Healthcare Fraud Investigator - SIU & Claims Recovery
Prudential Financial
Meritain Health, a CVS Health/Aetna subsidiary, is seeking a SIU Investigator to support the Network Cost Management team's Special Investigations Unit. You will conduct investigations to prevent fraud, recover funds, and ensure compliance with state regulations. Responsibilities include coordinating with law enforcement, reviewing insured and provider cases, documenting activities, and communicating findings. #J-18808-Ljbffr Prudential Financial
Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Healthcare Fraud Investigator - SIU & Claims Recovery in Hartford, CT vacancy
- CVS Health, Meritain Health’s SIU, seeks an Investigator to support the Network Cost Management team in pursuing fraud prevention and recovery across self-insured commercial plans. You... ...investigations of known or suspected healthcare fraud and abuse, coordinate with law...Suggested
$56.2k - $101k
...high preference on candidates residing within New York. Position Purpose Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential...ClaimsFull timePart timeWork at officeRemote workFlexible hours- CVS Health is seeking a skilled investigator to assess and enhance processes preventing fraudulent healthcare claims. The role involves case analysis, documentation, and collaboration... ...law enforcement to support prosecution of fraud and abuse, while presenting findings to...Claims
$46.99k - $122.4k
...commercial health plans. The SIU Investigator will support Meritain... ...investigation and prosecution of healthcare fraud and abuse, to recover lost... ...payment of fraudulent claims committed by insured's, providers... ..., etc. Facilitates the recovery of company and customer money...ClaimsHourly payFull timeTemporary workWork experience placementWork at officeLocal areaFlexible hours$46.99k - $112.2k
...seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU), Self‑Funded investigations... ...of suspect or fraudulent claims submitted by insureds, providers... ...timeframes. Facilitate the recovery of company and customer...ClaimsHourly payFull timeTemporary workWork experience placementLocal areaWork from home$43.89k - $102.08k
...thoroughness and accuracy of investigations aimed at preventing payment of fraudulent claims by insured individuals,... ...timeframe. Support the recovery of company funds lost due to fraud by providing insights and... ...the prosecution of healthcare fraud and abuse matters....ClaimsHourly payFull timeTemporary workLocal areaFlexible hours- ...Independently manage a caseload of PFML claims from intake through resolution Conduct thorough... ...internal resources such as peers, CRO, SIU and Team Leader Escalate complex or high... ...in insurance claims adjudication, healthcare, or a related field preferred THAA experience...ClaimsWork experience placement
- The Hispanic Alliance for Career Enhancement is seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit. This role involves managing complex investigations into suspected healthcare fraud, waste, and abuse while enabling remote...Remote jobWork at office
- Jobtailor seeks an experienced attorney to lead recovery and subrogation efforts in Connecticut. You will analyze complex claims, coordinate with underwriting, and manage outside counsel to optimize outcomes and mitigate loss exposure. The role requires strong negotiation...Claims
$23.16 - $35.88 per hour
A healthcare organization is seeking a Claims Analyst to review and process Stop Loss claims, managing client relationships and ensuring compliance with organizational standards. Candidates should have at least 5 years of relevant experience in health insurance claims,...ClaimsHourly pay$56.2k - $101k
Centene Corporation is seeking a qualified candidate for a remote role focused on investigating healthcare fraud. You will conduct thorough investigations into potential fraud, waste, and abuse, develop analytical reports, and work collaboratively with Health Plans. To...Remote job$72 - $100 per hour
...S. Powered by a passionate team of mental health advocates and healthcare veterans, Grow is looking for providers who want to build or expand... ...community. We handle credentialing, billing, and insurance claims so providers can enjoy the freedom of choosing when, where, and...ClaimsContract workPrivate practiceRemote workGrow Therapy
Hartford, CT2 days ago- AIG is seeking an experienced Senior Data/Business Analyst to lead global reporting for GI Claims Fraud and Recovery. You will transform data into dashboards and insights for leadership, working across regions and products. The role requires 6+ years in analytics or risk...Claims
- ...seeking skilled and experienced Field Investigators to join our team on an "as... ...investigate all types of insurance claims including workers' compensation, suspected fraud, liability and aimed at... ...and Special Investigations Unit (SIU) assignments, within an assigned...ClaimsFlexible hours
- ...holidays starting on day one Access $10K relocation assistance and claims-made malpractice with 100% tail coverage Community... ...epicenter catering to several large industries, including insurance, healthcare, and education Live in the heart of Connecticut and have...ClaimsFull timeH1bLive inImmediate startVisa sponsorshipRelocation packageMonday to FridayShift work
$101.7k - $155.9k
...delivering exceptional underwriting, claims, and risk management... ...Claims Specialist on the Healthcare team plays a critical role in... ...coverage, manage the claim investigation, evaluate the overall claim,... ...external stakeholders, and pursue recoveries and risk transfer where...ClaimsTemporary workMunich Reinsurance America, Inc.
