- Elevance Health (Atlanta, GA)
- **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU ** **Location:** This role requires associates to be ... questions as necessary to aid in investigations . + Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern.… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Supervisor - Special Investigations Unit Clinical Location: Hybrid | Eagan, Minnesota ... under the direction of the Manager, Operational Risk Management ( SIU ). This position ensures SIU department objectives...years staff, team lead or project lead experience * Registered nurse or licensed behavioral health clinician… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …OMIG's minimum investigator requirements as follows: Persons employed by the SIU as investigators shall be qualified by education or experience, which shall ... addition to Level I Accountabilities) + Performs more complex investigations with less direct supervision. Performs compliance and/or governance...criminal justice or related field; or employment as an investigator in the SIU on or before… more
- MVP Health Care (Rochester, NY)
- …limited to MD or RN . + New York State Nursing license required ( RN preferred). Experience in health insurance fraud investigations preferred. + Obtain CPC ... improvement. To achieve this, we're looking for a **Clinical Investigator ** to join #TeamMVP. This is the opportunity for...if you have a passion for problem solving and investigations , commitment to compliance and ethical standards and dedication… more
- Molina Healthcare (Ann Arbor, MI)
- …Microsoft Excel (edit/save spreadsheets, sort/filter) **Required License, Certification, Association** Licensed registered nurse ( RN ), Licensed practical ... **JOB DESCRIPTION** **Job Summary** The SIU Coding Investigator is responsible for...5+ years of experience working in a FWA / SIU or Fraud investigations + Thorough knowledge… more
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