SIU Claims Director Plymouth Rock Management Company of New JerseySIU Claims DirectorBoston, MA$137,000–$200,000 / yearReporting to the Vice President of Claims, the Director of Special Investigative Unit (SIU) provides strategic leadership for Plymouth Rock's enterprise fraud program across the Personal Lines Property & Casualty Claims organization. Provide oversight of fraud investigations involving Auto Physical Damage, Homeowners, Casualty, PIP, Appraisal, provider fraud, organized fraud rings, staged accidents, and Major Case initiatives.
Senior Property Adjuster (Commercial Property Claims) - Boston, MA Engle Martin & Associates, Inc.Senior Property Adjuster (Commercial Property Claims) - Boston, MAFoxborough, MAPHYSICAL ACTIVITIES AND REQUIREMENTS: In addition to the working conditions and associated physical activities and requirements above, the incumbent may be required to climb, balance, stoop, kneel, crouch, crawl, reach, stand, walk, push, pull, lift, finger, grasp, or feel, especially in the course of investigating and assessing property damage; these requirements may include the need to lift weights of up to 50 pounds, including a ladder. The work requires close visual acuity, with or without correction, to prepare reports containing words, symbols, and numerical figures; the incumbent is required to view a computer terminal, use a keyboard, read printed documents, make detailed visual inspections, perceive color, perceive depth, and have a sufficient field of vision to carry out all inspection and related duties.
Investigator Ethos Risk ServicesInvestigatorBoston, MAFull timePrevious Experience: Demonstrated proficiency in covert surveillance techniques, capturing high-quality video footage, and preparing thorough, well-organized investigative reports. This role involves performing both stationary and mobile surveillance, obtaining video and photographic evidence, and preparing thorough, detailed reports for clients.
Entry-Level Investigator Ethos Risk ServicesEntry-Level InvestigatorBoston, MAFull timeOur Full-Time Entry-Level Field Investigator position will help launch your career by providing you with an industry leading FULLY PAID Investigator Training Program - no prior experience necessary! Documentation: Finalize case files by submitting case reports and uploading video footage via personal laptop at the end of the day.
Surveillance Investigator Lemieux & Associates LLCSurveillance InvestigatorBridgewater, MAPart timeOur leadership team brings over 25 years of field experience and is committed to fostering a professional, results-driven environment. Join Lemieux & Associates , a trusted leader in investigative services, and make an impact with your surveillance expertise.
Surveillane Investigator Lemieux & Associates LLCSurveillane InvestigatorBoston, MAPart timeOur leadership team brings over 25 years of field experience and is committed to fostering a professional, results-driven environment. Join Lemieux & Associates , a trusted leader in investigative services, and make an impact with your surveillance expertise.
Senior Investigator, Special Investigations Unit (Aetna SIU) CVS Health CorpSenior Investigator, Special Investigations Unit (Aetna SIU)MA$46,988–$122,400 / yearAnticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $46,988.00 - $122,400.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations of fraud and abuse Required Qualifications 3 years working on health care fraud, waste, and abuse investigatory and audits required.
Investigator, Special Investigations Unit (Meritain Health) CVS Health CorpInvestigator, Special Investigations Unit (Meritain Health)MA$46,988–$122,400 / yearDemonstrated proficiency in Microsoft Office Suite (including Excel, specifically with pivot tables), database search tools, and use of the Intranet/Internet to research information. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
SIU Fraud Investigator Mass General BrighamSIU Fraud InvestigatorSomerville, MassachusettsPerforms case research to include the review, interpretation, and application of payment policies, medical policies, provider manuals, benefits documents, national or local coverage determinations, and other applicable clinical practice parameters, regulations, or guidance pertaining to the submission of claims to health insurance plans. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
Surveillance Investigator Allied UniversalSurveillance InvestigatorNashua, NH$20–$23 / hourThe Surveillance Investigator will perform discreet mobile and stationary surveillance of a Claimant to confirm current activities and capabilities to assist with the administration of an insurance claim. RESPONSIBILITIES: Conduct independent investigations of insurance claims across a range of coverage types, including workers' compensation, general liability, property and casualty, and disability.
