- Lundbeck (Deerfield, IL)
- Manager , Field Compliance Requisition ID: 7092 Location: Deerfield, IL, US Do you want to join a team where the mission is meaningful, the challenges are complex, ... Opportunity - Open to candidates within the United States** **Summary:** The Manager , Field Compliance will support the Director, Field Compliance and … more
- Zurich NA (Owings Mills, MD)
- …and internal controls throughout the claims process. + Identify and refer claims with subrogation or fraud potential to the appropriate internal teams for ... organizations. **This role will be filled at either the** **Senior or AVP Claims Professional** **Level.** **The hiring manager will determine the appropriate… more
- Army National Guard Units (Carson City, NV)
- Summary This position is for a INVESTIGATIONS AND INQUIRIES SPECIALIST, PD# D1165P01, part of the Nevada Air National Guard. This position is located in the Joint ... National Guard (NG). (2) Conducts oversight and quality review for investigations into allegations, ensuring thoroughness, impartiality, and appropriateness of any… more
- UPMC (Pittsburgh, PA)
- …to 4:30 pm This is a remote position. Under the direction of the manager , the Special Investigations Unit (SIU) Investigator is responsible for investigating ... to assigned cases. This role includes supporting current SIU staff and manager with investigations and special projects. Responsibilities: + Maintain neat… more
- Capital One (New York, NY)
- …to include Fraud Strategy and Prevention, Fraud Investigations , Claims and Disputes. **The Senior Manager supports the line of business by:** + ... Senior Manager , Compliance Advisor - Retail Bank The Senior Manager , Compliance Advisor - Retail Bank performs a key risk management role (second line of… more
- Bank of America (Jacksonville, FL)
- …enhance fraud prevention methodologies. + Analyze data and conduct investigations to identify patterns, trends, and anomalies indicative of potential fraud ... Fraud Analytics and Innovation Lead Analyst - ...improvements and efficiencies via data analysis. + Partner with claims , policy, strategy, and product teams to deliver data… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- …not help injured workers with the claims management. The Compliance Investigator Manager will manage the statewide Fraud and Compliance Program within the ... + Benefits + Questions About this Job Office of Workers' Compensation Division: Fraud Claims Location: Baton Rouge, LA Office of Workers' Compensation The… more
- Ford Motor Company (Phoenix, AZ)
- …(eg, Mitchell Connect) to establish the cost of repairs. + Lead subrogation investigations , salvage disposal, and fraud investigations . + Perform loss ... + American Road Services Company is seeking an APD Physical Damage Catastrophe Claims Adjuster/Field Service Manager . This Field Service Manager role… more
- Navy Exchange Services (NEX) (Virginia Beach, VA)
- …all Omni-Channel businesses as needed. Works closely with Sr. Business Financial & Fulfillment Manager to minimize fraud , waste, and abuse. - Assists in the ... Title: ASSET PROTECTION SAFETY MANAGER (OMNI CHANNEL and BUSINESS INTELLIGENCE) Location: United...Asset Protection and Safety programs, including shrink control, e-commerce fraud , and management of AP/S staff dedicated to Omni-Channel.… more
- Otsuka America Pharmaceutical Inc. (Baton Rouge, LA)
- The Senior Manager , Global Product Quality - Biologics is responsible for managing quality oversight of clinical and commercial products at CMOs under contract by ... for use in clinical studies and commercial supply. + Reviews/approves deviations, investigations , CAPA plans and change controls per Otsuka Policies and Procedures.… more
- Kemper (Doral, FL)
- …oral and written communications skills and promote a favorable company image to the public. + Fraud Claims Law Specialist (FCLS) or Fraud Claims Law ... SIU Investigator will conduct field as well as desk investigations of insurance claims referred to and...of all critical situations. + Reports findings of all investigations and makes recommendations to the responsible manager… more
- Centene Corporation (Frankfort, KY)
- …may substitute for the Bachelors Degree . 5+ years of management experience Investigations and healthcare fraud -related investigations with audit and risk ... a subject matter expert for the Contractor's Program Integrity unit to reduce Fraud , Waste and Abuse of Medicaid services within Kentucky. Provides direction and… more
- MyFlorida (Pensacola, FL)
- …law enforcement experience, or five (5) years of work experience conducting healthcare fraud investigations . Note: All newly hired employees must obtain CJSTC ... Statutes. These matters include but are not limited to: fraud against the Medicaid Program, false claims ...work which may include performing all aspects of Medicaid fraud investigations . This work includes but is… more
- CVS Health (Columbus, OH)
- …high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high profile, those ... investigations + Serves as back up to the manager as necessary + Cooperates with federal, state, and...with an additional four+ years working on health care fraud , waste, and abuse investigations and audits;… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …FWA investigations and audits; or five years of insurance claims investigation experience or professional investigation experience with law enforcement agencies; ... for the accurate and thorough clinical investigation of potential fraud , waste and abuse (FWA) for all lines of...and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. +… more
- Molina Healthcare (Covington, KY)
- …from opinions + Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations + Knowledge of Managed Care and the Medicaid and ... company + Minimum of two (2) years' experience working on healthcare fraud related investigations /reviews + Proven investigatory skill; ability to organize,… more
- Travelers Insurance Company (Hunt Valley, MD)
- …. Coordinate medical and indemnity position of the claim with a Medical Case Manager . Independently handles assigned claims of low to moderate complexity where ... all offset opportunities, including apportionment, contribution and subrogation. Evaluate claims for potential fraud .Proactively manage inventory with documented… more
- Travelers Insurance Company (Irvine, CA)
- …. Coordinate medical and indemnity position of the claim with a Medical Case Manager . Independently handles assigned claims of low to moderate complexity where ... all offset opportunities, including apportionment, contribution and subrogation. + Evaluate claims for potential fraud . Proactively manage inventory with… more
- Point32Health (Canton, MA)
- …responsible for conducting high-volume Pre-Payment Fraud Waste & Abuse ("FWA") investigations under the direction of the Manager , FWA Prepayment Review. The ... + Required (minimum): 1-3 years' related experience in health insurance fraud investigations . + Preferred: Related experience in audits/ investigations… more
- CDM Smith (Lakewood, CO)
- …CDM Smith is seeking a Forensic Accounting Specialist with expertise in disaster fraud claims . This role is critical in evaluating and analyzing financial ... data related to disaster-related claims , including property damage, business interruption, and other loss...other loss categories. The specialist will conduct thorough forensic investigations to identify discrepancies, detect potential fraud ,… more
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