- CVS Health (Frankfort, KY)
- …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,...abuse (FWA). **Key Responsibilities** + Conduct high level, complex investigations of known or suspected acts of healthcare fraud,… more
- USAA (Louisville, KY)
- …truly makes us special and impactful. **The Opportunity** As a dedicated **Manager, Special Investigations Unit for Property & Casualty** , you will be ... of investigative tools and techniques to guide and coach special investigators. + Proven ability to build and maintain...to demonstrate monthly productivity and cycle time outcomes from investigations assigned to the SIU team. +… more
- CVS Health (Frankfort, KY)
- …day. The Senior Certified Professional Coder (CPC) will perform medical claim reviews for the Special Investigations Unit ( SIU ) to ensure compliance with ... review guidance. + Collaboration with investigators, data analytics and plan leadership on SIU schemes. + Act as management back-up and supports the team when the… more
- CVS Health (Frankfort, KY)
- …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 (Frankfort, KY)
- …position can be work from home anywhere in the United States. **Position Summary** The Special Investigations Unit ( SIU ) is looking for an analytically ... and reviewing incoming referrals and leads to determine if additional investigations are warranted. **Key Responsibilities** + Identify, research, analyze and… more
- CVS Health (Frankfort, KY)
- …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
- Elevance Health (Louisville, KY)
- …questions as necessary to aid in investigations . + Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern. ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU ** **Location:** This role requires associates to be in-office 1 - 2 days… more
- Molina Healthcare (Bowling Green, KY)
- **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit ( SIU ) Investigator is responsible for supporting the prevention, detection, investigation, ... review audits that may also include coding and billing reviews. The SIU Investigator is responsible for reviewing and analyzing information to draw conclusions… more
- Molina Healthcare (KY)
- **JOB DESCRIPTION** **Job Summary** Under direct supervision of the Manager, SIU , the Team Lead is responsible to lead a small team of investigators and provide ... on daily investigative activities as a back-up to the SIU Manager. This position will be accountable for tracking...Manager. This position will be accountable for tracking on investigations conducted by his/her team and will provide oversight… more
- Molina Healthcare (Louisville, KY)
- …hospital, clinic settings) or 5+ years of experience working in a FWA / SIU or Fraud investigations + Thorough knowledge of PC based software including ... **JOB DESCRIPTION** **Job Summary** The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical… more