Investigator Ethos Risk ServicesInvestigatorCharleston, WVPart timeCONDITIONS:While we aim to keep assignments within a 2-hour drive of your residence, occasional further travel and overnight stays (covered by the company) may be requiredMost surveillance cases start at 6:00AM. REQUIREMENTS:Previous Experience: Demonstrated proficiency in covert surveillance techniques, capturing high-quality video footage, and preparing thorough, well-organized investigative reports.
NewSenior Investigator, Special Investigations Unit (Aetna SIU) CVS Health CorpSenior Investigator, Special Investigations Unit (Aetna SIU)WV$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 fraud schemes. 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.
SIU Investigator Lead (Must live in OH or surrounding states) CareSource Management Services LLCSIU Investigator Lead (Must live in OH or surrounding states)Charleston, WVThis role is also responsible for the identification and monitoring of emerging FWA trends and conducting research and interactions on claims, industry and other sources (internal and external) of data and information to identify potential FWA and support ongoing fraud investigations. Act as the Program Integrity liaison and ensure collaboration with state and federal agencies and facilitate accurate deployment and ongoing monitoring of state-specific regulations and ongoing partnership with state regulators in managing Medicaid and Medicare programs.
Nurse Investigator The Health PlanNurse InvestigatorWheeling, WVRequired: Registered Nurse; Certified Coder (or eligible within 12 months)or similar certification; Basic knowledge of ICD-9/10, CPT, HCPCS, DRG and/or Rev codes; Proficiency with Office products, including Word and Excel; Critical problem-solving skills and attention to detail. The successful candidate will utilize their unique blend of coding, claims payment, clinical, and payment integrity/investigations expertise to assist the SIU in achieving its mission to prevent, detect, investigate, and resolve healthcare fraud, waste, and abuse.
Part-Time Surveillance Investigator The Robison GroupPart-Time Surveillance InvestigatorCharleston, WVThrough 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.
Investigator Associate State of West VirginiaInvestigator AssociateCharleston, WV$39,416–$51,832 / yearConduct routine investigations of tax violations related to cigarettes, motor fuel, soft drinks, consumer sales tax, withholding tax, use tax, business registration, bingo & raffle licenses, and other tax types. WE DO NOT ACCEPT THE FOLLOWING DOCUMENTATION: Unofficial transcripts High school diplomas or transcripts Birth certificates Social Security Cards Driver's Licenses Passports These documents will be removed from your profile if submitted.