Top 49 Investigations Jobs in Pinellas County Fl

Special Investigation Unit (SIU) Lead/Investigator (Medicare Advantage Plan)
Ultimate Health Plans —Tampa, FL
- From $75,000 a year
- Full-time
- Anatomy knowledge
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
Entry Level Background Investigator (On Site)
CACI —Tampa, FL
- $26.07 an hour
- Part-time
- Writing skills
- English
- Office
- Health insurance
MEDICAL MALPRACTICE INVESTIGATOR - 64085699
The State of Florida —Saint Petersburg, FL
- $42,561.57 - $43,561.57 a year
- Multiple hires
- Background check
- Microsoft Outlook
- Writing skills
- Paid holidays
- Dental insurance
6d
Code Compliance Supervisor
City of Clearwater —Clearwater, FL
- $71,912 - $75,507 a year
- Full-time
- Computer literacy
- Writing skills
- Mid-level
- Paid holidays
- Health insurance
Private Investigator / SIU Fraud Investigator
Selective Investigations Inc. —Tampa, FL
- $22 - $32 an hour
- Weekends as needed
- Spanish
- Computer literacy
- Reliable transportation
- Profit sharing
- Health insurance
Quick Apply
10d
ADULT PROTECTIVE INVESTIGATOR - 60021061
The State of Florida —Largo, FL
- $37,000.08 a year
- Background check
- Customer service
- Military
- Opportunities for advancement
INVESTIGATION SPECIALIST II - 41000271 1
The State of Florida —Tampa, FL
- $48,000 a year
- Extended hours
- Mid-level
- Microsoft Office
- Finance
- Paid holidays
- Dental insurance
3d
Junior Compliance Officer - Southeast: Charlotte, Atlanta, Tampa, Miami
LIS Solutions —Tampa, FL
- Full-time
- US work authorization
- In-person
- Communication skills
Director of Compliance
Johns Hopkins All Children's Hospital —Saint Petersburg, FL
- Full-time
- Master's degree
- Bachelor's degree
- Children
SIU Desk Investigator - Tampa
AssuranceAmerica —Tampa, FL
- Full-time
- Customer service
- Mid-level
- Office
SVP, Investigations and Recovery
Bank OZK —Clearwater, FL
- Extended hours
- Microsoft Excel
- Microsoft Outlook
- Writing skills
- Dental insurance
- Paid time off
Safety and Compliance Officer - Engineering
University of South Florida —Tampa, FL
- Full-time
- Mid-level
- Master's degree
- University
- Health insurance
- Dental insurance
21h
Junior Compliance Officer/Auditor
SGI Global, LLC —Tampa, FL
- 8 hour shift
- Bachelor of Science
- Research
- Finance
Quick Apply
ASST INVESTIGATION MANAGER - SES - 64085703
The State of Florida —Tampa, FL
- $65,000 a year
- Background check
- Microsoft Outlook
- Writing skills
- Paid holidays
- Dental insurance
11d
Junior Compliance Officer (Operations, Junior Analyst)
The MIL Corporation —Tampa, FL
- $35,000 - $48,000 a year
- Overtime
- Bachelor of Science
- Research
- Finance
- Health insurance
- Tuition reimbursement
Part Time SIU Investigator
The Robison Group —Tampa, FL
- $30 - $35 an hour
- Part-time
- Background check
- 5 years
- Computer literacy
Quick Apply
Skip Trace Investigator
Provest LLC —Tampa, FL
- $20 an hour
- Extended hours
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
- Paid training
- On-the-job training
12d
Corporate Protection Officer, Corporate Security and Investigations (Armed Security Position) - Part-Time
Raymond James Financial, Inc. —Saint Petersburg, FL
- Part-time
- CPR Certification
- BLS Certification
- Mid-level
- Paid holidays
- Health insurance
5d
Manager, Governance, Risk & Compliance
Vocate Education Solutions —Tampa, FL
- $150,000 - $250,000 a year
- Weekends as needed
- 18 years or older
- Computer Science
- Office
- Health savings account
- Disability insurance
Quick Apply
7d
HSQE Compliance Officer – Health & Safety
OSG Ship Management —Tampa, FL
- Weekends as needed
- Bachelor's degree
- Driving
- Organizational skills
Quick Apply

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investigations jobs near pinellas county fl

Special Investigation Unit (SIU) Lead/Investigator (Medicare Advantage Plan)

Ultimate Health Plans -
Tampa, FL

Quick Apply

Job Details

Full-time
From $75,000 a year

Benefits

Health insurance
Dental insurance
401(k)
Vision insurance
401(k) matching

Qualifications

Healthcare financial misconduct investigations
Customer communication
Anatomy knowledge
Microsoft Excel
Investigations regulatory compliance
Microsoft Outlook
Medicare
Managed care
Customer service
Managed care organization experience
Writing skills
Health insurance policy knowledge
Presentations for conferences or internal meetings
Investigative data analysis
Driver's License
Insurance regulation
Healthcare regulatory compliance research
Medicare regulations
Risk management
SharePoint
Medicaid regulations
Medicaid
Healthcare claims compliance audits
Research findings presentation
Medical terminology
Professional development training

Full Job Description

Company Overview

CSTS Customer Service and Technology Solutions LLC is a dedicated third-party administrator specializing in managing the administrative and operational functions for insurance plans. Our mission is to revolutionize the healthcare experience by delivering exceptional products and services to our partners, ensuring compliance and efficiency at every step.

