- CVS Health (Springfield, IL)
- …Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU), dedicated to a specific ... self-funded plan sponsor. In this role, you will manage complex investigations into suspected and known acts of healthcare fraud, waste and abuse (FWA). **Key… more
- USAA (Chicago, IL)
- …truly makes us special and impactful. **The Opportunity** As a dedicated **Manager, Special Investigations Unit for Property & Casualty** , you will be ... actions and decisions to carry out proactive claim's projects and investigations . + Reviews and evaluates investigation recommendations from investigators to ensure… more
- CVS Health (Springfield, IL)
- …The Certified Professional Coder (CPC) will perform medical claim reviews to ensure compliance with coding practices through a comprehensive record review for ... medical, behavioral, transportation and other healthcare providers. The CPC must have the ability to determine correct coding and appropriate documentation during the review of medical records. The CPC must also ensure that the state, federal and company… more
- CVS Health (Springfield, IL)
- …waste, abuse (FWA), and compliance violations. This position is embedded within the International Special Investigations Unit (ISIU) and is designed to lead ... with heart, each and every day. **Position Summary** The Senior Analyst, Investigations at Aetna International plays a pivotal role in safeguarding the organization… more
- CVS Health (Springfield, IL)
- …can be work from home anywhere in the United States. **Position Summary** The Special Investigations Unit (SIU) is looking for an analytically driven ... and reviewing incoming referrals and leads to determine if additional investigations are warranted. **Key Responsibilities** + Identify, research, analyze and… more
- Capital One (Chicago, IL)
- AML Sr Investigator II-SIU Subject Matter Expert (SME) **The Special Investigations Unit in the AML Department** performs specialized investigations to ... of ideas + Collaborating with investigators and people leaders on complex investigations and/or special projects, often functioning in a leadership capacity… more
- Zurich NA (Schaumburg, IL)
- …Assist in the identification of fraudulent billings by reporting suspicious activity to Special Investigations Unit . + Resolve escalated issues by exercising ... or more years of experience in the Critical Care Unit or Emergency Room or Medical Surgical Facility or...or more years of experience in the Critical Care Unit or Emergency Room or Medical Surgical Facility or… more
- Travelers Insurance Company (Chicago, IL)
- …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
- Palo Alto Networks (Chicago, IL)
- …expert-level guidance on all areas of cybersecurity and data breach response to Unit 42 clients across a wide array of industries, geographies, and organizational ... leadership, customer briefings, planning and other activity as needed **The Team** Unit 42 Consulting is Palo Alto Network's security advisory team. Our vision… more
- Elevance Health (Chicago, IL)
- …questions as necessary to aid in investigations . + Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern. ... analysis and clinical evaluation of the collected data. + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance… more