- CVS Health (Boston, MA)
- …with medical record review within a healthcare insurance company. - Prior special investigation unit experience. - Excellent analytical skills. - Excellent ... communication skills. **Education** - GED or equivalent - AAPC Certified Professional Coder Certification (CPC) **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $43,888.00 - $102,081.00 This pay… more
- NTT DATA North America (Boston, MA)
- …strategy. NTT DATA's Client is seeking a Investigator for Health Plan Special Investigations Unit ( " SIU ) REMOTE EAST COAST The Investigator will ... experienced pre-payment review investigator and work closely with other members of the SIU . Reviews are fast-paced and require the investigator to be organized and… more
- CVS Health (Boston, MA)
- …Certified Professional Coder (CPC) Manager will oversee a team of medical coders within the Special Investigations Unit ( SIU ) to ensure compliance with ... Qualifications:** + A minimum of 2 years of managing staff within a Special Investigation Unit ( SIU ). + Excellent analytical skills and the ability to mentor… more
- Prime Therapeutics (Boston, MA)
- …It fuels our passion and drives every decision we make. **Job Posting Title** SIU Specialist - Pharmacy Tech - Remote in the California market **Job Description** ... additional information, facts and supporting documentation. + Collaborate and refer non- SIU related issue and activities to external departments (Cost Containment,… more
- MAPFRE Insurance (MA)
- Field Investigator, SIU Date: Aug 5, 2025 Location: MA, US Company: MAPFRE **Summary:** This position requires a high level of independence due to the extensive ... Assigned tasks may also include the assisting of Medical Provider, Underwriting, Agency investigations as well as any other investigative needs that may arise. +… more
- Travelers Insurance Company (Framingham, MA)
- …internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit . + ... Identifies and refers claims with Major Case Unit exposure to the manager. + Performs administrative functions such as expense accounts, time off reporting, etc. as… more
- State of Massachusetts (Boston, MA)
- …and others with insurance laws, rules, regulations and administrative bulletins (ie, referral to Special Investigations Unit ). * Participate on special ... Insurance Examiner II position reports to the Director of the Consumer Services Unit , which is responsible for ensuring that consumers are informed of their rights… more
- CVS Health (Boston, MA)
- …methods, and treatment protocols. + Serve as a clinical SME supporting SIU Investigators, Managers, and Directors as appropriate in matters pertaining to the ... cases. Completion of Fraud waste and abuse reviews in partnership with SIU + Provide SME support to enterprise-wide initiatives supporting members with… more
- Elevance Health (MA)
- …as appropriate. + Identifies and refers cases or issues to QI, SIU , Subrogation, Underwriting, or other departments as appropriate. + Documents appropriate clinical ... license in the applicable state(s) required. + **For Carelon - CareBridge business unit , bilingual or multi-language skills may be required.** + Bilingual Spanish is… more
- USAA (Boston, MA)
- …+ Identifies coverage concerns, reviews prior loss history, determines and creates Special Investigation Unit ( SIU ) referrals, when appropriate. Determines ... we treat each other and our members. Be part of what truly makes us special and impactful. **The Opportunity** As a dedicated Property Adjuster Specialist , you will… more
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