- Fallon Health (Worcester, MA)
- …resolve investigations, mitigate risk, and capture results. + 5-8 years of related health care claims auditing experience in a complex healthcare environment, ... and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and...Director of Internal Audit in their leadership of the Fraud , Waste and Abuse (FWA) program. The FWA Manager… more
- CVS Health (Hartford, CT)
- …situation. **Education:** + Bachelor's degree or equivalent experience (3-5 years of working health care fraud , waste and abuse investigations). **Pay ... + Researches and prepares cases for clinical and legal review + Documents all appropriate case activity in case... Examiners (CFE), or an accreditation from the National Health Care Anti- Fraud Association (AHFI)… more
- CVS Health (Tallahassee, FL)
- …of your health . This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with ... culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. **Position Summary** We are… more
- JPMorgan Chase (Newark, DE)
- …and programs to meet employee needs, based on eligibility. These benefits include comprehensive health care coverage, on-site health and wellness centers, a ... The Asset and Wealth Management Fraud Management is seeking a high performing Associate...and bank financial exposure with a high level of care . As our team and organization grows, flexibility with… more
- JPMorgan Chase (Plano, TX)
- …and programs to meet employee needs, based on eligibility. These benefits include comprehensive health care coverage, on-site health and wellness centers, a ... Join us as a Vice President in Merchant Services Fraud Operations and lead the charge in revolutionizing ...Operational Readiness teams to ensure preparedness for changes. + Review and approve procedure updates, ensuring accuracy and compliance.… more
- AIG (Atlanta, GA)
- …Fraud work items. . Define key metrics and key performance indicators to track and review the TPAs against for Fraud and Recovery work items. . Take ownership ... help customers to manage risk. Join us as a Fraud & Recovery TPA Analyst to play your part...starter. + Experience with Vendor and TPA management and review + A candidate who is comfortable handling large… more
- Quantexa (New York, NY)
- …We'd love you to join us. The opportunity. We are looking for a Head of Fraud Solutions - North America who can take ownership of our fraud solution suite ... government and large corporates) as assigned by the Global Head of Fraud . This includes structuring strategic Go-to-Market plan, driving account expansion by… more
- Walmart (Bentonville, AR)
- Position Summary What you'll do The Manager, Operations - Fraud Operations provides senior leadership and stakeholders oversight in the operations for on-trip ... fraud . This role involves assisting in the execution and...operational processes including report/data pulls that require operational support/manual review . + Assist in tracking and reporting for on-trip… more
- TTEC (Concord, NC)
- …fraudulent activities? You'll review and analyze cases to prevent and detect fraud . You'll work to resolve issues and protect the interests of the client and ... days and ignite your career with TTEC's award-winning employment experience. As a ** Fraud Detections Representative working onsite in Concord, NC** you'll be a part… more
- Guidehouse (Richardson, TX)
- …Parental Leave + 401(k) Retirement Plan + Basic Life & Supplemental Life + Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts + ... but are not limited to: + Performing Anti Money Laundering (AML) and/or Fraud alert/case reviews, seeking to mitigate risks associated to financial crimes and… more
- PNC (Pittsburgh, PA)
- …onto the complex quantitative analysis mainly on PNC's CECL and CCAR models and fraud models. You will be responsible for the implementation and maintain of these ... and drive the growth and mitigate credit risk and fraud risk across PNC's balance sheet. Preferred Skills &...owners and model developers during the course of the review . Works with large data to create models. +… more
- L'Oreal USA (St. Petersburg, FL)
- …Search (https://careers.loreal.com/en\_US/jobs/SearchJobs) / 190248 Analyst, Brand Equity ( Fraud ) Saint Petersburg, FL, Florida Apply now ... professional beauty. We are an open space for innovation and technology while we take care of the planet, creating more hope and less waste, we create as unique… more
- Guidehouse (New York, NY)
- …Plan + Group Term Life and Travel Assistance + Voluntary Life and AD&D Insurance + Health Savings Account, Health Care & Dependent Care Flexible Spending ... covering transaction monitoring, sanctions compliance, KYC/CDD, blockchain analysis, and fraud prevention solutions. + Work on technical projects that evaluate,… more
- PNC (Tysons Corner, VA)
- …rigorous independent reviews of some of PNC's most important models including fraud models, anti-money laundering models, as well as various types of ... machine-learning models. Key Responsibilities: 1. Independent Model Review : Perform qualitative and quantitative assessments of all aspects of models including data… more
- CVS Health (Hartford, CT)
- …of your health . This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with ... our ability to innovate and deliver solutions to make health care more personal, convenient and affordable....fraud , waste and abuse schemes and trends + Review company clinical & payment policies to determine the… more
- MyFlorida (Orlando, FL)
- …Control Unit in Orlando, Florida. This position involves auditing of complex multi-million-dollar health care fraud investigations that can result in ... AUDIT EVALUATION & REVIEW ANALYST - 41001237 Date: Nov 5, 2024...as lead investigator on cases involving suspected Cost Report Fraud : + Nursing Homes, Hospitals, and Intermediate Care… more
- Bear Mountain Health Care (Boston, MA)
- …of experience as a supervisor in a hospital, nursing care facility, or other related health care facility. . Must have, as a minimu m of six (6) months ... and procedures. + Report known or suspected incidents of fraud to the Administrator. Nursing Care Functions:...and his/her family to participate in the development and review of the resident's plan of care .… more
- City of New York (New York, NY)
- …found to be eligible can use coverage provided to access doctors, medication and other health care services at little or no cost. The Medical Assistance Program ... the three divisions keep pace with changes relating to health care reform and anticipated program growth...responsibility areas. - Identify areas of vulnerability for committing fraud , and program changes through the monthly statistics and… more
- CVS Health (Columbus, OH)
- … fraud and abuse **Required Qualifications** + **3 years three years working on health care fraud , waste, and abuse investigatory and audits required.** + ... - Researches and prepares cases for clinical and legal review . - Documents all appropriate case activity in case...1-3 years experience working on health care fraud , waste, and… more
- CVS Health (Columbus, OH)
- …research information **Education:** - Bachelor's degree or an additional 5 years of working health care fraud , waste and abuse investigations. **Pay Range** ... - Researches and prepares cases for clinical and legal review - Documents all appropriate case activity in case... Examiners (CFE), or an accreditation from the National Health Care Anti- Fraud Association (AHFI)… more