NewSpecial Investigator AmeriHealth CaritasSpecial InvestigatorManchester, NHRemoteWe offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. The Investigator is responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving the full range of products at the AmeriHealth Caritas Family of Companies (ACFC).
Special Investigations Unit Senior Investigator CVS Health CorpSpecial Investigations Unit Senior InvestigatorMA$46,988–$112,200 / yearThis position will routinely handle high profile or highly sensitive matters involving cases that are national in scope, as well as, complex cases involving multi-lines of business, multiple subjects, or intricate healthcare. Strong communication skills, both written and oral, are necessary for the development and implementation of professional presentations for internal and external stakeholders regarding healthcare fraud matters and Enterprise approach to FWA.
Part-time Surveillance Investigator The Robison GroupPart-time Surveillance InvestigatorBoston, MassachusettsThrough our operating brands, HVACi, StrikeCheck, National Fire Experts, Donan Engineering, BSC Forensics, Component Testing Laboratories, The Robison Group, VRC Investigations, TechLoss, Mecanica Scientific Services, and HMI we are respected as the industry leader for our scale and our track record of conducting expert, specialized, and accurate investigations. Individuals selected for the position will be expected to perform investigations of workers compensation claims, liability investigations, multi-line insurance claims, criminal and civil background checks, and other investigative tasks.
Affirmative Civil Enforcement ACE Investigator Contact Government Services LLCAffirmative Civil Enforcement ACE InvestigatorBoston, MAPerforms sophisticated analyses of large-scale hard-copy and electronic data such as health care claims data, financial transaction data, accounting records, or bank records to develop investigative leads and to determine their potential relevance to the allegations at issue. • Performs analysis to clarify the target suspects or organizations pattern of operations to identify information relevant to the legal issues involved and to recommend valuable approaches to the AUSAs or other members of the investigative team.
SIU Fraud Investigator Brigham and Women's HospitalSIU Fraud InvestigatorSomerville, MA$79,560–$115,720.80 / yearPerforms case research to include the review, interpretation, and application of payment policies, medical policies, provider manuals, benefits documents, national or local coverage determinations, and other applicable clinical practice parameters, regulations, or guidance pertaining to the submission of claims to health insurance plans. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
Employment Investigator Commonwealth of MassachusettsEmployment InvestigatorBoston, MAA. Jimenez'',''Shirani A. Jimenez'',''6179946029'',''06-NAGE - Professional Admin.'',''06-NAGE - Professional Admin.'',''No'',''No'',''Yes'',''Yes'',''false'',''1088385'',''1088385'',''true'',''1088385'',''false'',''Submission for the position: Employment Investigator - (Job Number: 260004PO)'',''false'',''1088385'',''false'',''true''. The incumbent investigates complaints; obtains evidence and gathers facts concerning complaints and cases of alleged noncompliance with laws, rules, and regulations; performs related work as required and prepares dispositions recommending a finding.
Auditor/Investigator II Qlarant Quality Solutions IncAuditor/Investigator IIMACollects data for audits/investigations into claims, utilizing a combination of analytical skills and attention to detail, reviewing documentation, interviewing involved parties, and communicating with various stakeholders to gather relevant information for successful resolution and closure. Essential Functions: Conducts routine and impartial audits/investigations from start to closure into customer claims, ensuring accurate and fair assessments of claims validity.
Surveillance Investigator VRC InvestigationsSurveillance InvestigatorBoston, MassachusettsVRC provides their investigators with necessary equipment and comparable pay, to include drive time, above normal commute mileage reimbursement, company paid licensing fees in most states and allowance for non-reimbursed business expenses. We currently have career opportunities for experienced, self-determined, and highly motivated SURVEILLANCE INVESTIGATORS that would like to join our team of professionals in our efforts to deter and combat insurance fraud.
