Certified Coder Special Investigations Unit SIU SummaCare IncCertified Coder Special Investigations Unit SIUAkron, OH$28.10–$42.15 / hourSummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2026 by the Centers for Medicare and Medicaid Services (CMS). Maintain excellent working knowledge of process improvement techniques, methodologies and principles applying these in the normal course of operations.
Special Investigation Unit Investigator III L.A. Care Health PlanSpecial Investigation Unit Investigator IIILos Angeles, CAThe Special Investigation Unit Investigator III performs in-depth evaluation of potential fraud & abuse cases and develops complex investigations that involve high dollar amounts, sensitive issues, or that otherwise meet criteria for fraud, waste & abuse. claims history, provider files) to determine provider billing patterns and detect potential fraudulent or abusive billing practices or vulnerabilities in Medi-Cal/Medicare policies and initiates appropriate action.
NewSpecial Investigation Unit Manager Donegal Insurance GroupSpecial Investigation Unit ManagerMarietta, PA$90,000–$115,000 / yearDonegal Insurance Group provides commercial and personal insurance products through a network of independent agents in 21 states and across several regions of the U.S. In Texas, Colorado, Utah, New Mexico and Arizona, business is conducted under the Mountain States Insurance Group name; and in Michigan, business is conducted under the Michigan Insurance name. Check out our Glassdoor profile where our rating speaks for itself: By joining Donegal, you would be joining a team of dedicated, hard-working employees, all with a common goal of providing peace of mind to our policyholders and being There when it matters most.
Clinical Special Investigations Unit Investigator- Health Plan Parkland HospitalClinical Special Investigations Unit Investigator- Health PlanTXMust be currently certified and in good standing or obtain certification within twelve (12) months of hire with one of the following: Health Care Anti-Fraud Associate (HCAFA), Accredited Health Care Fraud Investigator (AHFI), Association of Certified Fraud Examiners (CFE), or National Health Care Anti-Fraud Association (NHCAA). Responds to Requests for Information (RFIs) from National Benefit Integrity MEDIC, U.S. Office of Personnel Management Office of the Inspector General (OPM OIG), State Departments of Insurance (DOI), and other law enforcement agencies, as appropriate.
NewSpecial Investigation Unit Investigator Centene Corporation GroupSpecial Investigation Unit InvestigatorMO$56,200–$101,000 / yearCollaborates 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. 2+ years Fraud, waste, and abuse investigations, healthcare investigations, claims audits, payment integrity, healthcare compliance, law enforcement investigations, or a related investigative field.
Investigator, Special Investigations Unit (Aetna SIU) - Must reside in Oklahoma CVS Health CorpInvestigator, Special Investigations Unit (Aetna SIU) - Must reside in OklahomaOK$43,888–$76,500 / yearThe Special Investigations Unit (SIU) Investigator is responsible for thoroughly investigating any allegations of Medicaid healthcare fraud, waste, or abuse in accordance with federal and state regulation. Experience with using fraud, waste, and abuse (FWA) detection tools and enterprise databases to support data mining, analysis, and information gathering.
Behavioral Health Senior Investigator (BCBA), Special Investigations Unit (Aetna SIU) CVS Health CorpBehavioral Health Senior Investigator (BCBA), Special Investigations Unit (Aetna SIU)Hartford, CT$46,988–$112,200 / yearAnalyze clinical documentation, treatment plans, progress notes, billing records, and utilization patterns for indicators of inappropriate services, overutilization, unbundling, duplicate billing, or services not supported by clinical documentation. The Behavioral Health Senior Investigator is responsible for conducting complex investigations involving Applied Behavior Analysis (ABA) services and behavioral health providers to identify, detect, and prevent potential fraud, waste, and abuse (FWA).
NewSpecial Investigations Field - Investigator I Cincinnati Financial CorpSpecial Investigations Field - Investigator ICincinnati, OH$60,000–$88,000 / year167548'',''true'',''167548'',''false'',''Submission for the position: Special Investigations Field - Investigator I - (Job Number: 2600707)'',''false'',''167548'',''false'',''true'',''Special Investigations Field - Investigator I'',''2600707'',''US-AZ-Phoenix'',''!*! '',''false'',''167548'',''167548'',''true'',''167548'',''false'',''Submission for the position: Special Investigations Field - Investigator I - (Job Number: 2600707)'',''false'',''167548'',''false'',''true''.
Special Investigations Unit (SIU) Analyst II CoventBridge GroupSpecial Investigations Unit (SIU) Analyst II$74,000–$87,000 / yearFull timeUtilize data analysis techniques to detect aberrancies in our health plan clients’ Commercial, Medicare, Medicaid, ACA/Exchange, FEHB, and Tricare claims data, and proactively seeks out and develops leads/investigations received from a variety of sources. CoventBridge 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.
Clinical Special Investigations Unit Investigator- Health Plan Parkland HealthClinical Special Investigations Unit Investigator- Health PlanMust be currently certified and in good standing or obtain certification within twelve (12) months of hire with one of the following: Health Care Anti-Fraud Associate (HCAFA), Accredited Health Care Fraud Investigator (AHFI), Association of Certified Fraud Examiners (CFE), or National Health Care Anti-Fraud Association (NHCAA). Responds to Requests for Information (RFIs) from National Benefit Integrity MEDIC, U.S. Office of Personnel Management Office of the Inspector General (OPM OIG), State Departments of Insurance (DOI), and other law enforcement agencies, as appropriate.
