- TD Bank (Mount Laurel, NJ)
- …you more specific details for this role. **Line of Business:** Financial Crimes & Fraud Mgmt **Job Description:** _Debit Card Investigations Team_ _The team is ... responsible for reviewing debit card claims and determining if they will be paid or...escalation for customers/internal clients/business partners + Applies knowledge of Fraud systems, processes and regulations in resolving escalated client… more
- Wells Fargo (Chandler, AZ)
- **About this role:** Wells Fargo is seeking a Fraud & Claims Operations Senior Manager in Consumer & Small Business Banking providing coverage for the ... to ensure proactive identification, prevention, detection, investigation and/or reporting of fraud and claims activity + Engage and influence stakeholders… more
- Fallon Health (Worcester, MA)
- …Audit Manager , theAnalyze and interpret patient medical records pertaining to FWA investigations Compare to information submitted on the claims in order to ... to SIU staff related to clinical topics as neededFWA Manager will oversees the day-to-day operations over investigations...Fraud , Waste and Abuse (FWA) program. The FWA Manager will be responsiblefor general supervisionover a number of… more
- TD Bank (Mount Laurel, NJ)
- …assigned claim fraud files and conducts effective analysis and/or investigation of fraud claims /disputes to minimize financial loss to the Bank + Completes ... escalation and/or evaluation process support for a defined area or function like Claims /Detection/Specialty within the Fraud group. The Fraud Agent II… more
- Under Armour, Inc. (Baltimore, MD)
- …and customer escalations. Identify training opportunities within customer service that impact fraud . + Support Retail UA Protect, Investigations and DH teams ... on cross-functional investigations + Represent Fraud Operations with integrity and professionalism + Assist with...+ Protect the business from non-traditional card not present fraud including but not limited to claims … more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- Position Purpose: The Manager - Fraud , Waste & Abuse (FWA) is responsible for day-to-day activities of the FWA Program while meeting operational and service ... fraud , waste and abuse cases + Lead special investigations , maintain FWA records, submit to I-MEDIC + Partner...at large + Proven track record in FWA, special investigations and risk assessment + Knowledge of claims… more
- Elevance Health (Atlanta, GA)
- …in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to identify ... **Nurse and CPC - Clinical Fraud Investigator II - SIU Fraud ...prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new… more
- The Hartford (GA)
- …with claim handlers across all lines of business to investigate suspicious claims . The Field Investigators performing investigations to provide information to ... The mission of the SIU is to contribute to claims accuracy by building fraud awareness and...claims . This position will report to the SIU Manager and will be responsible for conducting thorough, timely,… more
- Ford Motor Company (Columbus, OH)
- …using Mitchell Connect estimating system to establish cost of repairs. + Subrogation investigations , salvage disposal, and fraud investigations + Loss ... you'll do ** The APD Auto Physical Damage Catastrophe Claims Adjuster/Field Service Manager is a field-based...for vehicle inspections and travel throughout key-point. + Coverage investigations including fire, theft, false pretense claims ,… more
- OneMain Financial (Baltimore, MD)
- …to personal loan and credit card claim/chargeback processing, lending, collections, or fraud investigations with the ability to apply that understanding to ... Ability to discuss feasibility and appropriateness of high dollar Fraud claims with Customers o Ability to.... Judgmental skills necessary to escalate high-risk matters to Fraud Manager , Senior Investigator and/or management. .… 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
- Kemper (San Diego, CA)
- …multi-injury claims that may contain elements of fraud or claims otherwise deemed suspicious in nature. These investigations may include multi-feature ... digital photo/document metadata and using the internet/social networking for investigative purposes. + Fraud Claims Law Specialist (FCLS) or Fraud Claims… more
- Kemper (Los Angeles, CA)
- …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
- Kemper (Miami, FL)
- …oral and written communication skills and promote a favorable company image to the public. + Fraud Claims Law Specialist (FCLS) or Fraud Claims Law ... Summary:** The SIU Investigator will conduct field and 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
- Premera Blue Cross (Mountlake Terrace, WA)
- …collecting, and evaluating information and data, including financial data, in support of investigations of external fraud . The reports prepared by this position ... perform analysis and obtain analytical information of significance to support case investigations . You will also conduct proactive fraud detection using… more
- Walmart (Bentonville, AR)
- …you'll do **Position Overview:** The Supply Chain Asset Protection Divisional **Senior Manager ** of Grocery Automation will play a critical role in overseeing ... including inventory, equipment, and facilities. Implement strategies to prevent theft, fraud , and other security risks. + **Compliance:** Ensure all operations… more
- American Family Insurance - Corporate (Houston, TX)
- …and external partners, agents and customers. You will report to a Senior Special Investigations Manager . In this primarily home-based role, you will spend 80% of ... Investigate low to moderately complex insurance fraud activity involving non-auto property claims ,..., develop meaningful industry social network and assist special investigations leadership in promoting fraud awareness and… more
- State of Massachusetts (Boston, MA)
- …Stay updated on changes in legislation and best practices related to unemployment fraud . Flag suspicious employer accounts and fraudulent claims for further ... available for work and looking for a job. The Manager of Program Integrity plays a crucial role in...legal teams, enforcement agencies, and other stakeholders to support investigations and ensure thorough resolution of fraud … more
- CVS Health (Columbus, OH)
- …deliver solutions to make health care more personal, convenient and affordable. The Special Investigations Unit is seeking a Manager to lead our team of ... claims processing, and regulatory requirements related to healthcare fraud . Proficient in researching information and identifying information resources AAPC… more
- CareOregon (Portland, OR)
- …The work of that team includes delegation oversight of subcontracted entities, fraud waste and abuse prevention planning and investigations , grievances, hearings ... Job Title Delegation and Quality Oversight Manager Exemption Status Exempt Department Health Share of...Federal Regulations, Oregon Revised Statutes and Administrative Rules, HIPAA, Fraud , Waste, and Abuse laws, False Claims … more
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