Remote SIU Lead Investigator (Healthcare Fraud)
Optum
Optum is seeking an SIU Lead Investigator to drive investigations into healthcare fraud, abuse, and related conduct. You will triage, document findings, and report illegal activities while maintaining compliance with laws and policies. You will work remotely from anywhere in the U.S., collaborating with legal, compliance and external partners to develop cases, present findings, and mentor junior staff. Strong CPT knowledge and advanced Excel/Word skills are required. #J-18808-Ljbffr
- ...CareSource seeks an experienced SIU III to investigate high-complexity healthcare fraud, waste, and abuse. The role analyzes provider billing data, identifies patterns, and develops actionable investigation outcomes. You will coordinate audits, advise on corrective actions...Fraud
- ...A healthcare company in New York is seeking a Fraud Investigator to conduct in-depth investigations of reported fraud. Responsibilities include mentoring other investigators, investigating Medicaid fraud cases, and maintaining relationships with law enforcement. Candidates...Fraud
- ...Description Description Healthcare Fraud Shield, a leader in... ...Clinical Coder/Fraud Investigator to join our team. Key... ...Work with SIU Team (Clinical Reviewers... ...Perform data analysis and lead generation/data mining... ...development initiatives ~ Remote work eligible...Remote workFraudFlexible hours
- ...EMC Insurance Companies seeks a Senior SIU Investigator to examine complex referrals, review related... ...and qualifications. The position supports remote work from anywhere in the United States and offers comprehensive anti-fraud initiatives and training. #J-18808-Ljbffr...Remote workFraud
- ...VRC Investigations in Phoenix, AZ is seeking experienced SIU investigators for part-time (and full-time hourly) roles. This hybrid position requires travel within... ...joining a team of professionals to deter insurance fraud. You will conduct multi-line investigations,...Remote workFraudHourly payFull timePart timeWork from home
- ...To manage comprehensive fraud, waste, and abuse investigations, the full-time remote CPC Certified Senior SIU Investigator will develop investigative strategies, analyze data... ...in fraud investigations or related healthcare insurance roles Bachelor's degree or a combination...Remote workFraudFull timeWork experience placement
- ...Experienced in auto claims investigations, the full-time Florida Licensed SIU Investigator will lead comprehensive SIU investigations... ...complex auto claims, identify fraud networks, and collaborate with... ...science teams, all while working remotely. Key responsibilities Lead...Remote workFraudFull time
$30 - $35 per hour
...VRC Investigations in Nashville, TN is seeking experienced, self-determined SIU investigators for part-time and full-time hourly roles. This hybrid position requires travel... ...include investigating multi-line insurance fraud, interviewing insureds and witnesses, documenting...Remote workFraudBi-weekly payHourly payFull timePart time- ...Healthcare Fraud Shield is seeking a CPC-certified Medical Coding Specialist to join our SIU team. You will review medical records, abstract CPT/HCPCS/Revenue Codes, DRG and ICD... ...provide subject matter expertise for clients. Remote work eligible; 401(k), generous PTO, and...Remote workFraud
- ...Kemper is seeking a remote SIU Investigator to conduct field and desk investigations of insurance claims referred to the Special Investigative... ...include training, documenting actions, diary system, state fraud reports, coordinating with agencies, and reporting findings...Remote workFraudWork from home
- ...Conduct complex, in-depth investigations of reported fraud involving the full range of healthcare products. Develop and maintain relationships... ...to the Fraud Investigators on SIU investigations and issues.... ...healthcare product. Develop leads from various sources to review...Remote workFraudWork experience placement
- ...team has an opportunity for a SIU Investigator . The Special Investigator... ...agencies to prevent and deter fraud. What You’ll Do Conduct timely... ...Ability to work independently and lead others Maintains highest... ...This position is open to U.S. remote work. However, team members...Remote workFraudWork at office3 days per week
$22 - $28 per hour
...or an alternative application process. SIU Investigator Part Time Technical Saint Paul, MN, US Salary... ..., Net-Sweep Investigations, Remote Controlled Surveillance, and more, we’re... ...our clients time and money on insurance fraud cases. Advantage Investigations is seeking...Remote workFraudBi-weekly payHourly payPart timeWork at officeFlexible hours- ...Molina Healthcare Inc. is seeking an experienced professional to support the Special Investigation Unit (SIU) activities focused on medical provider CPT coding fraud, waste and abuse. You will investigate post-payment claims against records and summarize findings for...Fraud
$56.2k - $101k
