UNKNOWN

FEED

Routinely handles cases that are sensitive or high profile, those that are complex cases involving or cases involving multiple perpetrators or intricate healthcare fraud schemes. Demonstrates high level of knowledge and expertise during interactions and acts confidently when providing testimony during civil and criminal proceedings.

YEAR

<p>CVS Health offers a world of promising job opportunities across a diverse range of careers in everything from corporate and pharmacy roles to retails positions. No matter where you work at CVS Health, your unique skills, talents and abilities are welcome and valued. We recognize and reward greatness and want our employees to know their work is making a difference in the lives of millions. Join us today. Together we can continue making innovative, high-quality health and pharmacy services safe, affordable and accessible – for all. </p>

CVS Health Corp

Senior Investigator, Special Investigations Unit (Aetna SIU)

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FULL_TIME

OTHER

Complies with the Veterans Affairs Community Care Network (CCN) and TRICARE T-5 contracts; DHA and TRICARE program guidelines and pertinent Federal regulatory requirements; assists supervisors with FWA trending and reporting requirements; coordinates and assists with investigations and prosecutions by federal agencies interfaces directly with Veterans, Military members and family (as warranted), providers, subcontractors, and other TriWest departments on FWA issues; assist supervisor with the education and training of TriWest, subcontractor, and provider personnel on current FWA matters; prepares appropriate responses to provider compliance issues and complaints referred to Program Integrity by other TriWest departments or external referrals. The PI Investigator t is responsible for the identification, analysis, case development, and reporting of suspected fraud, waste and abuse (FWA) cases as defined by the Department of Veterans Affairs (VA), the Healthcare Finance Administration (HCFA) and the Department of Defense, Defense Health Agency for the TRICARE program; requests and reviews issue-related medical claims and records for FWA and/or administrative and clerical error(s).

TriWest Healthcare Alliance

Program Integrity Investigator

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JOB SUMMARY: Our dynamic Ethos team is seeking a Special Unit Investigations (SIU) Field Investigator to conduct field investigations, gather and analyze evidence, and produce detailed reports that support claims decisions. Case Documentation: Conduct in-person interviews and obtain accurate, detailed statements from all parties involved, and retrieve relevant documents to support investigative findings.

Ethos Risk Services LLC

Special Investigations Unit (SIU) - Field Investigator

Serve as the primary liaison with state fraud bureaus, NICB, law enforcement, and prosecutors when cases present indicators of criminal activity or organized fraud schemes affecting commercial policyholders or business operations. Utilize advanced analytical reasoning to assess the extent and financial impact of suspected fraudulent activity, including complex commercial claim structures, multi‑party losses, and layered coverages.

W. R. Berkley Corp

SIU Sr. Investigator

Berkley

[AW]-iCims

The 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.

Allied Universal provides unparalleled service, systems and solutions to the people and business of our communities, and is North America's leading security services provider. With over 140,000 employees, Allied Universal delivers high-quality, tailored solutions, which allows clients to focus on their core business. For more information: 866.825.5433 or <a href="http://www.aus.com/" target="_blank">www.AUS.com</a>


Allied Universal

Surveillance Investigator

REQUIREMENTS: Previous 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.

Investigator

The 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.

Claims Investigator Jobs in Kansas, MO

Senior Investigator, Special Investigations Unit (Aetna SIU) CVS Health Corp

Program Integrity Investigator TriWest Healthcare Alliance

Special Investigations Unit (SIU) - Field Investigator Ethos Risk Services LLC

SIU Sr. Investigator W. R. Berkley Corp

SIU Sr. Investigator Berkley

Surveillance Investigator Allied Universal

Investigator Ethos Risk Services LLC

SIU Medical & Behavioral Health Coding Analyst CVS Health Corp

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