- Centene Corporation (Frankfort, KY)
- …Position acts as a subject matter expert for the Contractor's Program Integrity unit to reduce Fraud, Waste and Abuse of Medicaid services within Kentucky. Provides ... + Manage and coordinate cases being investigated by the SIU + Maintain all vendor cases + Assist with...Maintain all vendor cases + Assist with conducting complex investigations , including on-site investigations , review, complete and… more
- Command Investigations (Baltimore, MD)
- Seeking experienced Claims / SIU and/or Workers' Comp. Investigators for Insurance Investigations that include Recorded Statements, Accident Scene, and ... and staff. Must have a background in handling multi-lines investigations with personal lines highly desired. Must have reliable...our website and find out why at www.GoCommand.com. The SIU /WC Investigator should demonstrate proficiency in the… more
- CVS Health (Columbus, OH)
- …do it all with heart, each and every day. **Position Summary** As a Senior Investigator you will conduct high level, complex investigations of known or suspected ... fraud schemes. + Investigates to prevent payment of fraudulent claims submitted to the Medicaid lines of business +...in identifying resources and best course of action on investigations + Serves as back up to the manager… more
- Philadelphia Insurance Companies (Ewing, NJ)
- …: Review and evaluation of claims and applications referred to the SIU for possible fraud. Conduct database investigations , including use of CLEAR, ISO ... by AM Best. We are looking for a Sr. Claims Examiner - SIU to join our...for thoroughness and accuracy. Review and evaluation of completed SIU investigations for referral to state authorities,… more
- USAA (Phoenix, AZ)
- …time zones. + Active P&C Adjuster's License. + Experience working as aP&C SIU investigator . **Compensation range:** The salary range for this position is: ... special and impactful. **The Opportunity** As a dedicated SIU case manager, within defined guidelines and framework you...defined guidelines and framework you will evaluate and conclude claims identified by SIU Investigators as having… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …OMIG's minimum investigator requirements as follows: Persons employed by the SIU as investigators shall be qualified by education or experience, which shall ... investigations and audits; or five years of insurance claims investigation experience or professional investigation experience with law...criminal justice or related field; or employment as an investigator in the SIU on or before… more
- Humana (Oklahoma City, OK)
- **Become a part of our caring community and help us put health first** Humana's Special Investigations Unit is seeking a Senior Fraud & Waste Investigator ... to join the Oklahoma Medicaid Team. This team of Investigators conducts investigations into allegations of fraud, waste, and abuse involving providers who submit … more
- Command Investigations (Detroit, MI)
- …) is seeking qualified, driven, and experienced candidates to join our special investigations unit as an ACP Investigator . SuperiorX Investigations ... demand for quality investigations to gather critical information, conduct special investigations , examine coverage/loss, and combat fraud, one case at… more
- MVP Health Care (Tarrytown, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Clinical Investigator ** to join #TeamMVP. This is the opportunity for you if you have ... a passion for problem solving and investigations , commitment to compliance and ethical standards and dedication...related field, and minimum of five years of insurance claims investigation experience; or five years of professional investigation… more
- Point32Health (Canton, MA)
- …an essential team member of the Special Investigation Unit (" SIU ") responsible for leading complex provider investigations related to fraud, waste, and ... **Job Summary** The Investigator I is...for conducting high-volume Pre-Payment Fraud Waste & Abuse ("FWA") investigations under the direction of the Manager, FWA Prepayment… more