SIU Field Investigator Job at Geico (Melbourne)

Senior SIU Field Investigator

At GEICO, we offer a rewarding career where your ambitions are met with endless ...

Location

United States , Fort Lauderdale; Miami; Plantation

Salary:

Not provided

Geico

Expiration Date

Until further notice

Requirements

Qualified candidates must possess a strong investigative background
Minimum of 3-5 years documented fraud investigative experience in areas of SIU and/or law enforcement experience
For law enforcement experience, prior detective-level experience required
Prior field investigative statements
Fact finding details to include complex investigations
Exceptional verbal and written communication skills
Proficiency in Microsoft Word and Outlook with working knowledge of Excel and PowerPoint
Typing of a minimum 35 WPM
Candidate must have a valid Driver’s License and will be subject to background and driving record checks

Job Responsibility

Conduct investigations of suspected cases of fraud or other illegal activities against the Company, including interviewing, database inquiries, taking statements, and locating sources of information and witnesses
Evaluating information to determine its credibility
Referring and coordinating investigation assignments to outside agencies
Providing training and support to all departments in the claims handling process
Participate in SIU industry meetings

What we offer

Premier Medical, Dental and Vision Insurance with no waiting period
Paid Vacation, Sick and Parental Leave
401(k) Plan
Tuition Reimbursement
Paid Training and Licensures
Mental healthcare as well as fertility and adoption assistance
Workplace flexibility
GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year

Fulltime

Senior Director of Operations - PACE

Advance Your Career in Insurance Claims with Allied Universal® Compliance and In...

Location

United States , Dallas

Salary:

Not provided

Allied Universal®

Expiration Date

Until further notice

Requirements

Must possess one of the following: Bachelor’s degree in Healthcare Administration, Nursing, or Business
Associate’s degree in Healthcare Administration, Nursing, or Business and a minimum of eight (8) years of related experience in a healthcare leadership role
Minimum of three (3) years managing or directing an SIU insurance investigation program
Minimum of six (6) years of experience in a progressive healthcare leadership role
Ability to think strategically, make timely decisions and implement change
Ability to remain highly productive in a changing environment, possess strong attention to detail and well-developed organizational skills, and maintain a high level of discretion
Demonstrated proficiency in using subscription databases to search for relevant information on investigative assignments in support of the technical and professional staff of the SIU
Outstanding written and oral communication skills
Proficiency in Microsoft Outlook, Excel, Word, and PowerPoint

Job Responsibility

Oversight of SIU (Special Investigative Unit) Investigations team associated with the PACE contract
Use independent judgment to define and confirm client objectives (including due dates) on all new, reopen, and investigative referral cases
Provide consultation to the client using independent discretion to develop and implement an efficient, effective, and ethical investigation of an insurance claim
Ensure adherence to clear guidelines regarding company policies on privacy, compliance, and ethics
Ensure independently that the investigators assigned to complete the investigative tasks requested by the client have been given clear instruction on the client’s expectations at the time the case is approved
Maintain quality control after investigation is completed, ensuring that all client’s objectives have been addressed and achieved, and the billing applied to this work product falls within the standard billing schedule or client contract rates
Ensure team meets “reopen” sales goals on a monthly basis, creating accurate funding records for all items billable to the client
Use sound management, discretion, and independent judgment to resolve conflicts between clients and/or investigators
Handle customer complaints (negotiating as needed) and forward field operational issues to appropriate Vice President as needed
Provide daily updates to the clients within one business day after an investigative task has been completed, or per the client’s updating protocols set forth in a contract (if applicable)

What we offer

Medical, dental, vision, basic life, AD&D, retirement plan and disability insurance
Seven paid holidays annually, sick days available where required by law
Vacation time offered at an initial accrual rate of 3.08 hours biweekly for full time positions. Unused vacation is only paid out where required by law
Employee Assistance Program
Employee Discount Program
Tuition Discount Program
Training & Career Development Programs

Fulltime

Director, Compliance on Special Investigations Unit and Fraud, Waste and Abuse

The Director, Compliance on Special Investigations and Fraud, Waste and Abuse (F...