Director, Special Investigations Unit CVS Health CorpDirector, Special Investigations UnitHartford, CT$100,000–$231,540 / yearReporting to the SIU Executive Director, the Investigative Lead Director is responsible to detect, investigate, and mitigate Fraud, Waste and abuse across our Commercial and Medicare business lines. Provides guidance to and ensures training for Managers and investigators regarding obtaining evidence, sufficiency of evidence, investigative interviews, and other investigatory techniques and practices.
Special Investigations Unit Investigator Delta Dental Plan of MichiganSpecial Investigations Unit InvestigatorOkemos, MichiganRemotePosition requires advanced knowledge of dental terminology and dental procedure codes; knowledge of common data mining tools, such as Audit Command Language (ACL), SQL Developer and IBM’s Fraud and Abuse Management System (FAMS); strong verbal and written communication skills; strong organizational and analytical skills; ability to manage multiple assignments with competing deadlines; and the ability to resolve complex problems using independent judgment. Position requires a bachelor's degree in accounting, business administration, finance, healthcare administration, information technology, or a related field and three years of experience auditing, utilizing analytical tools and software, dental claims billing or review, or as a dental hygienist.
Complex Litigation Attorney - Special Investigations Unit (Remote, NY Metro Area) Allstate Insurance CompanyComplex Litigation Attorney - Special Investigations Unit (Remote, NY Metro Area)New York, NYRemote$130,000–$177,000 / yearThe attorney will be required to travel within the New York Metro area for court appearances, hearings, trials and other legal matters, as well as periodic travel to the local Allstate office location. From advocating for seat belts, air bags and graduated driving laws, to being an industry leader in pricing sophistication, telematics, and, more recently, device and identity protection.
Special Matters & Government Investigations Associate Marina Sirras & Associates LLCSpecial Matters & Government Investigations AssociateChicago, IL$260,000–$365,000 / yearOur client, a prominent AmLaw 100 firm, is seeking a highly motivated and experienced Associate to join its Special Matters & Government Investigations practice group in its Chicago office. This is an excellent opportunity for a candidate with strong white collar and regulatory experience to handle sophisticated government investigations, internal investigations, and related matters in a dynamic and collegial environment.
NewSpecial Agent (Central Region): OLES Investigations Unit #01445 Commonwealth of VirginiaSpecial Agent (Central Region): OLES Investigations Unit #01445VA$59,755–$81,683 / yearLayoff Preferences: Applicants who possess an Interagency Placement Screening Form (Yellow Form) or a Preferential Hiring Form (Blue Form) as issued under the Department of Human Resources Management (DHRM) Policy 1.30 Layoff (Commonwealth of VA employees only) MUST attach these forms when submitting their state application and/or résumé. This position is based in the Central Region of the state and requires coverage of facilities located within approximately one hour's drive of Augusta, Albemarle, Nelson, Prince Edward, Cumberland, Culpeper, Nottoway, Orange, Louisa, Fluvanna, Powhatan, Goochland, Amelia.
NewCertified Professional Coder, Special Investigations Unit (Aetna SIU) CVS HealthCertified Professional Coder, Special Investigations Unit (Aetna SIU)MissouriThe 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.
NewSpecial Investigations Unit Claims Specialist Delta Dental Plan of MichiganSpecial Investigations Unit Claims SpecialistMichiganRemotePosition requires advanced knowledge of dental terminology and dental procedures and the ability to read and interpret radiographs, electronic images and photos; experience working with word processing, and spreadsheet software; effective verbal and written communication skills; ability to resolve moderately complex problems and use independent judgment; experience with Provider system; ETS; Client and Provider contracts are preferred. At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities.
NewSpecial Investigations Unit (SIU) - Field Investigator Ethos Risk Services LLCSpecial Investigations Unit (SIU) - Field InvestigatorSeattle, WAJOB 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.
Senior Investigator, Special Investigations Unit (Aetna SIU) - Must reside in Florida CVS Health CorpSenior Investigator, Special Investigations Unit (Aetna SIU) - Must reside in FloridaPlantation, FL$46,988–$102,000 / yearCredentials such as a certification from the Association of Certified Fraud Examiners (CFE), an accreditation from the National Health Care Anti-Fraud Association (AHFI), or have a minimum of three years Medicaid Fraud, Waste and Abuse investigatory experience. Bachelor's degree preferred, or an Associate's degree, with an additional three years (3 years total) working on health care fraud, waste, and abuse investigations and audits required.
Scaled Abuse Specialist, Special Projects & Investigations Amazon.com IncScaled Abuse Specialist, Special Projects & InvestigationsTempe, AZThe Special Projects & Investigations (SPI) team protects Amazon's WW stores store by creating projects and programs focused on the detection of abuse at its earliest point and identifying the root causes, vulnerabilities or exploits to systematically address to prevent future abuse. The Special Projects & Investigations team is looking for an experienced, motivated industry specialist with background in risk, digital fraud, compliance, or cyber investigations who also have advanced data analysis skills (SQL, Python, Machine Learning, Data Science).