...laboratory, etc. Provides investigative support to the Special Investigations Unit (SIU) related to coding and... ...suspected health care fraud and abuse. Position... ...Key Details : This is a remote position. Candidates must... ...skills while making healthcare more accessible and effective...Remote workFraudFull timePart timeWork at officeFlexible hours- UnitedHealth Group is seeking a Senior Investigator in Virginia, with remote work options and 25% travel to client... ...gathering and analysis to identify fraud and waste in health care, maintaining... ...ideal candidate brings 5+ years in FWA/SIU, familiarity with health insurance...Remote jobFraud
- ..., Veterans and Diverse Job Seekers seeks a SIU Investigator to conduct field and desk investigations of insurance claims from a remote home office, servicing Los Angeles, CA and... ...coordinating with NICB, the Department of Insurance Fraud Division, and law enforcement....Remote jobFraudHome office
- ...Selective Investigations Inc. is seeking a Hybrid SIU Field Investigator to conduct desktop and local field investigations across Dade and Broward Counties... ..., cell phone, and high-speed internet, with 60% remote/desktop work and 40% on-site investigations. #J-18808-...Remote workFraudLocal area
$72.04k - $94.55k
...re hiring a Senior Analyst, SIU Investigator to join our SIU team. Oscar... ...process improvements for Fraud Waste and Abuse (FWA) recoupments... ...Work Location: This is a remote position, open to candidates... ...Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI),...Remote workFraudFull timeWork from homeHome office- ...Premera Blue Cross is hiring an Investigator III in our Hybrid SIU team. You will lead medium to high complexity fraud cases from start to finish, analyze claims data, and... ...law enforcement as needed. The role requires healthcare fraud investigation experience, strong writing...Fraud
- The SIU Investigator will conduct field as well as desk investigations of insurance claims referred... ...Special Investigator will function as a remote investigator working from her/his... ...SIU contacts, the Department of Insurance Fraud Division, NICB, and various law enforcement...Remote workFraudWork experience placementWork at office
- Molina Healthcare is seeking a dedicated investigator to support the Special Investigations Unit (SIU) with medical coding fraud, waste and abuse reviews. You will analyze CPT coding, review post-payment claims, and prepare case materials for potential law enforcement action...Fraud
$25 - $50 per hour
...strategy & scheduling Paid travel for field investigations when required Job Summary The SIU Investigator conducts field and remote investigations involving insurance claims. This... ...principles, compensability analysis, fraud indicators, and investigative documentation....Remote workFraudHourly payPart timeWork at officeHome officeFlexible hoursAfternoon shift- ...Tuition assistance Job Summary: The SIU Field Investigator is responsible for investigating the facts surrounding insurance fraud claims across Dade and Broward Counties... ...role split consists of approximately 60% remote/desktop investigations and 40% local field...Remote workFraudLocal areaFlexible hoursAfternoon shift
- ...Peraton’s SafeGuard Services (SGS) is seeking a Fraud Investigator to conduct complex investigations into medical professional services, develop cases for potential referrals, and coordinate with law enforcement and other agencies. The role requires independent judgment...Remote workFraud
- ...Peraton seeks a Fraud Investigator for SafeGuard Services to conduct complex investigations of medical providers and develop actionable cases for law enforcement referrals and overpayment recovery. The role requires strong investigative, communication, and organizational...Remote workFraud
- ...reviews of medical records and claims, the full-time remote Behavioral Health Investigator (MO Licensed) will support the Special Investigations... ...by identifying potential overpayments and suspected healthcare fraud while ensuring compliance with coding and billing regulations...Remote workFraudFull time
$84.63k - $112.84k
...seeking an experienced Corporate Investigator to join our Ethics &... ...team. In this role, you will lead complex internal investigations... ...relations, ethics & compliance, fraud, business integrity, or related... ...working effectively in a remote or distributed work environment...Remote workFraudTemporary work- ...Providing investigative support for special investigation unit activities, the full-time Healthcare Fraud Investigator will focus on the prevention... ...and abuse, while working remotely. Key responsibilities Conducts... ...data analysis Develops leads and produces audit reports...Remote workFraudFull time
- ...Highmark Inc. seeks an investigations professional to develop and maintain an anti-fraud program, conduct field investigations, and coordinate with law enforcement to recover misappropriated funds. The role conducts interviews with providers and members, prepares cases...Fraud
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