• Manager, Fraud and Waste * Special…

    Humana (Boston, MA)
    …and help us put health first** The Manager, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste ... works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. The Manager, Fraud and Waste… more
    Humana (09/05/25)
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  • SIU Investigator

    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
    NTT DATA North America (08/26/25)
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  • SIU Specialist - Pharmacy Tech - Remote…

    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
    Prime Therapeutics (06/24/25)
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  • Field Investigator, SIU

    MAPFRE Insurance (MA)
    Field Investigator, SIU Date: Sep 3, 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
    MAPFRE Insurance (08/08/25)
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  • Outside Property Claim Representative

    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
    Travelers Insurance Company (08/26/25)
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  • Insurance Examiner II - Pharmacy

    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
    State of Massachusetts (08/19/25)
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  • Clinical Psychologist

    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
    CVS Health (09/02/25)
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  • Property Adjuster Specialist - Desk

    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
    USAA (09/06/25)
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  • Claims Investigation Associate

    Staples (Framingham, MA)
    …impactful outcomes. Your responsibilities include managing third-party field investigations , supporting discovery and litigation processes, facilitating prompt scene ... plus relevant technical coursework + Minimum 2+ year's experience in claims support, investigations , asset protection, or a related role + Proven ability to retrieve… more
    Staples (09/05/25)
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  • Virtual Triage Nurse I - CareBridge - Bilingual…

    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
    Elevance Health (08/29/25)
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