- CVS Health (Wellesley, MA)
- … Unit is seeking a Sr. Manager to lead our new ASO investigations team. The Healthcare Fraud Senior Manager is responsible for overseeing ... and external stakeholders and ensuring compliance with regulatory requirements. The Senior Manager develops strategies to mitigate fraud risks, analyzes complex… 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
- Wells Fargo (Wilmington, DE)
- **About this role:** Wells Fargo is seeking an Analytics Senior Manager for the Enterprise Internal Fraud Detection Analytics Team. A part of the Chief Operating ... Office under Fraud and Claims Operations, the team provides...knowledge of allegation lifecycle including sensitive matters, intake, internal investigations , root cause and customer impact **Job Expectations:** +… more
- NBT Bank (Norwich, NY)
- Pay Range: $21.63 - $28.87 Responsible for investigating external fraud investigations in the area of check fraud , identity theft, online fraud and cyber ... withduties and decisions relating to fraudulent applications, transactions, and customer fraud claims . Develops solutions to problemsbased on experience and… more
- Bank of America (Phoenix, AZ)
- …to maximize client experience while managing fraud mosteffectively. As a Fraud Strategy Manager with the Client Protection organization, you will capitalize ... fraud prevention methodologies. + Analyze data and conduct investigations to identify patterns, trends, and anomalies indicative of...causes + Basic understanding of 1st and 3rd party fraud ( claims to charge-off timing, chargeback recovery… more
- Elevance Health (Los Angeles, CA)
- …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
- New York State Civil Service (New York, NY)
- …data analysts, and legal support analysts to conduct complex, long-term healthcare fraud investigations . Medicaid provides health coverage to millions of New ... General, Office of the Title Legal Nurse: Medical Analyst Support Medicaid Fraud Cases (6345) Occupational Category Legal Salary Grade NS Bargaining Unit M/C… more
- Crawford & Company (New Orleans, LA)
- …decisions on claims within delegated limited authority. Responsibilities + Conducts investigations of claims to confirm coverage and to determine liability, ... $2,500 after compensability has been determined. + Evaluates medical claims for potential fraud issues, loss control...bill coding rules and state regulations. + Keeps Team Manager informed verbally and in writing of activities and… more
- Travelers Insurance Company (Walnut Creek, 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
- Walmart (Brundidge, AL)
- …with specific types of tools used for theft prevention. Conducts investigations . Recognizes and investigates security breaches, thefts, shortages (loss), and ... management. Responds to inquiries by regulatory authorities. Consults on complex claims and settlements. Designs preventative claims management processes (for… more
- Travelers Insurance Company (Franklin, TN)
- …. 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
- Elevance Health (Columbus, OH)
- …for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. **How you will make an impact:** + Examines claims ... relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control. + Reviews and...prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses… more
- Elevance Health (Houston, TX)
- …would provide an equivalent background. **Preferred Qualifications:** + Behavioral Health investigations experience preferred. + Fraud certification from CFE, ... investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client funds...to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim… more
- Elevance Health (Mendota Heights, MN)
- …the identification, investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on fraudulent ... claims . **How you will make an impact:** + Claim...+ Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company health… more
- CVS Health (Vero Beach, FL)
- … investigations including, but not limited to: Internal/External theft, fraud , falsification of company records, misappropriation of company assets, safety ... employees, building, product, supplies, etc.), conducting internal and external investigations , overseeing Environmental Health and Safety programs, conducting operational… more
- State of Colorado (Denver, CO)
- …state residents. The Consumer Engagement and Data Services Unit performs consumer fraud intake functions for the Consumer Protection Section and will ultimately ... The Complaint Intake Coordinator researches and collects data to support investigations , education and outreach efforts, and policy decisions while maintaining call… more
- MyFlorida (Miami, FL)
- …is to protect public health, safety, and welfare by preventing fraud , adulteration, misbranding, and false advertising in the preparation, manufacture, repackaging, ... submits technical and operational documents related to inspections and investigations , including inspection and investigation reports, complaints, notices of… more
- City of New York (New York, NY)
- …FOR 6.1.9 TITLE CHANGE. BFI is mandated to detect and deter Public Assistance fraud and misuse by conducting investigations of individuals and groups that ... telephone contacts and other means for referral to the Supplemental Nutrition Assistance Program- Claims and Recovery (SNAP CR). - Review claims calculations and… more
- Delek US Holdings (Brentwood, TN)
- …from commercial agreements, including contract breaches, performance issues, and liability claims . + Lead internal investigations and collaborate with external ... offering innovative legal strategies to navigate contract requirements, negotiations, obligations, claims , and exposures. **EDUCATION AND EXPERIENCE** + 4 year /… more
- Stitch Fix (Lithia Springs, GA)
- …People and Culture team to develop these strategies. Reporting to the Business Partner Manager at the Lithia Springs, GA facility, you will play a pivotal role in ... + Provide backup to the P&C Coordinator in responding to unemployment claims , accurately and timely addressing separation reasons, employment history, and relevant… more
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