2 specialty unit staff rn jobs found

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The role of the Special Investigations Unit (SIU) Investigator is to assist in the reduction and recuperation of losses to CareFirst through the detection, investigation, and resolution of low to medium levels fraud, waste, and abuse schemes, resulting in the savings and recovery of funds. ESSENTIAL FUNCTIONS: Independently conduct low to medium level investigations and provide support as part of an assigned team to all levels (low to medium) investigations of suspected fraud, waste, and abuse. In conjunction with assigned team or management, develop and execute investigative plans that may include performance of audits of financial business records, provider and subscriber medical data, claims, systems? reports, medical records, analysis of contract documents, provider/subscriber claims history, benefits, external data banks and other documents to determine the possible existence of fraud and/or...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The role of the Special Investigations Unit (SIU) Investigator is to assist in the reduction and recuperation of losses to CareFirst through the detection, investigation, and resolution of low to medium levels fraud, waste, and abuse schemes, resulting in the savings and recovery of funds. ESSENTIAL FUNCTIONS: Independently conduct low to medium level investigations and provide support as part of an assigned team to all levels (low to medium) investigations of suspected fraud, waste, and abuse. In conjunction with assigned team or management, develop and execute investigative plans that may include performance of audits of financial business records, provider and subscriber medical data, claims, systems report, medical records, analysis of contract documents, provider/subscriber claims history, benefits, external data banks and other documents to determine the possible existence of fraud and/or abuse....