- CVS Health (Austin, TX)
- …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 (TX)
- …as appropriate. + Identifies and refers cases or issues to QI, SIU , Subrogation, Underwriting, or other departments as appropriate. + Documents appropriate clinical ... information, decisions, and determinations in a timely, accurate, and concise manner. + Develops a working knowledge of member benefits, contracts, medical policy, professional standards of practice, and current health care practices. Position requirements: +… more
- USAA (Houston, TX)
- …+ 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
- GuideOne Insurance (Houston, TX)
- …claim. + Recognizes and pursues recovery opportunities and prepares submissions to SIU when indicated. + Assigns and supervises field examiners and vendor resources, ... including but not limited to independent adjusters, engineers and other experts as needed. + Assumes additional duties as defined. Required Qualifications: + 5 or more years in the handling of Commercial Liability Claims. + Property and casualty license or… more
- Allied Universal (Dallas, TX)
- …As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation ... **to!** + **Guaranteed Time Off** **!** **RESPONSIBILITIES:** + Conduct independent investigations of insurance claims across a range of coverage types, including… more
- CVS Health (Austin, TX)
- …Health Care Anti-Fraud Association (AHFI) + Experience In Medicaid Compliance, Medicaid Investigations , MCO Medicaid FWA Unit in the following States: **Texas, ... Leads a team in the planning and execution of investigations of acts of healthcare fraud and abuse by...and development needs. Assesses training needs and works with SIU Director on development plans for team members. Develops… more
- Command Investigations (Laredo, TX)
- …lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals ... proficiency in the following areas: + AOE/COE, Auto, or Homeowners Investigations . + Writing accurate, detailed reports + Strong initiative, integrity, and… more
- Molina Healthcare (Houston, TX)
- …accountability for compliance by overseeing, follow-up and resolution of investigations . **Knowledge/Skills/Abilities** * Responsible for oversight and management of ... AVP of Compliance or the AVP of the Corporate SIU an active relationship with third parties who have...who have specific experience in conducting fraud and abuse investigations . * Prepares written reports to inform the AVP… more
- USAA (San Antonio, TX)
- …+ 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 Senior Property Adjuster, you will work… more