Top 60 Siu investigator Jobs in New York State

Senior Fraud Investigator-NYC (Hybrid)
1199SEIU Family of Funds —New York, NY
- $89,200 - $111,500 a year
- Full-time
- Microsoft Outlook
- HIPAA
- Office
SIU Investigator
Centene —New York, NY
- $56,200 - $101,000 a year
- Full-time
- Remote
- 5 years
- Fair chance
- Senior level
- Paid holidays
- Health insurance
Senior Investigator, Special Investigations Unit (Aetna SIU)
CVS Health —New York State
- $46,988 - $112,200 a year
- Full-time
- Remote
- Mid-level
- 3 years
- Analysis skills
- Health insurance
- Dental insurance
6d
Manager, Special Investigative Unit-NY (remote)
Molina Healthcare —New York, NY
- $73,102 - $171,058 a year
- Full-time
- Remote
- Analysis skills
- 1 year
- Senior level
- Health insurance
4d
Investigator, Special Investigations Unit (Aetna SIU)
CVS Health —Albany, NY
- $43,888 - $93,574 a year
- Full-time
- Microsoft Word
- Spanish
- Microsoft Excel
- Health insurance
- Dental insurance
6d
Manager, Sales Investigations
Centene —New York, NY
- $87,700 - $157,800 a year
- Full-time
- Remote
- High school diploma or GED
- Fair chance
- 1 year
- Paid holidays
- Health insurance
SIU, Investigator
Marshall Investigative Group —New York, NY
- $50,000 - $65,000 a year
- Weekends as needed
- Remote
- Microsoft Word
- Mid-level
- High school diploma or GED
- Travel reimbursement
- Mileage reimbursement
Quick Apply
1d
Investigator, Special Investigations Unit (Meritain Health)
CVS Health —Albany, NY
- $46,988 - $122,400 a year
- Full-time
- Customer service
- Research
- Mid-level
- Health insurance
- Dental insurance
5d
Surveillance and SIU Investigator
NWI Investigative Group, Inc. —New York, NY
- From $25 an hour
- Part-time
- Microsoft Word
- Clean driving record
- Research
- Profit sharing
- 401(k)
Quick Apply
SIU Investigator
VRC Investigations —Queens, NY
- $30 - $35 an hour
- Part-time
- Customer service
- 5 years
- Military
- Profit sharing
- Paid training
Quick Apply
SIU Claims Director
Plymouth Rock Assurance Corporation —Uniondale, NY
- $137,000 - $200,000 a year
- 5 years
- Office
- Analysis skills
- Paid holidays
- Disability insurance
Quick Apply
6d
SIU Claims Investigator
Lemieux & Associates LLC —Albany, NY
- $25 - $32 an hour
- Part-time
- Bilingual
- Microsoft Word
- Computer literacy
- Paid holidays
- Health insurance
Quick Apply
SIU - Experienced Field Investigator - Part-Time
Command Investigations, LLC —Flushing, NY
- $28 - $32 an hour
- Overtime
- Bilingual
- Microsoft Outlook
- Customer service
- Health insurance
- Dental insurance
Quick Apply
SIU Investigator - NY Labor Law
Allied Universal® Compliance and Investigations —Manhattan, NY
- $32 - $40 an hour
- Weekends as needed
- Spanish
- OSHA
- Military
- AD&D insurance
- Paid holidays
Quick Apply
5d
Private Investigator - Retired/Former Law Enforcement
Lemieux & Associates LLC —Queens, NY
- $25 - $32 an hour
- Part-time
- Bilingual
- Computer literacy
- Mid-level
- Mileage reimbursement
Quick Apply
New York, Hempstead SIU Investigator PT
Insight Service Group (ISG) —Hempstead, NY
- $20 - $27 an hour
- Part-time
- Mid-level
- Analysis skills
- Driver's License
Quick Apply
NYSIF Surveillance & SIU Investigator
Lemieux & Associates LLC —Queens, NY
- $25 - $35 an hour
- Weekends as needed
- Bilingual
- Writing skills
- Mid-level
Quick Apply
New York, Bronx SIU Investigator
Insight Service Group (ISG) —Bronx, NY
- $20 - $27 an hour
- Full-time
- Mid-level
- Analysis skills
- Driver's License
Quick Apply
New York, Albany SIU Investigator PT
Insight Service Group (ISG) —Albany, NY
- $20 - $27 an hour
- Part-time
- Mid-level
- Analysis skills
- Driver's License
Quick Apply
New York, Rochester SIU Investigator PT
Insight Service Group (ISG) —Rochester, NY
- $20 - $27 an hour
- Part-time
- Mid-level
- Analysis skills
- Driver's License
Quick Apply

