- UPMC (Pittsburgh, PA)
- …such as copiers, multi-line phone systems, fax machines and paging systems Preferred Qualification: + Experience in investigations, claims , medical coding, ... has an exciting opportunity for a Special Investigations Unit Investigator position. This is a temporary position working Monday...abuse (FWA) cases, as well as researching and analyzing claims data in order to identify potential FWA. The… more
- Sanford Health (Fargo, ND)
- …Minimum 3 years' experience in health insurance investigation/audit. - Master's Degree preferred - Accredited Health Care Fraud Investigator (AHFI) certification ... Minimum 3 years' experience in health insurance investigation/audit. Master's Degree preferred Accredited Health Care Fraud Investigator (AHFI) certification or… more
- AmeriHealth Caritas (Columbia, SC)
- … preferred + SIU and/or State Medicaid regulatory compliance;work experience preferred . + Knowledge and; proficiency in claims adjudication standards & ... administrative services. Discover more about us at www.amerihealthcaritas.com. The Investigator is responsible for conducting comprehensive investigations of reported,… more
- Molina Healthcare (Ann Arbor, MI)
- …Experience** + 2+ years of experience working in the group health business preferred , particularly within claims processing or operations. + A demonstrated ... **JOB DESCRIPTION** **Job Summary** The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical… more
- Humana (Dayton, OH)
- …community and help us put health first** This Senior Fraud and Waste Investigator will serve as Humana's Program Integrity Officer, who will oversee the monitoring ... outcomes; work closely with internal and external auditors, financial investigators, and claims processing areas + Adequately staff and manage the program integrity … more
- St. Luke's University Health Network (Allentown, PA)
- …patient's ability to pay for health care. The Employee Relations Investigator reviews and investigates all assigned employee policy violations, complaints, concerns, ... disputes, claims of harassment, discrimination, and complaints of unfair treatment...with priority given to the most egregious allegations. The Investigator will have significant interaction with Human Resources, Operations… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Blue Cross and Blue Shield of Minnesota Position Title: Program Integrity Analyst/ Investigator Associate Location: Hybrid | Eagan, Minnesota Career Area: Legal About ... will be responsible for the prospective and retrospective investigation of suspect claims and assisting in initial development of fraud, waste, abuse and… more
- Point32Health (Canton, MA)
- …about who we are at Point32Health (https://www.point32health.org/) . **Job Summary** The Investigator I is an essential team member of the Special Investigation Unit ... ("FWA") investigations under the direction of the Manager, FWA Prepayment Review. The Investigator I works closely with other members of the SIU to set investigative… more
- Centene Corporation (Columbus, OH)
- …however, candidates who reside in the state of Ohio are highly preferred .** **Position Purpose:** Investigate allegations of potential healthcare fraud and abuse ... activity. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure...related field or equivalent experience. 1+ years of medical claim investigation, medical claim audit, medical … more
- MyFlorida (Doral, FL)
- INVESTIGATOR SPECIALIST II - 79001458 Date: Dec 5, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 865093 Agency: Business and Professional Regulations Working Title: INVESTIGATOR SPECIALIST II - 79001458 Pay Plan: Career Service Position Number:… more