- Travelers Insurance Company (Riverside, CA)
- …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 (Hollywood, CA)
- …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
- 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
- USAA (MD)
- …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
- CVS Health (Hartford, CT)
- …legal holds, managing data and document collection. + Provide legal support to the Special Investigations Unit (SIU) in investigating and pursuing fraud, ... waste, and abuse matters. + Manage or participate in special projects. **PREFERRED EXPERIENCE** + Demonstrate analytical ability, good communication skills and… more
- Humana (Baton Rouge, LA)
- …related communication/interaction with outside regulators, as necessary. + Coordinate with the Special Investigations Unit (SIU) to operate and effective ... fraud, waste and abuse program integrity program. **Use your skills to make an impact** **Required skills/Qualifications** + Bachelor's degree or higher in Public Policy, Public Health, or related field + Minimum of 5+ years experience working in a… more
- Elevance Health (Chicago, IL)
- …(Data Mining, Coordination of Benefits, Complex and Clinical Audit, Claims Edits, and the Special Investigations Unit ) operating as an internal consultant to ... build trusted executive relationships, assess the area for opportunities, use Lean Six Sigma tools and methodologies to execute opportunities, and drive change that will deliver current savings and efficiency targets while also identifying new targets. Our… more
- 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 and… more
- Sedgwick (Irving, TX)
- …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. Associate's… more
- 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, productivity,… more