Senior SIU Clinical Investigator - Remote Forensic Auditor
Oscar Health Insurance
- Remote job
Oscar Health Insurance is seeking a Senior Analyst, SIU Clinical Investigator to detect and audit aberrant billing patterns in claims and clinical documentation. You will review medical records to ensure alignment with guidelines and regulations, and identify schemes such as upcoding or unbundling. As a clinical SME, you will translate findings into education for Oscar teams and build evidentiary files for potential recovery or referrals. This is a remote role with NYC/Tempe office options. #J-18808-Ljbffr Oscar Health Insurance
- Oscar Health Insurance is seeking a Senior Analyst, SIU Clinical Investigator to detect and audit aberrant billing patterns in claims and clinical documentation... ...files for potential recovery or referrals. This is a remote role with NYC/Tempe office options. #J-18808-Ljbffr...Remote jobSeniorWork at office
- ...integrity solutions, is looking for a talented Clinical Coder/Fraud Investigator to join our team. Key Responsibilities Work with SIU Team (Clinical Reviewers, CPCs,... ...Professional and career development initiatives ~ Remote work eligible REMOTE WORK...Remote workFlexible hours
- Healthcare Fraud Shield is seeking a Clinical Coder/Fraud Investigator to join our SIU team at headquarters. You will analyze medical records, abstract CPT/... ...attention to detail and the ability to work independently. Remote work eligibility is available. #J-18808-Ljbffr...Remote job
- Centene Corporation is seeking a seasoned Health Care Fraud Investigator to support a remote SIU team across the continental US. You will guide investigations, develop plans, document findings, and collaborate with regulators and internal counsel to mitigate risks. The...Remote jobSeniorFlexible hours
- National General is seeking an experienced SIU Investigator to join our team. This role handles highly complex, multi-discipline claims including attorney represented and large losses, with emphasis on potential fraud. The investigator conducts background searches, site...Remote jobSenior
$68.7k - $123.7k
...Senior Clinical Coding Auditor & Trainer-Remote The Senior Clinical Coding Auditor & Trainer will conduct audits of inpatient coding processes for Fiscal care and assist in development of training and audit tools. Location: The Senior Clinical Coding Auditor & Trainer...Remote jobSeniorFull timePart timeWork at officeFlexible hours- ...of the Inspector General is seeking a Senior Auditor who will report to the Audit and Contract... ...and participate in audits, reviews, investigations, and management studies. Illustrative... ...and operational audits, assisting with forensic audits, reviewing work papers, and...SeniorContract workWork at office
- UnitedHealth Group seeks a Clinical Review Clinician to analyze itemized hospital bills and document adjustments for forensic reviews. Telecommute from anywhere in the U.S. The role requires clinical experience, RN or LPN license, and bill review knowledge. You will support...Remote job
$60.2k - $107.4k
...have the flexibility to work remotely as you take on some tough challenges... ...are met Collaborate with clinical coding consultant to apply... ...validity of aberrances (SIU only) Gather all relevant... ...articulate behavior through an Investigation Summary and compliance package...Remote workSeniorMinimum wageFull timeWork experience placementLocal area- Centene Corporation is seeking a clinical compliance investigations professional to lead enterprise-wide investigations for all business units and health... .... You will collaborate with Legal, People Relations, SIU, Privacy, Finance, and Operations to drive timely remediation...Remote jobSenior
- ...Senior Auditor Employment Type: Full Time, Mid-level CGS is seeking a Senior Auditor who will assist the district legal staff by conducting medical claims data analysis, forensic investigations, financial damages, statistical sampling, and ability-to-pay analyses...Remote workSeniorFull timeFlexible hours
- Revolutional is seeking a Senior Forensic Analyst to lead end-to-end forensic evaluations of federal systems suspected of compromise.... ...interface directly with the intelligence community to inform investigations. The role requires a TS clearance, 7+ years of digital...Remote jobSeniorLocal area
- ...Blue Cross NC is seeking a Special Investigations Unit (SIU) Manager of Audit/Clinical to lead a clinician and coder team dedicated to detecting and preventing... ...The position supports a Hybrid Flex workplace with remote leadership responsibilities and collaboration with...Remote workFlexible hours
$70.1k - $126.2k
...million members as a clinical professional on our Medical... ...the VP of Compliance Investigations this position assists... ...Investigations and/or senior management regarding... ...Legal, People Relations, SIU, Privacy, Finance, and... ...approach to work with remote, hybrid, field or...Remote workSeniorFull timePart timeWork at officeFlexible hours$107.9k - $172.64k