Location

United States , Los Angeles

Salary:

135136.00 - 216218.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Bachelor's Degree in Criminal Justice or Related Field
At least 7 years of experience in healthcare compliance, fraud investigations, law enforcement, or related field
At least 5 years of experience in leading teams, projects, initiatives, or cross-functional groups
Demonstrated experience managing complex investigations in a managed care or healthcare environment
Experience in coordinating with external regulators and law enforcement agencies
Proven knowledge of CMS, DHCS, DMHC, OIG, and DOJ regulatory frameworks governing FWA programs
Strong investigative skills, including evidence gathering, interviewing, and case documentation
Demonstrated success in leading complex, multi-party investigations with integrity and discretion
Excellent communication skills
Strong organizational and project management abilities

Job Responsibility

Lead L.A. Care’s Special Investigations Unit (SIU) in overseeing internal and external investigations into fraud, waste, abuse, and compliance violations
Drive the design, implementation, and continuous improvement of the Fraud, Waste, and Abuse (FWA) program
Ensure effective case intake, triage, investigation, tracking, and resolution processes
Develop and support enterprise policies, procedures, and training programs supporting FWA prevention, detection, and response
Direct and oversee investigations into allegations of non-compliance, ethical violations, or fraudulent behavior
Partner with Legal, Compliance, and Human Resources on sensitive internal investigations
Ensure timely and accurate reporting of SIU/FWA activity to external agencies
Lead enterprise readiness for external audits, regulatory inquiries, and enforcement actions
Conduct strategic planning to use resources to meet departmental and Enterprise-wide goals
Monitor investigative trends, emerging risks, and regulatory developments

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Senior Field Security Investigator

We have an exciting opportunity to join the SIU team as a Senior Field Security ...

Location

United States , Charlotte

Salary:

Not provided

Geico

Expiration Date

Until further notice

Requirements

An associate or bachelor’s degree in criminal justice or a related field
Five years of insurance claims investigative experience (includes TCR1, TCR2, CU, PIP technical and/or PIP litigation desk experience), professional investigation experience with law enforcement agencies
Seven years of professional investigation experience involving economic or insurance related matters
Experience handling in-person or phone statements from various parties in an investigation
Ability to gather a broad range of evidence related to an investigation and draw conclusions
Demonstrated ability to organize and prioritize investigative volume workloads and stressful situations
Must be able to always maintain a professional attitude and appearance
Must be able to document files in a clear, concise, professional written manner
Must be able to obtain and maintain a valid driver’s license, certifications and permits
Must be able to lift and carry materials and equipment

Job Responsibility

Conduct investigations of suspected cases of fraud or other illegal activities against the Company
Interviewing, database inquiries, taking statements, and locating sources of information and witnesses
Evaluating information to determine its credibility
Referring, and coordinating investigation assignments to outside agencies
Providing training and support to all departments in the claims handling process

What we offer

Comprehensive Total Rewards program
401K savings plan vested from day one that offers a 6% match
Performance and recognition-based incentives
Tuition assistance
Access to additional benefits like mental healthcare as well as fertility and adoption assistance
Workplace flexibility
GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year

Fulltime

Director, Fraud Prevention and Program Oversight

Community First Health Plans, Inc. (Community First) is an HMO providing health ...

Location

United States , San Antonio

Salary:

40.87 - 91.35 USD / Hour

University Health

Expiration Date

Until further notice

Requirements

Bachelor’s degree is required in accounting, business administration or related field
Experience in interpretation of regulatory agency policies is preferred
Experience with anti-fraud detection and prevention is required
Three years of supervisory experience is preferred
Experience with SEC SOX and/or NAIC MAR audits, and Enterprise Risk Management (ERM) is highly desirable
At least three years of professional audit experience is required

Job Responsibility

Leads the organization’s efforts to prevent, detect, investigate, and remediate fraud, waste, and abuse (FWA) across all product lines
Ensures program integrity by setting organizational standards, strengthening internal controls, and overseeing the Special Investigations Unit (SIU) operations, payment integrity analytics, and vendor oversight
Ensures program integrity by setting enterprise standards, strengthening internal controls, and overseeing SIU operations, payment integrity analytics, vendor oversight, and internal auditing functions

Fulltime

Pharmacy Auditor

In this role, you’ll conduct pharmacy desk and/or audits, review claims and supp...

Location

United States , New York

Salary:

30.00 - 38.00 USD / Hour

Robert Half

Expiration Date

Until further notice

Requirements

Experience (3–5 years) in pharmacy auditing, PBM operations, or retail/clinical pharmacy with billing knowledge
Prior work with SIU or FWA investigations is a major plus
Strong command of pharmacy claims processing & PBM systems
Excel proficiency (pivots, VLOOKUPs, data comparisons)
Experience with audit management tools and reporting
CPhT strongly preferred
Bachelor’s in Pharmacy, Healthcare, Business, or related field a plus
Familiarity with NCPDP standards and third‑party billing rules
Exceptional attention to detail
Strong written communication (audit reports, summaries)

Job Responsibility

Conduct pharmacy audits (desk or field) to verify accuracy of billed claims
Review prescriptions, invoices, and dispensing logs for discrepancies
Identify and document issues related to: Days’ supply, NDC accuracy, Quantity and reimbursement mismatches, Purchase vs. dispensing inconsistencies, Duplicate billing or non‑covered items
Draft clear and defensible audit findings reports
Calculate recoveries and overpayments
Collaborate with SIU, Compliance, Legal, Finance, and Provider Relations
Support escalation of potential FWA issues

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

New

Leading Hand Process Operator

Reporting to the Shift Supervisor, the Leading Hand Process Operator is responsi...

