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Special Investigator Jobs

1000+ jobs

Job Description: Maryland Auto Insurance seeks a qualified candidate to fill the position of Special Investigations Unit (SIU) Investigator. This position is located at Maryland Auto’s Baltimore office, but spends a significant period of time in the field conducting investigations. Duties to include: Functioning as a field investigator for the SIU Investigations teamSupporting the activity of bot...
Position Description: SIU (Special Investigative Unit) Investigator I is an office based position that does not require field work 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 I...
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...
Manager of the Special Investigations Unit (SIU) drives the daily operations of the SIU. This includes detection, prevention, investigation, education, correction, and resolution of Medicare Parts C and D as well as Medicaid and Traditional Lines of Business FWA. Our health plan client is seeking a creative- thinker with the ability to understand the big picture and to drive process and team impr...
Summary: Supports SIU Claims Representatives with various tasks relating to the set up and ongoing handling of claim investigations. Responsibilities: Reviews and assigns new investigative referrals Answers phone calls and customer inquiries. Maintains supplies and distributes to staff. Sets up initial claim investigative files and ensures proper maintenance of closed files. Orders police r...
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 ...
Job Summary Advocates for the rights of all people receiving services throughout the Agency by: conducting investigations of situations which may violate a person’s rights and/or protections of people receiving services, providing training to Agency wide staff on topics related to the protection of the rights of people receiving our services. Member of Agency standing committees, as assigned. Pre...
Req ID: 35217BR Must be local to Rockville, MD. Any candidate needs to start & train in the Rockville, MD office. POSITION SUMMARY We are currently seeking an SIU (Special Investigations Unit) Analyst for our Rockville, MD location. The successful candidate will prevent, detect, and investigate suspect acts of health care fraud that involve Aetna providers and members for the purpose of protec...
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 one...
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 one...
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 data mining ...
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 data mining ...
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...
Role: Medical 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 for providing perfe...
ProSight’s fast paced and dynamic Claims Department is looking for a highly motivated professional to build our SIU team. We are seeking a highly organized, self-starter who embraces challenge and acts with sense of urgency. Our ideal candidate is a specialist in insurance fraud investigation who can set up and lead a team of SIU professionals. Our ideal candidate is a hands-on manager, adaptable ...
What you will get to do: The Special Investigations Coding Analyst serves to protect the Plan, its membership, and the provider community from health risks by identifying, investigating, and eliminating complex, abusive and fraudulent activities related to billing practices. This position works in collaboration with other special investigators as an expert resource in the review and analysis of m...
The Louisiana Lottery will hire a Special Investigator for our headquarters located in Baton Rouge. For a preview of some of the functions you will be involved in supporting, follow the link below. Security and Compliance Requirements SUMMARY Responsible for ensuring security of lottery operations, and conducting investigations to enforce applicable state laws and regulations pertaining to th...
Description The Louisiana Lottery will hire a Special Investigator for our headquarters located in Baton Rouge. For a preview of some of the functions you will be involved in supporting, follow the link below. Security and Compliance Requirements SUMMARY Responsible for ensuring security of lottery operations, and conducting investigations to enforce applicable state laws and regulations per...
Your career starts now. We’re looking for the next generation of health care leaders. At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and awar...
Your career starts now. We’re looking for the next generation of health care leaders. At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and awar...