SIU Investigator Salary at Allstates BETA

A company is seeking an experienced Director of Compliance to manage compliance functions within an MLTC (Managed Long-Term Care) organization. The ideal candidate will have a strong background in regulatory affairs, internal auditing, and oversight of delegated functions. This role requires exceptional organizational, leadership, and communication skills to ensure adherence to compliance standards and regulations. Responsibilities Include: Collaborate with the VP of Compliance and Regulatory Affairs to investigate suspected compliance issues. Manage the internal audit process and coordinate audits conducted by the SIU. Implement and oversee key delegated functions, including Magellan, Beacon, and DentaQuest. Work with operational supervisors to coordinate internal audit and monitoring programs. Provide added depth and expertise for auditing processes. Coordinate external reporting to regulatory agencies such as DOH, CMS, and others. Ensure compliance with HIPAA when coordinating membe

The Casualty Claim Representative will be responsible for the handling of First and Third Party Bodily Injury claims in a Personal Lines/Commercial environment for the Plymouth Rock Operation. Essential Functions and Responsibilities Initiate prompt contact of all insureds/claimants/witnesses on all new claim assignments to conduct thorough coverage and liability/injury investigations. These investigations might require the representatives take in depth recorded statements to investigate coverage and liability/injury claims. Analyze, review and interpret policies to assess coverage and liability. Provide advice to Excess and Primary coverage issues. Conduct field investigations, interviews with insureds, witnesses and claimants while maintaining a pending of represented and unrepresented claimant cases. Manage and direct outside vendors (Field/Counsel/Surveillance, etc.) to determine what investigation is necessary and give them direction to bring a claim to conclusion. Ensure only nec

Job Summary Analyze, review, and process suspended claims, predetermination, and Service Requests based on industry standards and clinical guidelines. Research, analyze, and investigate member benefits, policy and procedures for claims, grievance and appeal cases. Provide provider outreach where necessary to facilitate claim resolution and escalated service requests. Obtain claim records and supporting documentation needed for resolution. Collaborate with Dental Consultants to review and triage escalated claims, pre-determinations, and service requests. Integrate clinical expertise with industry knowledge to identify potential fraud patterns upon claim submission, alerting dental director, and SIU team when applicable. Responsibilities •Review and analyze claims and pre-determinations within suspended system inventory using clinical expertise, industry standard guidelines, and benefit policy and procedures and make changes to procedure codes when necessary, using-supporting documentati

Attorney - SIU Internal Investigator needed for long term contract position with a leading financial institution located in NYC. The attorney will assist with the internal investigations of employee business conduct-related matters, with primary focus on the use of non-Firm approved devices/messaging platforms in violation of Firm policy and regulatory rules. This is a hybrid position working three days in office / 2 days remote. The office is located in midtown Manhattan. The role is expected to run up to one year with a possible extension. Hourly rate $80-90. Primary Responsibilities: Assist investigation team with internal investigations across the Firm in matters involving potential employee business-related misconduct. In addition to assisting team attorneys on a variety of business conduct-related matters, the qualified candidate will primarily focus on handling investigations involving the use of non-Firm approved devices/messaging platforms in violation of Firm policy. Conduct

Come grow with us! Lemieux & Associates, a national leader in the investigative industry, is seeking experienced SIU/Claims Investigators in the Brooklyn, NY or surrounding area. This is a full-time position for the right individual. The owners are entrepreneurial, experienced, field investigators, each with over 25 years of experience. We understand the job and never forgot our roots in the field. We are dedicated professionals with a motivational management style with proven ability to recruit, develop and direct highly successful teams that consistently excel. Requirements: You must have complex SIU/Claims experience and reside in the Brooklyn or surrounding area. If you do not have SIU/Claims experience, please do not apply because we can't hire you. Responsibilities Provide detailed accurate reports Obtain written and recorded statements Perform scene investigations Ability to accurately photograph evidence i.e., accident scenes, vehicle damage, etc. Skills/Experience Experience c