FWA Special Investigations Unit SIU Investigator SummaCare IncFWA Special Investigations Unit SIU InvestigatorAkron, OH$28.10–$42.15 / hour3) Maintains working knowledge of relative enterprise and local information systems, databases, data schemas, software packages, and business operations to facilitate precise, reliable and accurate fulfillment of information needs related to corporate operations. SummaCare 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).
Investigator, Special Investigations Unit (Meritain Health) CVS Health CorpInvestigator, Special Investigations Unit (Meritain Health)OH$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)OH$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)OH$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.
Sub Investigator Velocity Clinical Research, Inc.Sub InvestigatorBeachwood, OhioFull timeImplement and coordinate assigned clinical trials including start up, vendor management, subject recruitment, source development review, scheduling subjects, protocol training, collection of regulatory documents, conducting visits, ensuring data is entered in a timely manner and all queries are resolved, managing and reporting adverse events, serious adverse events, and deviations, implementing new protocol amendments, providing all close out reports. The Sub Investigator has responsibility for the clinical safety of the patients partaking in the clinical trial, collecting, and recording accurate clinical data while also ensuring that the well-being and interests of the subjects enrolled in the studies are being met.
Program Integrity Investigator IV CareSourceProgram Integrity Investigator IVOhio WFH, OH$83,000–$132,800 / yearReview reports and data for pattern identification, special cause variation identification, trend analysis, or other techniques that will reveal intelligence for identification of any associative or causal relationships pertaining to Fraud Waste and Abuse and Error, providing management level summaries that explain key findings and providing documentation for use during Audits. Utilizes a variety of data analytics platforms to mine large volumes of data to identify and mitigate fraudulent claim activity, discover patterns and anomalies in billing behavior and develop metrics around transactional and operational data to report on fraud attempts, losses and trends.
NewSIU Investigator III (Health Plan experience required) CareSourceSIU Investigator III (Health Plan experience required)OH$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.
Sub Investigator Velocity Clinical Research IncSub InvestigatorBeachwood, OHImplement and coordinate assigned clinical trials including start up, vendor management, subject recruitment, source development review, scheduling subjects, protocol training, collection of regulatory documents, conducting visits, ensuring data is entered in a timely manner and all queries are resolved, managing and reporting adverse events, serious adverse events, and deviations, implementing new protocol amendments, providing all close out reports. Summary: The Sub Investigator has responsibility for the clinical safety of the patients partaking in the clinical trial, collecting, and recording accurate clinical data while also ensuring that the well-being and interests of the subjects enrolled in the studies are being met.
NewClinical Fraud Investigator II Elevance Health IncClinical Fraud Investigator IICincinnati, OHMinimum Requirements: Requires an Associate Degree in Nursing and/or current certification as a Certified Professional Coder (AAPC or AHIMA) and minimum of 4 years related experience, including minimum of 1 year experience in a Clinical Fraud and Abuse Investigation area; or any combination of education and experience, which would provide an equivalent background. Locations: This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance.
SIU Investigator Centene Corporation GroupSIU InvestigatorOHRemote$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 ServicesInvestigatorCleveland, OHPart 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.
Surveillance Investigator Allied UniversalSurveillance InvestigatorAkron, OH$20–$22 / 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.
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 (SIU) Manager CVS Health CorpSpecial Investigation Unit (SIU) ManagerOH$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 AgentOH$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).
Pediatric Infectious Diseases Faculty Nationwide Children's HospitalPediatric Infectious Diseases FacultyColumbus, OhioPhysical Requirements: OCCASIONALLY: Bend/twist, Blood and/or Bodily Fluids, Chemicals/Medications, Communicable Diseases and/or Pathogens, Flexing/extending of neck, Fume /Gases /Vapors, Lifting / Carrying: 0-10 lbs, Lifting / Carrying: 11-20 lbs, Lifting / Carrying: 21-40 lbs, Loud Noises, Patient Equipment, Pushing / Pulling: 0-25 lbs, Reaching above shoulder, Squat/kneel. The section includes 20 faculty members and established programs in general infectious diseases, neonatal infectious diseases, the Host Defense Program, HIV patient-centered care, hepatitis C, global health and travel medicine, antimicrobial stewardship, hospital epidemiology and infection prevention.