- Prime Therapeutics (Columbus, OH)
- …a purpose-driven career? Come build the future of pharmacy with us. **Job Posting Title** Special Investigations Unit ( SIU ) Investigator - Remote **Job ... Description** The Special Investigations Unit ( SIU ) Investigator is responsible for conducting standard investigations of potential pharmacy, member,… more
- CVS Health (Columbus, OH)
- …seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU ), dedicated to a specific self-funded plan ... sponsor. In this role, you will manage complex investigations into suspected and known acts of healthcare fraud,...abuse (FWA). **Key Responsibilities** + Conduct high level, complex investigations of known or suspected acts of healthcare fraud,… more
- Humana (Dayton, OH)
- …Department of Medicaid (ODM) and other agencies such as the Medicaid Fraud Control Unit (MFCU) and coordinate all aspects of FWA activities in Ohio to increase ... to encourage sensible and culturally-competent business standards + Oversee internal investigations of FWA compliance issues + Work with the Contract Compliance… more
- CVS Health (Columbus, OH)
- …position can be work from home anywhere in the United States. **Position Summary** The Special Investigations Unit ( SIU ) is looking for an analytically ... and reviewing incoming referrals and leads to determine if additional investigations are warranted. **Key Responsibilities** + Identify, research, analyze and… more
- Molina Healthcare (OH)
- …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
- CVS Health (Columbus, OH)
- …are seeking a highly analytical and detail-oriented Data Analyst to join our Special Investigation Unit within a leading health insurance organization. This is ... datasets. + Design, develop, and maintain complex data analyses to support investigations of potential fraud, waste, and abuse in Medicaid claims and provider… more