Health Plan Special Investigative Unit Investigator - Health Alliance Plan Henry Ford HospitalHealth Plan Special Investigative Unit Investigator - Health Alliance PlanTroy, MICollaborative Skills: Demonstrates strong teamwork and collaboration abilities, effectively working with other investigators to achieve common goals and take responsibility for team outcomes while contributing to the overall success of the team. Proficiency using excel including ability to analyze large data sets to identify trends, anomalies, and opportunities for improvement, using data visualization techniques to present findings effectively.
Investigator, Special Investigations Unit (Meritain Health) CVS Health CorpInvestigator, Special Investigations Unit (Meritain Health)MI$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.
Investigator, Special Investigations Unit (Aetna SIU) CVS Health CorpInvestigator, Special Investigations Unit (Aetna SIU)MI$43,888–$93,574 / yearExperience with Microsoft Word, Excel, and Outlook products, open source database search tools, social media and internet research. Bachelor's Degree in Criminal Justice, Healthcare Management, Public Health, Biological Sciences, Data Analytics, or other related field preferred or equivalent experience.
Senior Investigator, Special Investigations Unit (Aetna SIU) CVS Health CorpSenior Investigator, Special Investigations Unit (Aetna SIU)MI$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.
Senior (Special Investigation Unit (SIU) Investigator AAA Life Insurance CompanySenior (Special Investigation Unit (SIU) InvestigatorLivonia, MIResults Orientation / Strategic Execution: Leads complex investigations with urgency and extremely high effectiveness, prioritizing high-risk matters, driving outcomes, and delivering high-quality results in a fast-paced, high-exposure environment. Professional certification(s) strongly preferred (e.g., Certified Fraud Examiner (CFE), Fraud Claim Law Specialist (FCLS), Associate, Life and Health Claims Designation (ALHC), or CFCI (Certified Financial Crimes Investigator - IAFCI).
Insurance Claims Investigator Data Surveys IncInsurance Claims InvestigatorHowell, MIhas been leading the private insurance investigative industry for over 50 years, servicing the self-insured, defense attorneys and all major insurance carriers defending against fraudulent claims. Insurance Claims Investigators at Data Surveys, Inc. are required to utilize their own personal vehicles for any necessary road travel throughout the week.
Asset Protection Investigator SaksAsset Protection InvestigatorSt LouisBy leveraging the most comprehensive luxury customer data platform in North America, cutting-edge technology, and strong partnerships with the world's most esteemed brands, Saks Global is shaping the future of luxury retail. Saks Global is the largest multi-brand luxury retailer in the world, comprising Saks Fifth Avenue, Neiman Marcus, Bergdorf Goodman, and Saks OFF 5TH.
NewFraud Investigator City of FlintFraud InvestigatorFlint, MI$35.60–$39.47 / hourUnder general direction, performs advanced professional investigative work involving allegations of employee misconduct, fraud, abuse, theft, ethics violations, misuse of City assets, procurement irregularities, payroll fraud, workers compensation fraud, residency violations, conflicts of interest, and other violations of City policies, collective bargaining agreements, and applicable federal, state, and local laws. Do you have three (3) to five (5) years of progressively responsible professional experience conducting fraud investigations, administrative investigations, internal investigations, compliance investigations, internal auditing, human resources investigations, law enforcement investigations, or other closely related investigative work?
NewSIU Investigator III (Health Plan experience required) CareSourceSIU Investigator III (Health Plan experience required)Michigan, MI$72,200–$115,500 / yearCareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. Job Summary: The Special Investigations Unit (SIU) III is responsible for investigating and resolving high complexity allegations of healthcare fraud, waste and abuse (FWA) by medical professional, facilities, and members.
Staff Investigator Branch CountyStaff InvestigatorColdwater, MichiganComputer skills necessary to effectively utilize word processing, databases, spreadsheet and presentation software applications for the creation and compilation of various documents, communications and reports. If not licensed, then must have proper documentation submitted to LARA (Licensing and Regulation Affairs) no later than 90 days into their 6-month probationary period of employment.
SIU Investigator Centene Corporation GroupSIU InvestigatorMIRemote$56,200–$101,000 / yearEducation/Experience: Bachelor's degree, or an Associate's degree with an additional 2 years working on health care fraud, waste, and abuse investigations and audits in lieu of a Bachelors is required. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse.
Investigator Ethos Risk ServicesInvestigatorFlint, MIPart 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.
Special Investigation Unit (SIU) Manager CVS Health CorpSpecial Investigation Unit (SIU) ManagerMI$54,300–$159,120 / yearThe Certified Professional Coder (CPC) Manager will oversee a team of medical coders within the Special Investigations Unit (SIU) to ensure compliance with coding practices through comprehensive record reviews for medical, behavioral, transportation, and other healthcare providers. Ensure staff provide detailed written summaries of medical record review findings and ensure the team articulates findings effectively to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, and state regulators.
Special Agent U.S. Department of Homeland SecuritySpecial AgentMI$48,854–$118,204 / yearOR Have at least 1 year of specialized experience equivalent to the GL-9 level (such as experience in or related to planning and conducting complex criminal investigations to determine violations of Federal laws and regulations; collecting and assembling facts to identify logical conclusions; gathering, analyzing, and evaluating evidence or data; conducting interviews and interrogations; making arrests; conducting searches and seizures; taking responsibility for own actions and those of team members to ensure the goals and deadlines for the team are met; partnering with or leveraging networks or relationships from outside the organization; experience managing complex projects including setting priorities and determining resource requirements). OR Have at least 1 year of specialized experience equivalent to the GL-7 level (such as experience applying law enforcement, protective, or investigative techniques in the performance of job duties; identifying problem areas and proposing and implementing solutions; taking responsibility for own actions and those of team members to ensure the goals and deadlines for the team are met; leading meetings or seminars on behalf of a professional or academic group; setting work priorities and allocating resources; partnering with other individuals from within and outside the organization).