- USAA (Phoenix, AZ)
- …what truly makes us special and impactful. **The Opportunity** As a dedicated SIU case manager , within defined guidelines and framework you will evaluate ... and conclude claims identified by SIU Investigators as having elements of fraud or an...write reports and document activities and decisions in a case management system. + Proficiency in understanding the legal… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …as a liaison for activity generated by Customer Advocacy (CAU), Customer Service (CS), Special Investigations Unit ( SIU ), Provider Relations (PR), or ... Job Description: Summary: Conducts case management program activities in accordance with departmental,...staff, members, and providers. + Provides backup for the Supervisor/ Manager , whenever necessary by: + Participating in the orientation… more
- CDPHP (Latham, NY)
- …as a liaison for activity generated by Customer Advocacy (CAU), Customer Service (CS), Special Investigations Unit ( SIU ), Provider Relations (PR), or ... values and invites you to be a part of that experience. Conducts case management program activities in accordance with departmental, corporate, NYS Department of… more
- State of Massachusetts (Boston, MA)
- …the improvement of monitoring systems and overall practices for the Special Investigations Unit . This strategic manager collaborates with the Associate ... individual to fill the role of Director for the Special Investigations Unit . In this...provides guidance to the Regional and Area Staff on special investigations procedures and monitors case… more
- UPMC (Pittsburgh, PA)
- …pm This is a remote position. Under the direction of the manager , the Special Investigations Unit ( SIU ) Investigator is responsible for investigating ... UPMC Health Plan has an exciting opportunity for a Special Investigations Unit Investigator position....role includes supporting current SIU staff and manager with investigations and special … more
- Centene Corporation (Frankfort, KY)
- …Position acts as a subject matter expert for the Contractor's Program Integrity unit to reduce Fraud, Waste and Abuse of Medicaid services within Kentucky. Provides ... an investigative workload of moderate to high complexity. Assists manager on monitoring team caseload and report on metrics....+ Manage and coordinate cases being investigated by the SIU + Maintain all vendor cases + Assist with… more
- CVS Health (Columbus, OH)
- …course of action on investigations + Serves as back up to the manager as necessary + Cooperates with federal, state, and local law enforcement agencies in the ... a Senior Investigator you will conduct high level, complex investigations of known or suspected acts of healthcare fraud...for clinical and legal review + Documents all appropriate case activity in case tracking system +… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …encourage you to apply! Job Description: Summary: Under the guidance of the SIU Management, this position is responsible for the accurate and thorough clinical ... compliance and regulatory requirements. Primary activities include substantiating referrals, case planning and research, conducting onsite or desk audits, clinical… more
- The Robison Group (Charleston, WV)
- …WITHIN THE COMPANY INCLUDE: SIU work, Field Supervisor, Field Operations Manager , Case Management, etc. Department Surveillance Employment Type Part time ... Individuals selected for the position will be expected to perform investigations of workers compensation claims, liability investigations , multi-line insurance… more
- Molina Healthcare (Covington, KY)
- …investigators and provide oversight on daily investigative activities as a back-up to the SIU Manager . This position will be accountable for tracking on ... investigators and analysts, the Team Lead will ensure the Manager is aware of any major case ...to Investigative team, particularly in the absence of the SIU Manager . + Provide training to team… more