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siu investigator jobs near new york state

Senior Fraud Investigator-NYC (Hybrid)

1199SEIU Family of Funds -
New York, NY

Apply Now

Job Details

Full-time
$89,200 - $111,500 a year

Qualifications

Healthcare financial misconduct investigations
Customer communication
Documentation review
Medical record review for billing accuracy
Documentation reviews

Full Job Description

Requisition #:

7462

# of openings:

Employment Type:

Full time

Position Status:

Agency Temp

Category:

Non-Bargaining

Workplace Arrangement:

Hybrid

Fund:

1199SEIU National Benefit Fund

Job Classification:

Exempt

Responsibilities

Conducts investigations into allegations of fraud, waste, or abuse, including preliminary assessments and full end-to-end case work.
Reviews and analyzes medical records, claims data, enrollment data, and other documentation to evaluate potential FWA.
Performs coding, billing, reimbursement, and medical necessity assessments based on CPT, HCPCS, ICD-9/10, DRG, and related coding guidelines.
Uses advanced data mining techniques to identify aberrant billing patterns, outliers, and other indicators of fraudulent activity.
Produces reliable, accurate and timely written investigative reports for internal and/external review detailing investigation findings, based on industry standard(s) and/or internal policy and procedure.
Recommends possible interventions for loss control and risk avoidance based on the outcome of the investigation.
Coordinates with various internal customers to gather documentation pertinent to investigations.
Incorporates communication skills to work with physicians, other health professionals, attorneys as well as external regulatory agencies and law enforcement personnel.
Communicate effectively and collaboratively with internal staff, leadership and external customers in a professional manner.
Conducts settlement negotiations with providers and/or attorneys.
Maintain the confidentiality required of the organization and the department.
Follow all Health Insurance Portability and Accountability Act (HIPAA) and Personal Health Information (PHI) requirements and regulations

Qualifications

Bachelor’s degree in business, criminal justice or related field.
Certified Professional Coder (CPC), Accredited Healthcare Fraud Investigator (AFHI), Certified Insurance Fraud Investigator (CIFI), and/or Certified Economic Crime Forensic Examiner (CECFE) preferred (but not required).
Minimum three (3) years’ experience with medical coding and medical record review performed required.
Minimum three (3) years’ experience in healthcare industry within a Special Investigation Unit (SIU) or equivalent governmental agency responsible for investigating healthcare fraud required.
Knowledge of medical coding and medical terminology.
Experience using STARSSolutions or other healthcare FWA case management and detection software preferred (but not required).
Proven track record in conducting investigations and/or the identification and pursuit of the recovery of overpayments.
Excellent report writing skills.
Knowledge of claims processing, reimbursement procedures, and a solid understanding of fraud detection and prevention practices.
Knowledge of data analysis of claims and documenting findings on spreadsheets.
Proficiency in Microsoft Office/Suite applications (Excel, Word, PowerPoint, Outlook, etc.).
Excellent interpersonal and communication skills – oral, written and listening.

This is a hybrid posiiton that will require you to report to our offices in Midtown Manhattan.

Apply Now

Refine Your Search

siu investigator jobs in new york state

Senior Fraud Investigator-NYC (Hybrid)

SIU Investigator

Senior Investigator, Special Investigations Unit (Aetna SIU)

Manager, Special Investigative Unit-NY (remote)

Investigator, Special Investigations Unit (Aetna SIU)

Manager, Sales Investigations

SIU, Investigator

Investigator, Special Investigations Unit (Meritain Health)

Surveillance and SIU Investigator

SIU Investigator

SIU Claims Director

SIU Claims Investigator

SIU - Experienced Field Investigator - Part-Time

SIU Investigator - NY Labor Law

Private Investigator - Retired/Former Law Enforcement

New York, Hempstead SIU Investigator PT

NYSIF Surveillance & SIU Investigator

New York, Bronx SIU Investigator

New York, Albany SIU Investigator PT

New York, Rochester SIU Investigator PT

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