Location

Australia , Pilbara

Salary:

Not provided

PLS

Expiration Date

Until further notice

Requirements

Prior experience as a Senior Process Operator in fixed operating plant or equipment in the mining industry
Previous experience in the Pilbara
Physical fitness to perform role and meet the physical demands required to respond in emergency or rescue situations
Mechanical aptitude
Teamwork and ability to contribute to a team
Initiative
Proactive safety focus
Computer literacy

Job Responsibility

Supporting the Supervisor in providing guidance and leadership to Process Operators across all areas of the production plant
Ensure compliance to operating procedures
Supporting the Supervisor in training and developing the processing team within the Supervisors span of control, providing on the job training and coaching to shift crew participants
Coordinate and delegate priorities that may shift quickly to adjust the demands of processing delivery
Liaise with the Shift Supervisor to assist in the management of workforce scheduling as needed to meet fluctuation demands, and coverage needs
Liaise with the Shift Supervisor on the daily tasks and jobs required
Communicate with the Shift Supervisor any issues that may arise and work with the operators to resolve

What we offer

18 weeks parental leave for primary carers and 4 weeks for secondary carers
Health and wellbeing allowance
Quarterly short-term incentive bonus that recognises individual and business performance
PLS employee share scheme
Novated leasing through salary sacrifice
Newly refurbished facilities at Pilgangoora including gym, tennis, pickleball and volleyball courts, sports oval, and scenic walking tracks
Paid community leave
Monthly employee recognition awards
Access to PLS’ KidsCo School Holiday Program

Fulltime

New

Pharmacy Technician

We’re building a world of health around every individual — shaping a more connec...

Location

United States , Shorewood

Salary:

17.00 - 27.00 USD / Hour

CVS Health

Expiration Date

May 30, 2026

Requirements

Must comply with any state board of pharmacy requirements or laws governing the practice of pharmacy, which includes but is not limited to, age, education, and licensure/certification
If the state board of pharmacy does not address or mandate a minimum age requirement, must be at least 16 years of age
If the state board of pharmacy does not address or mandate a minimum educational requirement, must have a high school diploma or equivalent, or be actively enrolled in high school or high school equivalency program
Regular and predictable attendance, including nights and weekends
Ability to complete required training within designated timeframe
Attention and Focus: Ability to concentrate on a task over a period of time
Ability to pivot quickly from one task to another to meet patient and business needs
Ability to confirm prescription information and label accuracy, ensuring patient safety
Customer Service and Team Orientation: Actively look for ways to help people, and do so in a friendly manner
Notice and understand patients’ reactions, and respond appropriately

Job Responsibility

Living our purpose by following all company SOPs at each workstation to help our Pharmacists manage and improve patient health
Following pharmacy workflow procedures at each pharmacy workstation (i.e., production, pick-up, drive-thru, and drop-off) for safe and accurate prescription fulfillment
Contributing to positive patient experiences by showing empathy and genuine care: creating heartfelt and personalized moments while serving patients at pick-up, drive-thru, and over the phone
keeping patients healthy by offering immunizations and other services at the register and over the phone
and demonstrating compassionate care by solving or escalating patient problems
Completing basic inventory activities, as permitted by law, and as directed by the pharmacy leadership team, such as accurately putting away medication deliveries and completing cycle counts, returns-to-stocks, waiting bin inventories, etc.
Contributing to a high-performing team, embracing a growth mindset, and being receptive to feedback
actively seeking opportunities to expand clinical and technical knowledge needed to better assist patients
Remaining flexible for both scheduling and business needs, while contributing to a safe, inclusive, and engaging team dynamic
voluntarily traveling to stores in the market to work shifts as needed by the business

What we offer

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
and other resources

Fulltime

SIU Field Investigator

Geico

Location:
United States , Melbourne ▼
Port St. Lucie
Vero Beach

Category:
Insurance

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
February 21, 2026

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Location:
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Job Posted:
February 21, 2026