• Senior Investigator (Hybrid)

    CareFirst (Baltimore, MD)
    **Resp & Qualifications** **PURPOSE:** The role of the Special Investigations Unit ( SIU ) Senior Investigator is to assist in the reduction and ... projects as assigned by management to meet the needs of the Special Investigations Unit . **QUALIFICATIONS:** **Education Level:** Bachelor's Degree… more
    CareFirst (07/12/25)
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  • Senior Fraud Investigations Analyst…

    BlueCross BlueShield of North Carolina (NC)
    **Job Description** The Special Investigations Unit ( SIU ) Investigator is responsible to conduct timely and thorough health care fraud investigations ... Investigations are confidential and are conducted in accordance with SIU Policies and Procedures, contractual obligation and in accordance with applicable state… more
    BlueCross BlueShield of North Carolina (07/25/25)
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  • Consumer Care Advocate

    Sedgwick (Irving, TX)
    …changes with internal departments. + Provides referrals to legal, utilization review, pharmacy, and Special Investigations Unit ( SIU ) as appropriate and ... coordinates independent medical examinations. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). **QUALIFICATIONS** **Education & Licensing** High school diploma or GED required.… more
    Sedgwick (06/20/25)
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  • Case Manager, RN (Multiple Openings!)

    Excellus BlueCross BlueShield (Rochester, NY)
    …as a liaison for activity generated by Customer Advocacy (CAU), Customer Service (CS), Special Investigations Unit ( SIU ), Provider Relations (PR), or ... Sales & Marketing. + Ensuring all regulatory requirements are being met, such as NYS DOH, CMS, NCQA, and HEDIS, serving as internal auditor within the group. + Responsible for all aspects of the Case Management department functions including quality,… more
    Excellus BlueCross BlueShield (06/18/25)
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  • Investigator, Special Investigative…

    Molina Healthcare (Idaho Falls, ID)
    **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 (07/24/25)
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  • Vice President, Ethics & Compliance

    Centene Corporation (Columbus, OH)
    …and federal requirements. + Will oversee Program Integrity Program, the Complaint, Grievance, Special Investigations Unit , and the fair hearing process, and ... ensure that Fraud, Waste and Abuse is reported in accordance with state and federal guidelines. + Will report directly to the Plan CEO and Board of Directors. + Will serve as an account manager to the Department of Healthcare and Family services to facilitate… more
    Centene Corporation (08/03/25)
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  • Outside Property Claim Representative Trainee

    Travelers Insurance Company (Bozeman, MT)
    …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
    Travelers Insurance Company (08/01/25)
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  • Sr. Auto Appraiser - San Diego Metro, CA - Field

    USAA (San Diego, CA)
    …and policy provisions. + Reviews claims/suppliers for fraud indicators and refers to Special Investigations Unit for handling, if applicable. + Maintains ... we treat each other and our members. Be part of what truly makes us special and impactful. **The Opportunity** As a dedicated Sr. Field Auto Appraiser, you will… more
    USAA (07/31/25)
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  • Service Rep Member / OPEIU

    Highmark Health (Albany, NY)
    …and provides supporting documentation. *Identifies potential fraud cases and forwards to Special Investigations Unit . E3. Adjusts claims: *Performs online ... providers, internal and external customers; Adjusts claims. This is a bargaining unit position. The collective bargaining agreement for this position requires that… more
    Highmark Health (07/29/25)
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  • Field Investigator - Macp/ACP/OOP

    Command Investigations (Detroit, MI)
    … Investigations ) is seeking qualified, driven, and experienced candidates to join our special investigations unit as an ACP Investigator. SuperiorX ... demand for quality investigations to gather critical information, conduct special investigations , examine coverage/loss, and combat fraud, one case at… more
    Command Investigations (07/18/25)
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