Position Overview

CSTS is seeking an experienced and highly The SIU Lead/Investigator is responsible for supporting the prevention, detection, investigation, reporting (when appropriate), and recovery of money related to health care Fraud, Waste, and Abuse (FWA). The SIU Lead is accountable for managing the day-to-day SIU activities. This position will ensure compliance with federal and state guidance related to FWA, and for reviewing and analyzing information to draw conclusions on allegations of FWA and/or may determine appropriateness of care.

Job Duties

Responsible for developing leads presented to the SIU to assess and determine whether potential FWA is corroborated by evidence.
Claims review for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims.
Lead investigation caseloads, document all case files appropriately to meet regulatory guidelines. Completing investigations within the mandated period of time required by state and/or federal contracts and/or regulations.
Communicate orally and in writing with all customers, internal and external, regarding findings.
Prepare reports to document findings and maintain up-to-date case files for management review.
Collaborate with other departments within UHP and outside vendors to ensure the success of the UHP SIU program.
Provide inter-departmental input regarding controls for preventing and monitoring FWA issues.
Develop strategies to create and maintain a FWA Unit that has the flexibility, knowledge, situational awareness, and capacity to successfully address the dynamic FWA environment.
Provide recommendations or intervention strategies to correct and/or prevent abusive practices, including proposals to recover inappropriately paid monies or to suspend or terminate program participation.
Lead the development and delivery of educational awareness and training programs for the organization and providers.
Maintain outcome-focused SIU Policies & Procedures that are consistent with all applicable contractual and regulatory requirements.
Develop and maintain a high degree of rapport and cooperation with the Federal, State, and local law enforcement and regulatory agencies which can assist in investigative efforts.
Prepares appropriate FWA referrals to regulatory agencies and law enforcement.
Present provider review findings to internal and external entities as requested.
Other duties as assigned

Job Qualifications

Required Education

Bachelor’s degree or associate degree, in criminal justice or equivalent combination of education and experience.

Required Experience/Knowledge, Skills & Abilities

1-3 years of Medicare managed care compliance and/or investigation experience, unless otherwise required by state contract.
Proven investigatory skill; ability to organize, analyze, and effectively determine risk with corresponding solutions; ability to remain objective and separate facts from opinions.
Knowledge of Managed Care and the Medicaid and Medicare programs.
Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems.
Understanding of datamining and use of data analytics to detect fraud, waste, and abuse.
Proven ability to research and interpret regulatory requirements.
Effective interpersonal skills and customer service focus; ability to interact with individuals at all levels.
Excellent oral and written communication skills; presentation skills with ability to create and deliver training, informational and other types of programs.
Excellent skills in Microsoft Office (Word, Excel, PowerPoint, Outlook), SharePoint and Intra/Internet as well as proficiency with incorporating/merging documents from various applications.
Strong logical, analytical, critical thinking and problem-solving skills.
Initiative, excellent follow-through, persistence in locating and securing needed information.
Fundamental understanding of audits and corrective actions.
Detail-oriented, self-motivated, able to meet tight deadlines.
Ability to develop realistic, motivating goals and objectives, track progress and adapt to changing priorities.
Collaborative and team-oriented

Required License, Certification, Association:

Valid driver’s license required.

Preferred Experience:

At least 5 years of experience in FWA and/or compliance in Medicare managed care organizations is required.

Preferred License, Certification, Association:

Health Care Anti-Fraud Associate (HCAFA)
Accredited Health Care Fraud Investigator (AHFI)
Certified Fraud Examiner (CFE)

CSTS is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Pay: From $75,000.00 per year

Benefits:

401(k)
401(k) matching
Dental insurance
Health insurance
Vision insurance

Application Question(s):

How many years of Medicare Advantage experience do you have?
Can you describe your experience with Medicare or Medicaid fraud and waste investigations?
How do you prioritize and manage your workload when dealing with multiple fraud cases at once?

Work Location: In person

Quick Apply

Refine Your Search

investigations jobs in pinellas county fl

Special Investigation Unit (SIU) Lead/Investigator (Medicare Advantage Plan)

Entry Level Background Investigator (On Site)

MEDICAL MALPRACTICE INVESTIGATOR - 64085699

Code Compliance Supervisor

Private Investigator / SIU Fraud Investigator

ADULT PROTECTIVE INVESTIGATOR - 60021061

INVESTIGATION SPECIALIST II - 41000271 1

Junior Compliance Officer - Southeast: Charlotte, Atlanta, Tampa, Miami

Director of Compliance

SIU Desk Investigator - Tampa

SVP, Investigations and Recovery

Safety and Compliance Officer - Engineering

Junior Compliance Officer/Auditor

ASST INVESTIGATION MANAGER - SES - 64085703

Junior Compliance Officer (Operations, Junior Analyst)

Part Time SIU Investigator

Skip Trace Investigator

Corporate Protection Officer, Corporate Security and Investigations (Armed Security Position) - Part-Time

Manager, Governance, Risk & Compliance

HSQE Compliance Officer – Health & Safety

I want to receive the latest job alert for investigations in pinellas county fl

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