R) is hiring a Claims Investigator . Claim Investigators validate the facts of loss for ... + One or more of the following professional industry certifications + Certified Fraud Investigator (CFE) + Certified Insurance Fraud Investigator… more
- Sedgwick (Fort Worth, TX)
- …university preferred. Fraud Claims Law Associate (FCLA), Certified Insurance Fraud Investigator (CIFI), or Certified Fraud Examiner (CFE) strong ... Work(R) Fortune Best Workplaces in Financial Services & Insurance Director Complex Claims **PRIMARY PURPOSE** **:** To be responsible for managing SIU investigations… more
- Command Investigations (FL)
- …hire. Visit our website and find out why at www.GoCommand.com . The Claims /Surveillance Investigator should demonstrate proficiency in the following areas: + ... setting the bar high for investigative excellence. Seeking experienced Insurance Fraud Investigators with commercial or personal lines experience, with multi-lines… more
- The Hartford (Los Angeles, CA)
- …The mission of the Special Investigations Unit (SIU) is to contribute to claims accuracy by building fraud awareness and investigating questionable claims ... in discussions with Claim and SIU personnel. + The Investigator will also be responsible for understanding fraud...of investigative techniques and the laws pertaining to insurance claims and mandated fraud reporting as well… more
- MyFlorida (Miami, FL)
- …in 409.920, Florida Statutes. These matters include but are not limited to fraud against the Medicaid Program, false claims against the Medicaid program, ... LAW ENFORCEMENT INVESTIGATOR II - 41001296 1 Date: May 29,...Statutes. These matters include but are not limited to: fraud against the Medicaid Program, false claims … more
- New York State Civil Service (New York, NY)
- …to prevent and mitigate fraud . DCI is comprised of four separate teams: Claims Fraud , Provider Fraud , Policyholder Fraud and Data ... NY HELP No Agency Insurance Fund, State Title Investigator 1, Senior Investigative Officer Occupational Category Other...arrest and indictment of individuals and businesses suspected of fraud involving NYSIF. DCI's mission is to reduce the… more
- State of Georgia (Fulton County, GA)
- …Job Alerts The Office of the Attorney General Georgia Department of Law Nurse Investigator - Medicaid Fraud Division *To move forward in the recruiting process ... Nurse Investigator Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/64040/other-jobs-matching/location-only) Hot...will serve within the Audits section of the Medicaid Fraud Division. Job Summary Under the direction of the… more
- Command Investigations (Detroit, MI)
- …Candidates may have an advantage where they possess: MACP experience A djuster/PIP claims experience Prior experience as a private investigator Prior law ... experienced candidates to join our special investigations unit as an ACP Investigator . SuperiorX Investigations is the premier servicer for insurers and defense… more
- Kemper (Henderson, NV)
- …: The SIU Desk Investigator I is responsible for the investigation of simple claims that may contain elements of fraud or claims otherwise deemed ... nature. These investigations may include single exposure losses and non-represented PIP/Med Pay claims . A Special Desk Investigator I may also handle task-based… more
- Travelers Insurance Company (Philadelphia, PA)
- …summarize and prioritize information to uncover potentially fraudulent activity. The investigator , supporting a Claim Center, will investigate claims deemed ... obtain assistance in conducting investigations. + Identifies cases for potential insurance fraud prosecution and submits questionable claims to the National… more
- Highmark Health (Tallahassee, FL)
- …Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of provider ... This job is responsible for developing and maintaining an anti- fraud program which includes development and delivery of training...facility payment methodology, claims processing systems and coding and billing proficiency +… more
- Molina Healthcare (NM)
- **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, ... reporting, and when appropriate, recovery of money related to health care fraud , waste, and abuse. Duties include performing accurate and reliable medical review… more
- AmeriHealth Caritas (Newtown Square, PA)
- …services. Discover more about us at www.amerihealthcaritas.com. The Investigator is responsible for conducting comprehensive investigations of reported, ... alleged or suspected fraud involving the full range of products at the...using the Internet, data analysis tools, etc., to analyze aberrant; claims billing and practice patterns. + Analyzes data as… more
- Elevance Health (Atlanta, GA)
- ** Investigator II** **Location Hybrid 1** : This role requires associates to be in-office **1 - 2** days per week, fostering collaboration and connectivity, while ... dynamic and adaptable workplace. Alternate locations may be considered. The ** Investigator II** is responsible for the identification, investigation and development… more
- Elevance Health (Indianapolis, IN)
- ** Investigator II** **Supporting the Payment Integrity line of business** _Location:_ **Hybrid 1** : This role requires associates to be in-office **1-2** days per ... to recover, eliminate and prevent unnecessary medical-expense spending. The ** Investigator II** is responsible for the identification, investigation and development… more
- Elevance Health (South Portland, ME)
- ** Investigator Senior** **Supports the Payment Integrity line of business** **Hybrid 1:** This role requires associates to be in-office **1-2** days per week, ... to recover, eliminate and prevent unnecessary medical-expense spending. The ** Investigator Senior** is responsible for the independent identification, investigation… more