- Molina Healthcare (Dayton, 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
- Command Investigations (Cincinnati, OH)
- …investigative excellence. What you'll get: + A dedicated position as a surveillance investigator on a full-time basis. + A steppingstone into the realms of ... investigations, security, and law enforcement . + Immersion in the world of covert investigations....in driving skills. + Ability to obtain a Private Investigator license in the state where work is performed… more
- Humana (Dayton, 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 enforcement of the fraud, waste, and abuse (FWA) compliance...areas + Adequately staff and manage the program integrity investigator (s) responsible for all FWA detection programs and activities… more
- Command Investigations (Cleveland, OH)
- …excellence. What you'll get: + A dedicated position as a surveillance investigator . + A steppingstone into the realms of investigations, security, and law ... enforcement . + Immersion in the world of covert investigations....damages. What a day in the life of an investigator looks like: + Surveillance involves monitoring, tracking, and… more
- AmeriHealth Caritas (Columbus, OH)
- …services. Discover more about us at www.amerihealthcaritas.com. The Investigator is responsible for conducting comprehensive investigations of reported, ... to others.; + Establishes and maintains liaison with public officials, law enforcement and others to obtain assistance in conducting investigations. + Performs… more
- Molina Healthcare (OH)
- **JOB DESCRIPTION** **Job Summary** The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical ... position completes a medical review to facilitate a referral to law enforcement or for payment recovery. **KNOWLEDGE/SKILLS/ABILITIES** + Reviews post pay claims… 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 ... fraud, waste and abuse. + Cooperate with federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud. + Demonstrate… 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 or ... Team Leader as necessary + Cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud and abuse… more
- Molina Healthcare (Cincinnati, OH)
- …Health Information Management, Health Care Administration, Finance, Criminal Justice, Law Enforcement , or related field (applicable FWA experience would be accepted ... Health Information Management, Health Care Administration, Finance, Criminal Justice, Law Enforcement , or related field (applicable FWA experience would be accepted… more
- Humana (Columbus, OH)
- …Fraud and Waste Professional 2 coordinates investigation with law enforcement authorities. Assembles evidence and documentation to support successful adjudication, ... where appropriate. Conducts on-site audits of provider records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Understands department, segment, and organizational strategy and operating objectives, including… more