Investigator, Crime Analysis & Special Services - Enterprise Physical Operations Washington University in St LouisInvestigator, Crime Analysis & Special Services - Enterprise Physical OperationsSt. Louis, MO$53,100–$90,600 / yearProactively analyze and investigate potential threats and complex criminal schemes directed at Wash U; perform and coordinate crime avoidance and prevention training for the campus community; author crime avoidance and prevention products to raise awareness of crime issues impacting the campus; conduct activities to ensure the university's compliance with the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act (Clery Act); collect, interpret, and disseminate intelligence information in support of operations and physical security; take immediate action to direct WashU Protective Services staff as necessary. Identifies vulnerable areas within the campus and its infrastructure that will benefit from increased security concentration or technology for greater protection of employees, visitors and assets; researches and reports on advanced security options and new technologies; ensures protection of sensitive research/clinical personnel and assets from domestic terror organizations and similar groups.
Special 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.
Fraud Investigator Blue Cross and Blue Shield of Kansas CityFraud InvestigatorKansas City, MO3 years' experience conducting healthcare FWA investigations at a health insurer; experience analyzing claims data to identify FWA trends and patterns using tools such as Excel and business intelligence platforms (e.g., Power BI, Business Objects). Knowledge of major BCBSKC business systems (e.g., Facets, ITS Host and Home) and operational processes (e.g., Claims Processing, Pharmacy, Provider Contracting/Relations, Member Services, Customer Service).
Asset Protection Investigator Saks Global Enterprises LLCAsset Protection InvestigatorSt. Louis, MO$21.53–$26.91 / hourIt is known for creating the Neiman Marcus magic through exceptional customer experiences including the Neiman Marcus Awards, Fantasy Gifts, seasonal campaigns, and "Retail-tainment" initiatives. Job Description: WHO WE ARE: Neiman Marcus is a leading luxury retailer that provides a curated product assortment, unparalleled services, and exclusive activations for customers in Pursuit of the Extraordinary.
SIU Investigator Centene Corporation GroupSIU InvestigatorMO$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.
Clinical Investigator Behavioral Health Centene Corporation GroupClinical Investigator Behavioral HealthMO$56,200–$101,000 / yearPosition requires the associate to verify authorization for services and written documentation of services provided against claim information, ensure the appropriateness and accuracy of diagnosis and procedure codes supporting such claims, coordinate medical necessity and appropriate level of care determinations with Medical Directors, and validate services against CMS and State-specific coverage, limitations and exclusion guidelines. 3+ years of providing direct Psychotherapy or Inpatient group therapy within inpatient psychiatric hospitals or units, residential treatment centers, substance abuse rehabilitation facilities, military or veteran hospitals.
Program Integrity Investigator TriWest Healthcare AllianceProgram Integrity InvestigatorKansas City, MORemoteFull timeComplies 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).
Program Integrity Investigator (Healthcare Fraud Waste & Abuse) TriWest Healthcare AllianceProgram Integrity Investigator (Healthcare Fraud Waste & Abuse)Kansas City, MORemoteFull timeComplies 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).
Investigator Ethos Risk ServicesInvestigatorSpringfield, MOPart 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.
Surveillance Investigator - Part Time Allied UniversalSurveillance Investigator - Part TimeSt Louis, MO$20–$25 / 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.
Surveillance Investigator Allied UniversalSurveillance InvestigatorSt Louis, MOThe 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.
Special Agent U.S. Department of Homeland SecuritySpecial AgentSpringfield, MO$48,854–$118,204 / yearYou are minimally qualified for the GL-07 Level starting base salary 48854 if you possess one of the following: A bachelors degree from an accredited college or university with Superior Academic Achievement (S.A.A.), which is based on: Class standing: Applicants must be in the upper third of the graduating class in the college, university, or major subdivision (such as the College of Liberal Arts or the School of Business Administration) based on completed courses. Grade-point average (G.P.A.): Applicants must have a grade-point average of 3.0 or higher out of a possible 4.0 (B or better) as recorded on their official transcript or as computed based on 4 years of education or as computed based on courses completed during the final 2 years of the curriculum.
Medical Science Liaison, (MSL or Sr. MSL) Neurology (Alzheimer''''s Disease) - Field Based IL and St. Louis, MO Eisai IncMedical Science Liaison, (MSL or Sr. MSL) Neurology (Alzheimer''''s Disease) - Field Based IL and St. Louis, MOSt. Louis, MO$144,300–$189,400 / yearThe impact that a Medical Science Liaison will have on the organization includes the following: a) as a representative of Eisai, a MSL will communicate key information about Eisai, the company and its hhc mission; b) provide key scientific and clinical information about Eisai's products/pipeline; serve as a conduit for communication between Eisai Research and the medical community regarding ideas for future research, and c) provide corporate value through demonstrated leadership, teamwork, participation in strategic thinking, and special projects. MSLs will be trained and certified on AD and Eisai's dementia pipeline data in order to fulfill educational gaps with KOLs/HCPs and gather medical insights to refine medical strategy and continue to close the gap on unmet educational needs for AD HCPs.
Medical Science Liaison (MSL or Sr. MSL), Neurology (Alzheimer's Disease) - Field Based, Central Midwest (KS, NE, IA & MO) EisaiMedical Science Liaison (MSL or Sr. MSL), Neurology (Alzheimer's Disease) - Field Based, Central Midwest (KS, NE, IA & MO)Kansas City, MissouriThe impact that a Medical Science Liaison will have on the organization includes the following: a) as a representative of Eisai, a MSL will communicate key information about Eisai, the company and its hhc mission; b) provide key scientific and clinical information about Eisai’s products/pipeline; serve as a conduit for communication between Eisai Research and the medical community regarding ideas for future research, and c) provide corporate value through demonstrated leadership, teamwork, participation in strategic thinking, and special projects. MSLs will be trained and certified on AD and Eisai’s dementia pipeline data in order to fulfill educational gaps with KOLs/HCPs and gather medical insights to refine medical strategy and continue to close the gap on unmet educational needs for AD HCPs.
Medical Science Liaison (Msl Or Sr. Msl), Neurology (Alzheimer's Disease) - Field Based, Central Midwest (Ks, NE, IA & MO) Eisai USMedical Science Liaison (Msl Or Sr. Msl), Neurology (Alzheimer's Disease) - Field Based, Central Midwest (Ks, NE, IA & MO)Kansas City, MO$144,300–$189,400 / yearThe impact that a Medical Science Liaison will have on the organization includes the following: a) as a representative of Eisai, a MSL will communicate key information about Eisai, the company and its hhc mission; b) provide key scientific and clinical information about Eisai's products/pipeline; serve as a conduit for communication between Eisai Research and the medical community regarding ideas for future research, and c) provide corporate value through demonstrated leadership, teamwork, participation in strategic thinking, and special projects. MSLs will be trained and certified on AD and Eisai's dementia pipeline data in order to fulfill educational gaps with KOLs/HCPs and gather medical insights to refine medical strategy and continue to close the gap on unmet educational needs for AD HCPs.