- 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
- USAA (St. Louis, MO)
- …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
- MTA (New York, NY)
- …the development of routine quality assurance evaluations in collaboration with Security Special Investigations unit (s), MTA Legal, Labor relations, the ... Director, Quality Assurance Job ID: 13522 Business Unit : MTA Headquarters Location: New York, NY, United States Regular/Temporary: Regular Department: HQ Office of… more
- Travelers Insurance Company (Richmond, VA)
- …other internal and external customers/business partners. + Recognizes when to refer claims to Special Investigations Unit and/or Subrogation Unit . + ... Performs administrative functions such as expense accounts, time off reporting, etc. as required. + Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, WC, GL and other areas of the… more
- Molina Healthcare (Bowling Green, KY)
- **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 (Cincinnati, OH)
- **JOB DESCRIPTION** **Job Summary** Under direct supervision of the Manager, SIU , the Team Lead is responsible to lead a small team of investigators and provide ... on daily investigative activities as a back-up to the SIU Manager. This position will be accountable for tracking...Manager. This position will be accountable for tracking on investigations conducted by his/her team and will provide oversight… more
- Molina Healthcare (Ann Arbor, MI)
- …hospital, clinic settings) or 5+ years of experience working in a FWA / SIU or Fraud investigations + Thorough knowledge of PC based software including ... **JOB DESCRIPTION** **Job Summary** The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical… more
- Molina Healthcare (Louisville, KY)
- …accountability for compliance by overseeing, follow-up and resolution of investigations . **KNOWLEDGE/SKILLS/ABILITIES** + Provides oversight and review of the ... SIU referral intake and investigation process while giving guidance and direction to team on case investigation steps and actions. + Works with leadership to maintain… more
- Point32Health (Canton, MA)
- …an essential team member of the Special Investigation Unit (" SIU ") responsible for leading complex provider investigations related to fraud, waste, and ... be responsible for conducting high-volume Pre-Payment Fraud Waste & Abuse ("FWA") investigations under the direction of the Manager, FWA Prepayment Review. The… more
- 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+ ... As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation… more