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Special Investigator Jobs

1000+ jobs

Position Description: Job Summary: The SIU (Special Investigative Unit) Investigator I will assist the SIU Supervisor and SIU team in the execution and maintenance of the Navitus fraud, waste and abuse program, including controls, policies & procedures, communications and training. The Investigator I will work in a semi-professional role with an intermediate level of independence, to ensure case...
Location: Bakersfield, CA The primary focus of this position is to support the Company’s anti-fraud initiatives and perform administration and investigations of suspected insurance fraud. The Special Investigations Claim Representative is responsible for reviewing reports of suspected fraud from field adjusting staff as well as the update and maintenance of accurate records related to fraud inves...
Special Investigative Unit Associate CLAIM YOUR FUTURE AS A GREAT PERFORMER! Providing both satisfying and challenging work along with a highly professional and friendly work atmosphere, Sedgwick has a strong commitment to its colleagues and its clients. If you are seeking a place where you can do great things for those whose lives you touch while maximizing your own career possibilities, Sedgwi...
Kemper at a glance With $8 billion in assets, Kemper is one of the nation's leading insurers. The Kemper family of companies specializes in home, auto, life, health and valuables insurance products for individuals, families and businesses. Kemper’s underwriting companies* are rated A- (Excellent) by A.M. Best Company, the leading insurance industry rating authority. Kemper services six million p...
Brevard County-Melbourne
Description: Job Description The SIU Senior Investigator is responsible for preventing, detecting, investigating and correcting incidents of health care fraud, waste and abuse (FWA). This includes, but is not limited to, investigations of medical professionals, non-medical professionals, beneficiaries, brokers/sales agents, employees, or business partners and contracted entities. The SIU Senior ...
Description Position Purpose: Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse. Conduct investigations of potential waste, abuse, and fraud Document activity on each case and refer issues to the appropriate party Perform...
Description Position Purpose: Assist with investigation of healthcare fraud and complete special projects/audits. Run data queries for investigations Review quarterly reports to detect potential outliers Review quarterly reports to validate data integrity Maintain medical record integrity Assist with collection of information for state investigators Develop new queries/reports to detect pot...
Under general direction, supervises special investigations unit in the BWC Central Office Intelligence Unit (IU) & the Safety Violations Investigation Unit (SVIU): ensures investigations adhere to all federal, state & local laws concerning BWC; develops, recommends & implements policies & procedures for administration of BWC special investigations program to identify & deter fraudulent activity & ...
Description: We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin...
Position Purpose: Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends and schemes. Monitor business processes and systems to assure integrity and compliance in billing and claims payment Lead a team appropriately investigate all possible fraud, waste and abuse referrals Develop educational materials to add...
We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, ...
Description Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care . This is an exceptional opportunity to do innovative work that means more to you and those we serve at on...
Description Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care . This is an exceptional opportunity to do innovative work that means more to you and those we serve at on...
We are currently seeking talented Insurance SIU Investigator for our Baltimore, MD/Washington, DC facility. The territory involved will be Maryland/DC/Northern Virginia. PURPOSE OF JOB Provide specialized investigative and advisory services, particularly when claim or underwriting fraud is suspected. Increase fraud awareness throughout USAA and its membership. Develop innovative and long-term f...
Requisition Number 16-0148 SAN Post Date 6/7/2016 Title Manager, Special Investigation Unit City San Diego State CA Description American Specialty Health, Inc. is seeking a Manager to ensure Special Investigation Unit and anti-fraud compliance matters are handled in accordance with regulatory and contractual requirements. The Manager will be responsible for managing all aspects of the compan...
About the Agency The Bureau of Safety & Environmental Enforcement (BSEE) works to promote safety, protect the environment, and conserve resources offshore through vigorous regulatory oversight and enforcement. For information about our bureau go to: http://www.bsee.gov/ This position is located within the Department of the Interior, Bureau of Safety and Environmental Enforcement (BSEE), National...
Description Position Purpose: Perform audits to identify inappropriate billing practices through extensive review of claims data, medical records, corporate policy, state/federal policy, and practice standards. Review medical records to determine if bills submitted by providers match the supporting documentation Assist the health plans with preventative measures including educational materials,...
Role: Medical Medicare Investigator - Special Investigations Unit Assignment: Special Investigations Unit Location: Green Bay, WI or Louisville KY, Virtual We’re looking for associates who are dedicated to service and believe in following the Golden Rule of treating others the way you want to be treated. Humana was founded on this premise, and this value is reflected in our expectations f...
OVERVIEW The Texas Department of Family and Protective Services (DFPS) is responsible for protecting the unprotected — children, elderly, and people with disabilities — from abuse, neglect, and exploitation. DFPS accomplishes this responsibility by employing over 12,000 workers who live up to the agency's Mission, Vision, & Values in service to the 27 million citizens of Texas. WHY WORK FOR DFPS...
American Specialty Health, Inc. is seeking a Manager to ensure Special Investigation Unit and anti-fraud compliance matters are handled in accordance with regulatory and contractual requirements. The Manager will be responsible for managing all aspects of the company’s fraud program, including developing and maintaining policies, procedures and trainings to support the company’s anti-fraud effort...