Undercover Investigator DATA QUEST INVESTIGATIONS LTDUndercover InvestigatorBEVERLY, MACorporate private investigations agency seeks contract Private Investigator to work undercover at a North Shore assignment in warehouse & distribution. Ideal opportunity for Criminal Justice students/graduates and/or individuals seeking investigative experience in pursuit of a career in law enforcement.
Investigator - Network Services - Full Time CoventBridge GroupInvestigator - Network Services - Full TimeBoston, MA$26–$30 / hourCoventBridge Integrity Systems delivers investigative services, technology, and expertise that help healthcare and government organizations protect critical programs, strengthen oversight, and address fraud, waste, abuse, and operational risk. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; 888-932-7364; humanresources@coventbridge.com.
Security Shift Supervisor Pharma Allied UniversalSecurity Shift Supervisor PharmaBoston, MADriving Positions: must possess a valid Driver's License with at least one year of driving experience, a clean driving record (no major violations within last 36 months, no more than 1 accident in last 24 months, no more than one minor moving violation in last 24 months), a minimum level of insurance as required by Company policy, and the ability to safely operate a vehicle required. Allied Universal SkillBridge Program Allied Universal partners with the U.S. Department of Defense (DoD) SkillBridge Program to support transitioning service members with up to 180 days of on-the-job training during their final months of active duty, while they continue to receive full DoD pay and benefits.
US Senior Medical Director, Rare Hematology SanofiUS Senior Medical Director, Rare HematologyCambridge, MA$206,250–$343,750 / yearThe mission of this team is to support the company by functioning as the internal expert in rare hematologic conditions - focusing on recent launch in Immune Thrombocytopenia (ITP), and potentially including warm Autoimmune Hemolytic Anemia (wAIHA), and Sickle Cell Disease (SCD) among other rare blood disorders - and helping Health Care Professionals and Payers optimize patient care and treatment outcomes through evidence-based decisions. The Senior Medical Director will establish and maintain collaborative medical and scientific relationships with key external physicians and internal constituencies from multiple functional groups - including, but not limited to, Medical Affairs, Clinical Research, Regulatory, Science, Marketing, Sales, Commercial Operations, and Patient and Product Services - while maintaining full compliance with all relevant company, industry, legal, and regulatory requirements.
US Medical Director, Indolent Systemic Mastocytosis (ISM) SanofiUS Medical Director, Indolent Systemic Mastocytosis (ISM)Cambridge, MA$178,500–$257,833.33 / yearThe Medical Director will establish and maintain collaborative medical and scientific relationships with key external physicians and internal constituencies from multiple functional groups including, but not limited to, Medical Affairs, Clinical Research, Regulatory, Science, Marketing, Sales, Commercial Operations, and Patient and Product Services - while maintaining full compliance with all relevant company, industry, legal, and regulatory requirements. The mission of this team is to support the company by functioning as the internal expert in rare blood disorders and therapies and helping Health Care Professionals and Payers optimize patient care and treatment outcomes through evidence-based decisions.
Director, Clinical Affairs of Coronary/Vascular PhilipsDirector, Clinical Affairs of Coronary/VascularBedford, MA$171,000–$273,000 / yearYou're the right fit if: You've acquired 10+ years of directly related clinical or scientific experience, including leadership or management experience within the medical device industry, and 5+ years managing a clinical research functional team with a proven track record delivering complex clinical programs on time, within budget, and in compliance with applicable requirements. Your skills include comprehensive knowledge of clinical research regulations across multiple regions, FDA medical device regulations, medical device clinical trial practices, Good Clinical Practice, informed consent requirements, regulatory documentation, and the clinical evidence requirements needed to support regulatory, product development, and commercial objectives.
