- Providence (Oakland, CA)
- **Description** ** Investigator External Audit Special Investigations Unit \*Remote The SIU Audit Investigator supports the compliance related ... Investigations Unit (SIU) at the Health Plan. This role assists the External Audit Senior Manager with developing, implementing and performing compliance… more
- Molina Healthcare (Nampa, ID)
- **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, ... may also include coding and billing reviews. The SIU Investigator is responsible for reviewing and analyzing information to...coding accuracy and excellence. The position also entails producing audit reports for internal and external review.… more
- Aramco Services Company (Houston, TX)
- … Audit on special assignments beyond the normal scope of the audit function. The Senior Lead Investigator handles hotline reports or calls and manages ... assignments include assistance to external auditors or special auditors. The Senior Lead Investigator handles...for new auditors; reviewing computer system proposals; and performing special assignments such as relief of Audit … more
- Blue KC (Kansas City, MO)
- …**Employee discount program** **Job Description Summary:** As part of Blue KC's Special Investigations Unit (SIU), the Fraud Investigator conducts reviews to ... and clinical standards, etc. In conjunction with the Manager and/or Senior Investigator , evaluate FWA risks and prioritize for further review, based upon member… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …performs clinical reviews of medical records. + Consults with external practitioners, medical professional groups and agencies, professional medical associations, ... less direct supervision. Performs compliance and/or governance on more complex special projects and audits. + Offers process improvement suggestions and participates… more
- Goodwill of the Finger Lakes (Syracuse, NY)
- SUMMARY: The Risk Management Investigator is responsible for protecting company assets and promoting safety through investigation, enforcement, audit , and ... at least one day per week spent in the Rochester office. The Investigator will provide root cause analysis, detailed reports, and investigative summaries across… more
- Sanford Health (Fargo, ND)
- …investigation/ audit . Master's Degree preferred Accredited Health Care Fraud Investigator (AHFI) certification or Certified Fraud Examiner (CFE) preferred Nursing ... education is required. - Minimum 3 years' experience in health insurance investigation/ audit . - Master's Degree preferred - Accredited Health Care Fraud … more
- Highmark Health (Montgomery, AL)
- …for the field investigative work necessary to complete a review of a special project, potential fraud, waste and abuse case, conducting the initial investigations ... for proactive and investigative purposes to comply with internal audit and regulatory requirements. **ESSENTIAL RESPONSIBILITIES** + Performs investigations into… more
- Insight Global (Norfolk, VA)
- …Skills and Requirements -2+ years in medical coding, insurance billing, internal/ external audit , claims investigations, etc. -Must have a Professional Coder ... claims data, provider enrollment data, and other sources to refer to Investigator for investigation or settlement. -Assures accurate reimbursement is obtained and… more
- The Goodyear Tire & Rubber Company (Akron, OH)
- …Management decision-making. + Collaborate with internal teams (HR, Legal, Compliance, Internal Audit ) and external law enforcement or consultants as needed. + ... units and geographies to resolve complex issues. Partners with internal teams and external agencies to support a safe, ethical workplace. **What You'll Do** + Lead… more