SIU Investigator, Senior Analyst
5 days ago
The SIU Investigator, Senior Analyst will be responsible for investigating changes in aberrant behavior observed in claims and enrollment data. This individual will work independently to analyze data, manage investigative caseload, and resolve cases through overpayment recovery, measuring behavior change, and completing necessary reporting to meet monetary and case load targets.
Key Responsibilities- Investigate claims and enrollment data to identify aberrant behavior
- Develop documentation to substantiate findings, including formal reports, graphs, audit logs, and other supporting documentation
- Meet targets through investigations and internal process improvements for FWA recoupments and savings
- Perform root cause analysis to inform future algorithmic identification of similar claims or cases and associated savings
- Participate in the development and presentation of FWA-related education for Oscar teams
- Perform coding reviews for flagged claims to support Coding team
- Bachelor's degree in Criminal Justice or a related field, or at least 3 years of insurance claims investigation experience or professional investigation experience with law enforcement agencies
- Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity
- Experience handling confidential information and following policies, rules, and regulations
- Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML and Fraud Professional (CAFP), or similar
- Certified Professional Coder (CPC) or similar
- Experience working in health insurance across several products specifically with claims processing, billing, reimbursement, or provider contracting
- Experience with HIPAA, data privacy, and/or data security processes
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SIU Investigator
6 days ago
New York, New York, United States Argo Group Full timeAbout the RoleArgo Group is a leading specialty insurance company that values innovation, respect, equality, wellness, and opportunity. We're seeking a highly skilled SIU Investigator to join our team and work from our New York, Chicago, Omaha, Richmond (VA), Rockwood (PA), or San Antonio office.Key ResponsibilitiesInvestigation and Analysis: Conduct...
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Investigator, SIU
16 hours ago
New York, New York, United States Molina Healthcare Full timeJob SummaryThe Special Investigations Unit (SIU) Investigator plays a critical role in supporting the prevention, detection, investigation, and reporting of healthcare fraud, waste, and abuse. This position is responsible for conducting thorough medical review audits, coding and billing reviews, and analyzing information to draw conclusions on allegations of...
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Insurance Fraud Investigator
7 days ago
New York, New York, United States Argonaut Management Services, Inc Full timeAbout the RoleWe are seeking a highly skilled and experienced SIU Investigator to join our team at Argo Group. As an SIU Investigator, you will play a critical role in identifying, investigating, and deterring instances of fraud in both claims and underwriting for a multi-line, commercial carrier.Key ResponsibilitiesInvestigation and Analysis: Conduct...
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Director, SIU
1 week ago
New York, New York, United States Centene Full timeSenior Investigator - Waste, Abuse and FraudAs a Senior Investigator at Centene, you will play a critical role in ensuring the integrity of our healthcare services and protecting our members from waste, abuse, and fraud.Key Responsibilities:Lead a team of investigators in conducting thorough and timely reviews of audit results, identifying areas of risk and...
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Senior Investigative Analyst, Enforcement
2 weeks ago
New York, New York, United States Financial Industry Regulatory Authority , Inc. Full timeThe Financial Industry Regulatory Authority, Inc. (FINRA) is dedicated to upholding the integrity of the securities industry through rigorous enforcement of rules and regulations. The Senior Investigative Analyst plays a pivotal role in examining potential violations of FINRA Rules and securities laws, contributing to the establishment of thorough and...
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Claims Investigation Expert
6 days ago
New York, New York, United States Argo Group International Holdings, Ltd. Full time**About Argo Group International Holdings, Ltd.**We are a leading provider of specialty insurance solutions, renowned for our commitment to respect, equality, wellness, and opportunity. Our organization is agile and innovative, making a significant impact in the industry.**Job Summary**We are seeking a skilled SIU Investigator to join our team. As a Claims,...
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Fraud Investigation Specialist
1 week ago
New York, New York, United States Lemonade Full timeAbout the Role We are in search of a dedicated and analytical SIU Investigator who possesses a keen eye for detail and a strong commitment to uncovering the truth. This role is essential in ensuring the integrity of our claims process and protecting our customers. Key Responsibilities Conduct thorough investigations into suspicious claims, utilizing...
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Special Investigations Unit Professional
7 days ago
New York, New York, United States Argo Group International Holdings, Ltd. Full time**About Argo Group International Holdings, Ltd.**We are a leading provider of specialty insurance solutions, renowned for our vibrant culture built on respect, equality, wellness, and opportunity.**Our Culture**We are an innovative organization that balances agility with the ability to make a significant impact in our industry.We offer a flexible work...
