• Lead Investigator , Special…

    Molina Healthcare (Covington, KY)
    …to the SIU Manager. This position will be accountable for tracking on investigations conducted by his/her team and will provide oversight and guidance throughout the ... life of an investigation as well as QA reviews and approvals. In...effectively and timely. + Manage the flow of day-to-day investigations . + Perform assessment that QA measures were complete… more
    Molina Healthcare (11/21/25)
    - Related Jobs

  • Clinical Fraud Investigator II - Registered…

    Elevance Health (Louisville, KY)
    **Clinical Fraud Investigator II - Registered Nurse and CPC -...aid in investigations . + Collaborates with the Special Investigation Unit and other ... eliminate and prevent unnecessary medical-expense spending. The **Clinical Fraud Investigator II** is responsible for identifying issues and/or entities that… more
    Elevance Health (12/18/25)
    - Related Jobs

  • Fraud and Waste Investigator

    Humana (Frankfort, KY)
    …looking for an experienced Healthcare Investigator to join its industry leading Special Investigations Unit . Do you enjoy speaking with members, ... requires an in-depth evaluation of variable factors. The Fraud and Waste Investigator collaborates in investigations with law enforcement authorities. Assembles… more
    Humana (12/24/25)
    - Related Jobs

  • Manager, Special Investigative Unit…

    Molina Healthcare (Louisville, KY)
    …accountability for compliance by overseeing, follow-up and resolution of investigations . **KNOWLEDGE/SKILLS/ABILITIES** + Provides oversight and review of the SIU ... referral intake and investigation process while giving guidance and direction to team...Association + Active and unrestricted Accredited Health Care Fraud Investigator (AHFI) designation or Certified Fraud Examiner (CFE) **Preferred… more
    Molina Healthcare (10/16/25)
    - Related Jobs