• Investigator , Special…

    Molina Healthcare (Dayton, OH)
    **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 on… more
    Molina Healthcare (11/24/25)
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  • Lead Investigator , Special…

    Molina Healthcare (Cincinnati, OH)
    …responsible to lead a small team of investigators and provide oversight on daily investigative activities as a back-up to the SIU Manager. This position will be ... complete and signed-off + Provide guidance to investigators as needed on investigative techniques, tools, or strategy. + Effectively investigate and manage complex… more
    Molina Healthcare (11/21/25)
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  • Investigator , Coding Special…

    Molina Healthcare (OH)
    **JOB DESCRIPTION** **Job Summary** The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical ... providers. This position uses information from a tip, member benefits, and medical records to document relevant findings of a post pay clinical review. This position manages documents and prioritizes case load to ensure timely turn around. This position… more
    Molina Healthcare (11/20/25)
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  • Senior Fraud and Waste Investigator…

    Humana (Dayton, OH)
    …community and help us put health first** This Senior Fraud and Waste Investigator will serve as Humana's Program Integrity Officer, who will oversee the monitoring ... and other agencies such as the Medicaid Fraud Control Unit (MFCU) and coordinate all aspects of FWA activities...Integrity + Cooperate effectively with federal, state, and local investigative agencies on FWA cases to ensure best outcomes;… more
    Humana (11/20/25)
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  • Senior Investigator , Special…

    CVS Health (Columbus, OH)
    …are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU), dedicated to a specific self-funded plan ... evidence in support of case investigations. **Required Qualifications** + 3-5 years investigative experience in the area of healthcare fraud, waste and abuse. +… more
    CVS Health (11/19/25)
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