NewManager, SIU Provider Investigations Point32Health, Inc.Manager, SIU Provider InvestigationsCanton, MA$105,477.36–$158,216.04 / yearWorks with investigators to recommend appropriate disposition for investigations, including closure or corrective actions such as provider education, prepayment denial of claims, recovery of overpaid funds, and referrals to appropriate regulatory and law enforcement agencies. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.
NewManager, SIU Provider Investigations Point32HealthManager, SIU Provider InvestigationsCanton, MassachusettsWorks with investigators to recommend appropriate disposition for investigations, including closure or corrective actions such as provider education, prepayment denial of claims, recovery of overpaid funds, and referrals to appropriate regulatory and law enforcement agencies. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.
Director, Special Investigations Unit Mass General BrighamDirector, Special Investigations UnitSomerville, MassachusettsThe SIU team will perform accurate and reliable medical review audits, analyze medical billing and codes, conduct confidential investigations related to compliance and regulatory requirements, documenting the investigation through audit reports for interview and external review which document the findings, and reporting issues of non-compliance in accordance with all laws and regulations. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
NewCertified Professional Coder, Special Investigations Unit (Aetna SIU) CVS Health CorpCertified Professional Coder, Special Investigations Unit (Aetna SIU)MA$43,888–$93,574 / yearThe Certified Professional Coder (CPC) will perform medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. Uses department resources regularly and follows workflows with minimal assistance or intervention to perform daily work to meet metrics.
Lead Biostatistician (Interventional Cardiology and Vascular Research) Lahey Hospital and Medical CenterLead Biostatistician (Interventional Cardiology and Vascular Research)Boston, MA$95,000–$145,000 / yearAdditional preferred qualifications include SAS Base and Advanced certification, hands-on experience working with SAS (Base, Stat, Macro, SQL), experience mentoring other statisticians and trainees in statistical methods, and expertise in at least one of the following areas: causal inference, longitudinal analysis, or weighting methods. Smith Center for Outcomes Research (bidmc.org)) is devoted to addressing the most pressing issues in cardiovascular care through innovative and rigorous analysis of diverse data sources, including large national registries, administrative claims data, survey-based data, and EHR data.
Director, Special Investigations Unit Brigham and Women's HospitalDirector, Special Investigations UnitSomerville, MAExperience: At least 5-7 years of experience in insurance audits, investigations, or a related field required At least 3-5 years of experience in a management role, preferably within healthcare required At least 5-6 years of experience in the Managed Care industry, Medicaid or Medicaid Managed care fraud detection unit preferred At least 6 years of experience in a health care payer setting and/or in a health care fraud control setting highly preferred. The SIU team will perform accurate and reliable medical review audits, analyze medical billing and codes, conduct confidential investigations related to compliance and regulatory requirements, documenting the investigation through audit reports for interview and external review which document the findings, and reporting issues of non-compliance in accordance with all laws and regulations.
Post Doctoral Research Fellow, Family Medicine Research Boston Medical CenterPost Doctoral Research Fellow, Family Medicine ResearchBoston, MA$65,000–$75,000 / yearDevelops analysis plans, writes statistical analysis for descriptive statistics and advanced analysis techniques (e.g., causal inference, target trial emulation, agent-based modeling, clinical trial analysis), compiles data, maintains large administrative and/or clinical datasets (e.g., Medicaid claims, EHR), creates summary tables and writes summaries of results. Candidate will initiate and participate in the design, execution and evaluation of innovative research studies focused on improving the delivery and effectiveness of evidence-based care in real world settings.
Site Recruiter - CorEvitas Thermo Fisher Scientific IncSite Recruiter - CorEvitasWaltham, MA$83,300–$125,000 / yearExperience identifying and sourcing investigator sites using multiple internal and external data sources, including ClinicalTrials.gov, investigator databases, publication searches, claims data, KOL referrals, and clinical trial networks. Conduct site identification using resources including ClinicalTrials.gov, investigator databases, literature and publication reviews, claims data, Key Opinion Leader (KOL) referrals, clinical trial networks, and other relevant intelligence sources.