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Surveillance Investigator for NYSIF in Manhattan
2 weeks ago
New York, New York, United States Lemieux & Associates Full timeWE OFFER A $500 SIGN ON BONUS Join Lemieux & Associates, a prominent name in the investigative sector, as we seek skilled Field Investigators in the Manhattan area. This is a full-time opportunity tailored for the right candidate. Our leadership comprises seasoned field investigators, each boasting over 25 years of expertise. We pride ourselves on our...
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Fraud Investigation Specialist
1 week ago
New York, New York, United States Lemonade Full timeAbout the Role We are seeking a dedicated and analytical SIU Investigator to join our innovative team. This role is essential in ensuring the integrity of our claims process and protecting our customers from fraudulent activities. Key Responsibilities Conduct thorough investigations into suspicious claims, utilizing various resources and...
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Medical Coding Auditor, SIU
2 days ago
New York, New York, United States Oscar Health Full timeAbout the RoleOscar Health is seeking a highly skilled Medical Coding Auditor, SIU to join our team. As a key member of our Special Investigations Unit (SIU), you will play a critical role in identifying and preventing healthcare fraud, waste, and abuse.Key ResponsibilitiesDevelop and maintain expertise on CPT, HCPCS, and ICD-10 coding guidelines and other...
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Medical Coding Auditor, SIU
6 days ago
New York, New York, United States Oscar Health Full timeAbout the RoleOscar Health is seeking a highly skilled Medical Coding Auditor, SIU to join our team. As a key member of our Special Investigations Unit (SIU), you will play a critical role in identifying and preventing healthcare fraud, waste, and abuse (FWA) across our operations.Key ResponsibilitiesDevelop and Maintain Coding Expertise: Stay up-to-date on...
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Lead Investigative Analyst
1 week ago
New York, New York, United States Nardello Full timePosition OverviewSalary: $90,000-$115,000 plus bonus & benefitsPOSITION SUMMARY:The Lead Investigative Analyst plays a crucial role in the firm's investigative efforts, focusing on areas such as due diligence, litigation support, asset tracing, and internal inquiries. This role requires a thorough understanding of open-source intelligence and modern...
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Junior Investigative Research Analyst
2 weeks ago
New York, New York, United States City of New York Full timeCompany OverviewPosition Overview The City of New York's Department of Investigation (DOI) stands as one of the nation's oldest law enforcement entities, dedicated to the fight against municipal corruption. This agency operates as an independent and impartial overseer of New York City's government, its agencies, employees, vendors engaged in City contracts,...
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Senior Fraud Investigator
6 days ago
New York, New York, United States City of New York Full timeJob SummaryWe are seeking a highly skilled Senior Fraud Investigator to join our team at the City of New York. As a Senior Fraud Investigator, you will be responsible for conducting thorough investigations into fraudulent activities and ensuring that those responsible are held accountable.Key ResponsibilitiesConduct investigations into claims and collections...
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Investigative Analyst
5 days ago
New York, New York, United States City of New York Full timeAbout the RoleWe are seeking a highly skilled Investigative Analyst to join our Hate Crimes Unit in the Trial Division. As an Investigative Analyst, you will provide analytical investigative support to the Chief and Deputy Chief of the Unit, Investigators, and Assistant District Attorneys (ADAs) prosecuting hate crimes in Manhattan.Key ResponsibilitiesAssist...
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Senior Grants Analyst
2 months ago
New York, New York, United States The Rockefeller University Full timeOrganization OverviewThe Finance Department of the University encompasses the Controller's Office and the Office of Budget,Treasury,and Research Administration. These offices are dedicated to ensuring the integrity of data submitted,recorded,and reported and to providing the highest level of financial services in support of the University's mission in...
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Investigator - International Investigations
7 days ago
New York, New York, United States United Nations Full timeJob SummaryThis is a challenging and rewarding opportunity to join the United Nations as an Investigator in the Operational Standards and Support Section (OSSS) at the Investigations Division (ID). The successful candidate will be responsible for conducting investigations, gathering evidence, and analyzing data to inform policy decisions.Key...
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New York, New York, United States Apex Systems Full timeAbout the RoleWe are seeking a highly skilled and experienced professional to join our team as a Senior Manager, Employee Relations and Investigations. This role is a critical part of our Human Resources function and will play a key role in ensuring a positive and respectful work environment for all employees.Key ResponsibilitiesInvestigate and resolve...
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Senior Associate
1 week ago
New York, New York, United States K2 Integrity Full timeJob DescriptionK2 Integrity is seeking a skilled professional to join our Investigations and Disputes practice in the United States. Our team conducts thorough investigations to uncover critical information, enabling our clients to make informed decisions, maximize opportunities, reduce risks, and protect their integrity, personnel, and assets.As an...