• Outside Property Claim Representative

    Travelers Insurance Company (Toledo, OH)
    …internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit . + ... handling throughout the claim life cycle (customer contacts, coverage, investigation , evaluation, reserving, negotiation and resolution) including maintaining full… more
    Travelers Insurance Company (09/12/25)
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  • Case Manager, RN or Licensed Behavioral Health…

    Excellus BlueCross BlueShield (Dewitt, 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 (08/28/25)
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  • Community Health Assessment Field Nurse (Rochester…

    Excellus BlueCross BlueShield (Rochester, NY)
    …agencies (eg APS/CPS) as needed, and any suspected/possible Medicaid fraud to the Special Investigations Unit ( SIU ) or designated internal/external ... entity. + Communicates with all internal and external stakeholders to obtain the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members. + Adheres to all Corporate and Departmental policies… more
    Excellus BlueCross BlueShield (08/19/25)
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  • Medical Bill Review Senior Nurse

    Zurich NA (Schaumburg, IL)
    …Assist in the identification of fraudulent billings by reporting suspicious activity to Special Investigations Unit . + Resolve escalated issues by exercising ... or more years of experience in the Critical Care Unit or Emergency Room or Medical Surgical Facility or...or more years of experience in the Critical Care Unit or Emergency Room or Medical Surgical Facility or… more
    Zurich NA (09/10/25)
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  • Risk Management 1

    M. C. Dean (Vienna, VA)
    …coverage; review the established reserve requirements, identified claims for subrogation and/or Special Investigations Unit as appropriate. + Assesses actual ... program monitoring, and manage routine to moderately complex claims from the investigation of an event through resolution. This includes making decisions about… more
    M. C. Dean (08/27/25)
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  • Surveillance / Claims Investigator - Part-Time

    Allied Universal (Fargo, ND)
    …standards in their home state and within their designated region of the country + Special Investigative Unit ( SIU ) Compliance knowledge + Ability to type 40+ ... Your Career in Insurance Claims with Allied Universal(R) Compliance and Investigation Services. Allied Universal(R) Compliance and Investigation Services is… more
    Allied Universal (09/06/25)
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  • Sr. Auto Appraiser - Field

    USAA (Charlotte, NC)
    …and policy provisions. + Review claims/suppliers for fraud indicators and refers to Special Investigations Unit for handling, if applicable. + Maintain ... 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 (09/12/25)
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  • Sr. Auto Appraiser - Field Auto CAT Team

    USAA (Denver, CO)
    …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 Senior Auto Appraiser, you will work… more
    USAA (09/04/25)
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  • Manager, Program Integrity

    Centene Corporation (Indianapolis, IN)
    …Safeguard against the potential for fraud, waste and abuse and coordinate with, the Special Investigations Unit and state agencies to promptly investigate ... field, or equivalent experience. 4+ years of combined medical claim investigation , financial impact analysis, business analysis, compliance or fraud and abuse… more
    Centene Corporation (08/21/25)
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  • Medical Director

    Blue KC (MO)
    …the company, including but not limited to Sales and Marketing, Job_Family_ID_Underwriting, PHP, Special investigations Unit (fraud and abuse), Legal, Product ... Development, and Provider Services. + Provides medical leadership and advice for conformance with standards and guidelines for NCQA, URAC, state and federal regulators, and other accrediting bodies. + Acts as liaison for communication with physicians,… more
    Blue KC (08/26/25)
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