Hartford, CT3 days ago$95.17k - $149.56k
...and generating high quality recoverable claims for the benefit of the company, for all... ...outside of the concept where additional recoveries may be available, such as re-admissions,... ...improving lives and communities – and making healthcare simpler. We are a Fortune 25 company...ClaimsFull timeTemporary workWork experience placementLocal area1 day per weekElevance Health
Hartford, CT2 days ago- Follow operational policies to analyze, investigate, and resolve BSI recovery claims of varying levels of severity with moderate supervision from claims management. Prepare and present reports for management that accurately reflect loss development, potential/actual financial...ClaimsWork at office
- ...where every moment matters. Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what... ...of third-party payers, resolving outstanding insurance claims across all Hartford HealthCare hospitals, medical group and homecare...ClaimsFor contractorsWork at office
Hartford Healthcare
Hartford, CT2 days ago $26 per hour
Position: Pharmacy Claims Adjudication Specialist Location: Hartford, CT Job Id: 5254 # of Openings: 1 We are seeking a Pharmacy... ...pharmacy operations. Practices first call resolution to help healthcare providers and patients with their pharmacy needs, answering questions...ClaimsFull timeTemporary workWork experience placementRemote workRelocation packageFlexible hoursShift work$24 per hour
...The Benefit Verification Specialist will investigate, review, and load accurate patient... ...assign coordination of benefits, run test claims to obtain a valid insurance response on... ...benefits, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy...ClaimsFull timeTemporary workWork experience placementRemote workRelocation packageMonday to FridayFlexible hoursShift work- J T Becker & Co Inc is seeking skilled and experienced Field Investigators to join our team on an "as needed" basis. This role offers flexible... ...surveillance and special investigations for various insurance claims. The ideal candidate must have a private investigator license,...Flexible hours
- J T Becker & Co Inc in Connecticut is seeking skilled Field Investigators for flexible, on-demand work. Ideal candidates will conduct investigations including surveillance and SIU tasks, ensuring confidentiality and meeting deadlines. The role requires a valid driver's...Flexible hours
- ...profile Hartford, CT - Remote Required Skillset: Primary: Synon, RPG LE, AS400 Secondary: Rx Claims / Healthcare domain Experience Range Preferred: 8-15+ years Familiarity with onsite/offshore delivery models...ClaimsRemote work
Apolis
Hartford, CT2 days ago - A leading healthcare services firm is seeking an experienced Inpatient Medical Coding Auditor to extract clinical information and assign medical codes for inpatient hospital claims. This remote role involves reviewing claims for reimbursement accuracy and handling provider...ClaimsRemote work
Humana
Hartford, CT2 days ago - ...boards, Metropolis offers a confidential experience for both the healthcare facilities and the candidatesMetropolis does not allow... ...operates off sincerity and integrity; job postings will never claim a job is located in the city when it is actually over an hour away...ClaimsPermanent employment
Confidential
Hartford, CT2 days ago $68.2k - $102.3k
Senior Manager, Claims Services Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual... ...within a high-volume claims, data operations, insurance, or healthcare environment. Bachelor’s degree with 5‑7 years of relevant...ClaimsWork at officeLocal area- A renowned claims adjusting firm in Hartford, Connecticut is seeking Independent Insurance Claims Adjusters. This rewarding career allows you to assist clients in recovery after disasters, with roles available for both seasoned adjusters and newcomers. The firm provides...ClaimsFlexible hours
- ...for global reporting, analysis, and data management for GI Claims Fraud and Recovery Deliver monthly and quarterly results at a Global/... ...Qualifications 6+ years in Business Analysis, Risk, Fraud (investigative services) and/or Claims Recovery Bachelor’s degree in computer...Claims
$64.97k - $99k
...our team as a Property Field Inspection Claim Specialist and showcase your expertise in... ...to support the claims handling process Investigate and adjust both personal and commercial... ...programs. State Farm pays most of your healthcare premium, and we offer multiple healthcare...ClaimsWork experience placementWork at officeLocal areaRemote workWork from homeFlexible hours
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Healthcare Fraud Investigator - SIU & Claims Recovery. Be the first to apply!
Related searches
- fraud manager Hartford, CT
- fraud prevention Hartford, CT
- medical claims auditor Hartford, CT
- claims attorney Hartford, CT
- claims counsel Hartford, CT
- healthcare internship Hartford, CT
- business analyst healthcare Hartford, CT
- healthcare call center Hartford, CT
- lpn health care Hartford, CT
- healthcare temporary Hartford, CT