...Job Description Blue Cross NC is hiring a Special Investigations Unit (SIU) Manager of Audit/Clinical to lead a team of clinicians and coders focused on detecting... .... Provide engaging, effective leadership for a remote workforce, including coaching, feedback, and...Remote workWork at officeLocal areaFlexible hours2 days per week$25.6 - $42.67 per hour
...currently hiring a Fraud and Abuse Investigator/Certified Professional Coder (CPC) Remote!Status: Full-time, permanent... ...wellness programs, and integrated clinical and behavioral health services—all... ...Abuse, Program Integrity, FWA, PI, SIU, Special Investigations...Remote workPermanent employmentFull timeTemporary workLive inCurrently hiringShift work- ...time off Vision insurance We are seeking a Senior Forensic Accountant to support financial investigations involving fraud, money laundering, asset tracing,... ...subject of money laundering and fraud in federal benefit programs is a plus. This is a remote position....Remote workSenior
$75.35k - $98.89k
...Oscar. We're hiring a Senior Analyst, Special Investigations Unit Clinical Investigator to join our SIU. Oscar is the first... ..., using forensic clinical expertise to... ...Location: This is a remote position, open to candidates... ...Professional Medical Auditor (CPMA), Certified Fraud...Remote workFull timeWork at officeWork from homeFlexible hours3 days per week- Praescient Analytics is looking for a Senior Forensic Accountant to support complex financial investigations, particularly in identifying fraud and abuse in federal programs. The ideal candidate will have extensive experience in forensic accounting, with a strong focus...Remote jobSenior
- Arizona Supreme Court is seeking an Investigator and Compliance Auditor - Specialist V to manage complaints, conduct investigations, and perform audits of certified entities and licensed individuals. The role requires a bachelor’s degree and 3 years’ related experience,...Remote workSeniorTrial period
- ...Senior Forensic Accountant At Ardent, we hire people who want more than a job — they want to serve a mission... ...Forensic Accountant to join our team. This is a remote position supporting complex financial investigations, fraud analysis, and the tracing of illicit financial...Remote workSeniorWork at officeLocal areaFlexible hours
- Location: Remote (Occasional Travel May Be Required) Clearance: Ability to obtain and maintain a Public... ...Praescient Analytics is seeking an experienced Senior Forensic Accountant to support complex financial investigations involving fraud, waste, abuse, and mismanagement...Remote workSeniorWork at office
- ...SIU Clinical Healthcare Fraud Investigator III Lead complex investigations into suspected healthcare fraud, waste, and abuse. Independently manage investigations from intake through closure. Develop strategies and prepare evidentiary packages for referrals. Collaborate...
$58.4k - $107.74k
...Clinical Provider Auditor II - Payment Integrity SIU Location: This role enables associates to work virtually full-time, with the exception of required... ...related questions as necessary to aid in investigations and stays abreast of current medical coding and billing...Full timeTemporary workWork experience placementWork at officeLocal area1 day per week$150 per hour
...Principal Investigator (MD/DO) Hawthorne Health is seeking an experienced Principal Investigator... ...as a PI or Sub-I on sponsor-initiated clinical trials. This role will lead Respiratory... ...training and oversight. Conduct remote review of patient assessments, including...Remote workContract workPart timeFor contractorsLocal areaFlexible hours$55.9k - $123.5k
...This position is responsible for auditing clinical, billing, coding and lowest cost setting... ...of findings and consulting with special investigation and the affordability of care area as... ...Medical Coding Certification #LI-MW2 #LI-Remote Are you being referred to one of our roles...Remote workWork from home- A growing multi-site clinical research company is seeking a Principal Investigator to lead and coordinate clinical trial activities. The role includes ensuring the... ...plan. The position is full-time and offers a mid-senior level career path with various health benefits. #J...SeniorFull time
- Centene Corporation seeks a seasoned Compliance Investigations leader to guide an enterprise-wide program for investigations across business... ...reports, and collaborate with Legal, People Relations, SIU, Privacy, Finance, and Operations. The role requires strong regulatory...Remote jobSenior
- ...stakeholders that delivers on our promises. Position Summary:The SIU Investigator will conduct field as well as desk investigations of... ...Investigative Unit. Our Special Investigator will function as a remote investigator working from her/his residence and servicing the...Remote workFull timeWork experience placementWork at office
$60.2k - $107.4k
...Senior Investigator At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers... ...thorough case information in the Special Investigations Unit's (SIU's) case tracking system Collect and secure documentation...Remote workSeniorMinimum wageFull timeTemporary workWork experience placementLocal area
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