Skilled in identifying potential fraud, waste, and abuse indicators through detailed record review ... SIU (Special Investigations Unit) operations - Knowledge Requirements * Medical terminology ...
Skilled in identifying potential fraud, waste, and abuse indicators through detailed record review ... SIU (Special Investigations Unit) operations - Knowledge Requirements * Medical terminology ...
... nature and valued in the multi-million dollar range. Insurance litigation and coverage ... SIU resources for further investigation. * Achieves quality standards by appropriately managing ...
... nature and valued in the multi-million dollar range. Insurance litigation and coverage ... SIU resources for further investigation. * Achieves quality standards by appropriately managing ...
Sr Field Adjuster
Fredericksburg, VA · On-site
$67K - $90K/yr
IN THIS ROLE, YOU WILL: * Independently manage field property claims, including those requiring ... SIU) as needed. Maintain awareness of fraud indicators and regulatory reporting obligations.
Sr Field Adjuster
Fredericksburg, VA · On-site
$67K - $90K/yr
IN THIS ROLE, YOU WILL: * Independently manage field property claims, including those requiring ... SIU) as needed. Maintain awareness of fraud indicators and regulatory reporting obligations.
Surveillance Investigator
$22 - $27/hr
... in our efforts to deter and combat insurance fraud. The surveillance investigator position is a ... Opportunities for advancement include Management, SIU Investigations, and other operational ...
Surveillance Investigator
$22 - $27/hr
... in our efforts to deter and combat insurance fraud. The surveillance investigator position is a ... Opportunities for advancement include Management, SIU Investigations, and other operational ...
Surveillance Investigator
Annapolis, MD · On-site
$21.25 - $26.25/hr
... in our efforts to deter and combat insurance fraud. The surveillance investigator position is a ... Opportunities for advancement include Management, SIU Investigations, and other operational ...
Surveillance Investigator
Annapolis, MD · On-site
$21.25 - $26.25/hr
... in our efforts to deter and combat insurance fraud. The surveillance investigator position is a ... Opportunities for advancement include Management, SIU Investigations, and other operational ...
Identify subrogation and Special Investigation Unit (SIU) opportunities and prepare referrals as ... Ability to obtain and maintain Department of Insurance (DOI) adjuster licenses in applicable states.
Identify subrogation and Special Investigation Unit (SIU) opportunities and prepare referrals as ... Ability to obtain and maintain Department of Insurance (DOI) adjuster licenses in applicable states.
Claims Investigator - Part Time
Laurel, MD · On-site
$23 - $30/hr
A minimum of 1-3 years of Claims, SIU, or adjusting experience. Other related experience should be ... the insurance defense industry. Grounded in core values of integrity, service, and results, we ...
Claims Investigator - Part Time
Laurel, MD · On-site
$23 - $30/hr
A minimum of 1-3 years of Claims, SIU, or adjusting experience. Other related experience should be ... the insurance defense industry. Grounded in core values of integrity, service, and results, we ...
... insurance claims presented by or against our members. You will confirm and analyzes coverage ... Candidates currently living in this location or willing to self-relocate are encouraged to apply.
... insurance claims presented by or against our members. You will confirm and analyzes coverage ... Candidates currently living in this location or willing to self-relocate are encouraged to apply.
Claims Investigator - Part Time
Laurel, MD · On-site
$23 - $30/hr
A minimum of 1-3 years of Claims, SIU, or adjusting experience. Other related experience should be ... the insurance defense industry. Grounded in core values of integrity, service, and results, we ...
Claims Investigator - Part Time
Laurel, MD · On-site
$23 - $30/hr
A minimum of 1-3 years of Claims, SIU, or adjusting experience. Other related experience should be ... the insurance defense industry. Grounded in core values of integrity, service, and results, we ...
Claims Investigator - Part Time
Laurel, MD · On-site
$23 - $30/hr
A minimum of 1-3 years of Claims, SIU, or adjusting experience. Other related experience should be ... the insurance defense industry. Grounded in core values of integrity, service, and results, we ...
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Claims Investigator - Part Time
Laurel, MD · On-site
$23 - $30/hr
A minimum of 1-3 years of Claims, SIU, or adjusting experience. Other related experience should be ... the insurance defense industry. Grounded in core values of integrity, service, and results, we ...
... SIU resources for further investigation. * Achieves quality standards by appropriately managing ... insurance policies and coverage. * Ability to manage multiple and shifting priorities in a fast ...
... SIU resources for further investigation. * Achieves quality standards by appropriately managing ... insurance policies and coverage. * Ability to manage multiple and shifting priorities in a fast ...
... SIU resources for further investigation. * Achieves quality standards by appropriately managing ... insurance policies and coverage. * Ability to manage multiple and shifting priorities in a fast ...
... SIU resources for further investigation. * Achieves quality standards by appropriately managing ... insurance policies and coverage. * Ability to manage multiple and shifting priorities in a fast ...
Complex Claims Consultant - Healthcare Medical Malpractice
Washington, DC · On-site
$100 - $125/hr
... in good underwriting decisions. This role collaborates with insureds, attorneys, other insurers and ... Claim, Recovery or SIU resources for further investigation. Achieves quality standards by ...
Complex Claims Consultant - Healthcare Medical Malpractice
Washington, DC · On-site
$100 - $125/hr
... in good underwriting decisions. This role collaborates with insureds, attorneys, other insurers and ... Claim, Recovery or SIU resources for further investigation. Achieves quality standards by ...
Identity Intelligence Analyst, Mid Level
Quantico, VA · On-site
$60K - $80K/yr
The opportunity to grow your skills in multi-source intelligence, biometrics, and identity ... Collaborating with agencies such as DFBA, NGIC, NCIS, and FBI SIU * Delivering intelligence that ...
