The SIU Investigator (Analyst) primary responsibility is to detect, investigate, and produce change ... Bachelor's degree in Criminal Justice or a related field, OR at least 3 years of insurance claims ...
The SIU Investigator (Analyst) primary responsibility is to detect, investigate, and produce change ... Bachelor's degree in Criminal Justice or a related field, OR at least 3 years of insurance claims ...
Knowledge of commercial insurance plans, Medicare, and Medicaid programs is essential. How You Will Make an Impact * Investigations and Audits : Conduct in-depth medical reviews through prepayment ...
Knowledge of commercial insurance plans, Medicare, and Medicaid programs is essential. How You Will Make an Impact * Investigations and Audits : Conduct in-depth medical reviews through prepayment ...
Remote Siu Insurance information
What is the difference between Remote Siu Insurance vs Remote Claims Adjuster?
| Aspect | Remote Siu Insurance | Remote Claims Adjuster |
|---|---|---|
| Certifications | Insurance licenses, SIU-specific training | Adjuster licenses, state-specific certifications |
| Work Environment | Insurance company, SIU department, remote | Insurance companies, third-party firms, remote |
| Industry Usage | Insurance industry, fraud investigation | Insurance industry, claims assessment |
| Job Focus | Investigating insurance fraud, SIU cases | Evaluating claims, determining payouts |
Remote Siu Insurance specialists focus on investigating insurance fraud cases remotely, requiring specific SIU training and licenses. Remote Claims Adjusters handle claims assessments and payouts, often with similar licensing. While both roles are remote and within the insurance industry, their core responsibilities differ: fraud investigation versus claims evaluation.
What are the key skills and qualifications needed to thrive as a Remote SIU (Special Investigations Unit) Insurance Investigator, and why are they important?
To thrive as a Remote SIU Insurance Investigator, you need a strong background in investigative techniques, insurance claims processes, and typically a relevant bachelor's degree or equivalent experience. Familiarity with case management software, fraud detection tools, and secure communication platforms is essential. Excellent analytical thinking, attention to detail, and strong written and verbal communication skills help you stand out in this role. These skills are crucial for accurately identifying and documenting fraudulent activity while maintaining compliance and protecting company assets.
What is a Remote SIU Insurance Investigator?
A Remote SIU (Special Investigations Unit) Insurance Investigator is a professional who works remotely to detect, investigate, and help prevent insurance fraud. They analyze claims for suspicious activity, gather evidence, interview claimants and witnesses, and work with law enforcement when necessary. Remote SIU investigators utilize digital tools and databases to conduct their investigations from home or another remote location instead of a traditional office. Their work is crucial for insurance companies to minimize fraudulent losses and ensure legitimate claims are processed correctly.
What are the typical challenges faced by Remote SIU Insurance Investigators, and how can they be addressed?
Remote SIU (Special Investigations Unit) Insurance Investigators often encounter challenges such as limited access to on-site evidence and coordinating effectively with field investigators or law enforcement. To overcome these, investigators leverage digital tools for secure document review, conduct interviews via video calls, and maintain thorough, organized records. Success also depends on strong communication skills and a disciplined approach to managing caseloads independently while collaborating closely with colleagues and external partners.
What are popular job titles related to Remote Siu Insurance jobs in Washington? For Remote Siu Insurance jobs in Washington, the most frequently searched job titles are:
- Seasonal No Experience Private Investigator
- Internship Siu Claims Investigator
- Background Investigation
- Entry Level Siu Claims Investigator
- Online Private Investigator
- Freelance Remote Siu Investigator
- Weekend Internet Investigator
- Remote Siu Investigator
- No Experience Insurance Investigator
- Remote Investigative
What job categories do people searching Remote Siu Insurance jobs in Washington look for? The top searched job categories for Remote Siu Insurance jobs in Washington are:
- No Experience Cargo Theft Investigator
- From Home Deviation Investigator
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- Overnight Geico Special Investigations Unit
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What cities in Washington are hiring for Remote Siu Insurance jobs? Cities in Washington with the most Remote Siu Insurance job openings:
SIU Healthcare Investigator (Full-time, Remote)
Alexandria, VA • On-site, Remote
Other
Posted 24 days ago
Job description
Job Summary
We are seeking a detail-oriented SIU Investigator to join our team. In this role, you will play a crucial role in ensuring the accuracy, compliance, and integrity of healthcare claims through comprehensive audits, analyses, and process improvements. The SIU Investigator (Analyst) primary responsibility is to detect, investigate, and produce change in aberrant behavior observed in our healthcare customer's claims and enrollment data. You will work both independently and with a team of clinical SMEs to analyze data, assess exposure, and manage investigative caseload from identification through to resolution including overpayment recovery, measuring behavior change and completing necessary reporting for FWA recoupments and savings.
Key Responsibilities
- Identify and conduct investigations into known or suspected FWA with high autonomy
- Develop documentation to substantiate findings, including formal reports, graphs, audit logs, and other supporting documentation.
- Perform root cause analysis to inform future algorithmic identification of similar claims or cases and associated savings (i.e., help move identified case types from "pay-and-chase" to preventive edits and pre-payment activity)
- Participate in the development and presentation of FWA-related education for assigned Customers
- Perform coding reviews for flagged claims, to support Coding team (if applicable).
Requirements
Qualifications
- Education:
- 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.
- Experience:
- Minimum of 2 years of experience in healthcare claims analysis, auditing, payment integrity, or a related field.
- 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
- Experience with commercial, Medicare, or Medicaid claims is highly preferred.
- Skills:
- Strong analytical and problem-solving skills, with attention to detail and accuracy.
- Excellent communication skills, both written and verbal, for effective collaboration with internal teams and external providers.
- Proficiency in Microsoft Office, particularly Excel, and familiarity with claims processing or audit software is a plus.
Preferred Qualifications
- Certifications: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML (Anti-Money Laundering) and Fraud Professional (CAFP), or similar desired.
- Additional Certifications: Certified Professional Coder (CPC) or similar desired.
About Integrity Management Services
Sourced by ZipRecruiter
Industry
Business management consulting
Company size
51 - 200 Employees
Headquarters location
Alexandria, VA, US
Year founded
2009