- The Cigna Group (Bloomfield, CT)
- **Fraud Senior Advisor - Special Investigations Unit (SIU) Matter Resolution** Our organization is a leader in healthcare services, committed to ... and collaboration. **Position Overview** The Fraud Senior Advisor - Special Investigations Unit (SIU) Matter Resolution plays a critical role in… more
- CVS Health (Topeka, KS)
- …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,...federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud. + Demonstrate high… more
- Centene Corporation (Oklahoma City, OK)
- …and Oklahoma markets. Develop internal processes for enhanced FWA detection and investigation completion. + Evaluate the department policies and procedures to ensure ... field, or equivalent experience. 6+ years of combined medical claim investigation , financial impact analysis, business analysis, compliance or fraud and abuse… more
- CVS Health (Concord, NH)
- …Senior Certified Professional Coder (CPC) will perform medical claim reviews for the Special Investigations Unit (SIU) 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… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Senior Fraud and Waste Professional conducts investigations of allegations of fraudulent and ... data requires an in-depth evaluation of variable factors. The Senior Fraud and Waste Professional coordinates investigation ...years of relevant work experience in Fraud & Abuse Investigations required + At least 2 years of healthcare… more
- Humana (Dayton, OH)
- …a part of our caring community and help us put health first** This Senior Fraud and Waste Investigator will serve as Humana's Program Integrity Officer, who will ... Department of Medicaid (ODM) and other agencies such as the Medicaid Fraud Control Unit (MFCU) and coordinate all aspects of FWA activities in Ohio to increase… more
- LA Care Health Plan (Los Angeles, CA)
- Director, Compliance on Special Investigations Unit and Fraud, Waste and Abuse Job Category: Administrative, HR, Business Professionals Department: ... Special Investigations Unit Location: Los...(DHCS), and state/federal requirements. Ensure effective case intake, triage, investigation , tracking, and resolution processes, including referral to law… more
- New York State Civil Service (Albany, NY)
- …and Community Supervision, Department of Title Investigator - Office of Special Investigations Occupational Category Enforcement or Protective Services Salary ... Grade NS Bargaining Unit M/C - Managerial/Confidential (Unrepresented) Salary Range From $71984...Be Determined Street Address NYS DOCCS - Office of Special Investigations Multiple Locations - see additional… more
- CVS Health (Salt Lake City, UT)
- …waste, abuse (FWA), and compliance violations. This position is embedded within the International Special Investigations Unit (ISIU) and is designed to lead ... it all with heart, each and every day. **Position Summary** The Senior Analyst, Investigations at Aetna International plays a pivotal role in safeguarding the… more
- Centene Corporation (Jefferson City, MO)
- …reporting of instances of potential fraud, waste and abuse no within scope of the Special Investigations Unit . + Prepare periodic reports and, as necessary, ... Medicare and Medicaid Services ("CMS"). + Oversees the management of the Compliance Investigation Unit (CIU), the Ethics Point hotline and risk assessments of… more