Identity Intelligence Analyst, Mid Level
Quantico, VA · On-site
$60K - $80K/yr
The opportunity to grow your skills in multi-source intelligence, biometrics, and identity ... Collaborating with agencies such as DFBA, NGIC, NCIS, and FBI SIU * Delivering intelligence that ...
Identity Intelligence Analyst, Mid Level with Security Clearance
Quantico, VA · On-site
$60K - $80K/yr
The opportunity to grow your skills in multi-source intelligence, biometrics, and identity ... Collaborating with agencies such as DFBA, NGIC, NCIS, and FBI SIU * Delivering intelligence that ...
Identity Intelligence Analyst, Mid Level with Security Clearance
Quantico, VA · On-site
$60K - $80K/yr
The opportunity to grow your skills in multi-source intelligence, biometrics, and identity ... Collaborating with agencies such as DFBA, NGIC, NCIS, and FBI SIU * Delivering intelligence that ...
Identity Intelligence Analyst, Mid Level
Quantico, VA · On-site
$60K - $80K/yr
The opportunity to grow your skills in multi-source intelligence, biometrics, and identity ... Collaborating with agencies such as DFBA, NGIC, NCIS, and FBI SIU * Delivering intelligence that ...
Identity Intelligence Analyst, Mid Level
Quantico, VA · On-site
$60K - $80K/yr
The opportunity to grow your skills in multi-source intelligence, biometrics, and identity ... Collaborating with agencies such as DFBA, NGIC, NCIS, and FBI SIU * Delivering intelligence that ...
Identity Intelligence Analyst, Mid Level
Quantico, VA · On-site
$60K - $80K/yr
The opportunity to grow your skills in multi-source intelligence, biometrics, and identity ... Collaborating with agencies such as DFBA, NGIC, NCIS, and FBI SIU * Delivering intelligence that ...
Identity Intelligence Analyst, Mid Level
Quantico, VA · On-site
$60K - $80K/yr
The opportunity to grow your skills in multi-source intelligence, biometrics, and identity ... Collaborating with agencies such as DFBA, NGIC, NCIS, and FBI SIU * Delivering intelligence that ...
Siu In Insurance information
What is the difference between Siu In Insurance vs Insurance Claims Adjuster?
| Aspect | Siu In Insurance | Insurance Claims Adjuster |
|---|---|---|
| Certifications | Typically requires insurance licensing and knowledge of insurance policies | Requires licensing, often with specific adjuster certifications |
| Work Environment | Office-based, handling insurance policies and client interactions | Field and office work, inspecting damages and assessing claims |
| Employer & Industry Usage | Insurance companies, brokers, and agencies | Insurance companies, third-party claims firms, and independent adjusters |
Both roles involve insurance knowledge and licensing, but Siu In Insurance primarily focuses on policy management and client service, while Insurance Claims Adjusters assess damages and determine claim validity. The roles often overlap in industry and required credentials, but differ in daily tasks and work environment.
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Fraud, Waste, and Abuse (FWA) Medical Record Reviewer
Elkridge, MD • On-site
Elite Technical •
51 - 200 employees51 - 200 employees
Other
Posted 22 days ago
Job description
Fraud, Waste, and Abuse (FWA) Medical Record Reviewer
Elite Technical is seeking a Fraud, Waste, and Abuse (FWA) Medical Record Reviewer! We are seeking an experienced healthcare fraud investigator and medical record reviewer with expertise in analyzing medical documentation, claims data, provider billing patterns, and regulatory compliance requirements. Skilled in identifying potential fraud, waste, and abuse indicators through detailed record review, coding validation, and investigative research. Knowledgeable in Medicare, Medicaid, HIPAA, CPT, HCPCS, and ICD-10 guidelines, with strong analytical and case documentation abilities.
<>Required SkillsEducation:
- Bachelor''s degree in:
* Health Information Management
* Nursing
* Healthcare Administration
* Medical Coding
* Criminal Justice
* Public Health
* Related healthcare field
- Experience
* 2-5+ years reviewing medical records, claims, or healthcare documentation. Experience in:
* Fraud, Waste, and Abuse investigations
* Medicare and Medicaid programs
* Claims auditing
* Utilization review
* Clinical documentation review
* SIU (Special Investigations Unit) operations
- Knowledge Requirements
* Medical terminology, anatomy, and physiology.
* CPT, HCPCS, and ICD-10 coding systems.
* Medicare, Medicaid, and commercial insurance regulations.
* Healthcare compliance requirements (HIPAA, OIG guidelines, CMS regulations).
* Documentation standards for healthcare providers.
- Technical Skills
* Electronic Medical Records (EMR/EHR) systems.
* Claims processing systems.
* Microsoft Office (Excel, Word, Outlook).
* Data analysis and reporting tools.
* Ability to identify documentation inconsistencies and billing irregularities.
- Certifications (Often Preferred)
* Certified Professional Coder (CPC)
* Certified Coding Specialist (CCS)
* Registered Health Information Technician (RHIT)
* Registered Health Information Administrator (RHIA)
* Certified Fraud Examiner (CFE)
* Accredited Healthcare Fraud Investigator (AHFI)
* Certified Professional Medical Auditor (CPMA)
- Key Competencies
* Strong analytical and critical-thinking skills.
* Attention to detail.
* Investigative mindset.
* Ability to interpret complex medical documentation.
* Report writing and case documentation skills.
* Knowledge of healthcare fraud schemes and abuse indicators.
About Elite Technical
Sourced by ZipRecruiter
Company size
51 - 200 Employees
Headquarters location
Ronkonkoma, NY, US
Year founded
1992