SIU / Claims Investigator - Central / South VA Allied UniversalSIU / Claims Investigator - Central / South VACharlottesville, Virginia$25–$32 / hourAcquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance . High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud .
SIU Investigator - Central / South VA Allied UniversalSIU Investigator - Central / South VACharlottesville, Virginia$25–$32 / hourFull timeAcquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance . High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud .
Surveillance Investigator Allied UniversalSurveillance InvestigatorCharlottesville, VA$21–$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.
NewSenior Fraud and Abuse Investigator/CPC/CFI/CFS/CHC/CFE/AHFI Sentara HospitalsSenior Fraud and Abuse Investigator/CPC/CFI/CFS/CHC/CFE/AHFIVirginiaRemoteExperience utilizing data analytics to identify high-risk providers and claims for pre-payment review within a healthcare payer, SIU, Program Integrity, or Payment Integrity environment is strongly preferred . Experience conducting pre-pay investigations, provider risk assessments, data mining, fraud, waste and abuse (FWA) analysis, and proactive identification of billing anomalies and emerging provider trends.
NewSenior Investigator, Special Investigations Unit (Aetna SIU) CVS Health CorpSenior Investigator, Special Investigations Unit (Aetna SIU)VA$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.
Contract Investigator - Harrisonburg, VA OMNIPLEX World Services Corporation, A Constellis CompanyContract Investigator - Harrisonburg, VAHarrisonburg, VirginiaWork hours vary depending on availability of leads and do not always fall within normal business hours, to include potential weekend hours or third-shift appointments. We are a trusted provider of high quality background investigations programs to Department of Homeland Security (DHS) and the intelligence community at locations throughout the United States.
Contract Investigator - Charlottesville, VA OMNIPLEX World Services Corporation, A Constellis CompanyContract Investigator - Charlottesville, VACharlottesville, VirginiaWork hours vary depending on availability of leads and do not always fall within normal business hours, to include potential weekend hours or third-shift appointments. We are a trusted provider of high quality background investigations programs to Department of Homeland Security (DHS) and the intelligence community at locations throughout the United States.
Wage Protection Investigator Commonwealth of VirginiaWage Protection InvestigatorHarrisonburg, VADOLI is seeking highly motivated and skilled individuals to work as full-time Wage Protection Investigators to support its enforcement efforts including the protection of workers' wages, protection from independent contractor misclassification, child labor protections and prevailing wage requirements on public works contracts. Current and former employees of the Commonwealth of Virginia who have either been laid off or will be laid off from State service, who indicate preferential hiring rights in the form of a valid Interagency Placement Screening Form (yellow card) or a Preferential Hiring Form (blue card), must submit the card to our office by the application deadline.
NewSIU Investigator Centene Corporation GroupSIU InvestigatorVA$56,200–$101,000 / yearLicenses/Certifications: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), or other related investigative, auditing, or compliance certification preferred. Collaborates with internal business partners, compliance, legal, provider and payment integrity teams, and external agencies to coordinate investigative activities, support corrective actions, recoveries, and case resolution efforts.
Wage Protection Investigator DHRMWage Protection InvestigatorHarrisonburg, VirginiaDOLI is seeking highly motivated and skilled individuals to work as full-time Wage Protection Investigators to support its enforcement efforts including the protection of workers’ wages, protection from independent contractor misclassification, child labor protections and prevailing wage requirements on public works contracts. Current and former employees of the Commonwealth of Virginia who have either been laid off or will be laid off from State service, who indicate preferential hiring rights in the form of a valid Interagency Placement Screening Form (yellow card) or a Preferential Hiring Form (blue card), must submit the card to our office by the application deadline.
Senior Compliance Investigator Centene Corporation GroupSenior Compliance InvestigatorVA$70,100–$126,200 / yearLeads and conducts compliance and ethics investigations across all business units and health plans, including but not limited to assessment of allegations, review of relevant documents, witness interviews, analysis of facts, root cause analysis, and preparation of investigation reports with recommended remedial or disciplinary actions. Education/Experience: A Bachelor's Degree in Related Field or Associates with 5 years of applicable experience, or a High School/GED with 6 years of applicable experience may substitute for the Bachelor's Degree, required.
Retail Crime Investigator Weis MarketsRetail Crime InvestigatorVirginiaThe requirements listed below are representative of the knowledge, skills, and/or abilities required: Bachelor's degree (BA/BS) Criminal Justice, Criminology, Business, or related field preferred, plus one (1) year retail loss prevention experience in a retail store environment. The associate is responsible for the functions below, in addition to other duties as assigned: Investigate and resolve external theft (Shoplifting, Organized Retail Crime, etc.).
Senior Fraud, Waste and Abuse (FWA) Investigator PacificSourceSenior Fraud, Waste and Abuse (FWA) InvestigatorVirginiaIndependently plan, conduct, and manage prompt, thorough onsite and desk-top investigations of health care claims, Thoroughly document investigative findings and actions to create comprehensive case files in accordance with established policies and procedures. Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Compensation Disclaimer .