- 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, ... the continental United States. **Position Purpose:** The VP Corporate Compliance Investigations is responsible for the initial assessment of internal allegations and… 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 ... the Oklahoma Medicaid Team. This team of Investigators conducts investigations into allegations of fraud, waste, and abuse involving...and other agencies such as the Medicaid Fraud Control Unit (MFCU) and coordinate all aspects of FWA activities… more
- Elevance Health (Atlanta, GA)
- …questions as necessary to aid in investigations . + Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern. ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU ** **Location:** This role requires associates to be in-office 1 - 2 days… more
- NJM Insurance (Trenton, NJ)
- …with Collections every 60-90 days for status; and assist GC Legal in reviewing the NJM Special Investigations Unit ( SIU ) fraud investigations . + ... using data provided from various sources including financial metrics databases, the NJM SIU , the GC Subrogation Department, GC Legal Staff, and GC Staff. + Review… 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
- Travelers Insurance Company (East Bridgewater, MA)
- …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 (Springfield, VA)
- …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
- Sedgwick (Frisco, TX)
- …changes with internal departments. + Provides referrals to legal, utilization review, pharmacy, and Special Investigations Unit ( SIU ) as appropriate and ... coordinates independent medical examinations. + Performs other duties as assigned. + Supports the organization's quality program(s). **QUALIFICATIONS** Education and Licensing High school diploma or GED required. Associate's degree from an accredited college… more
- 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
- CDPHP (Latham, 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