- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Manager, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The ... Manager, Fraud and Waste works within specific guidelines and procedures;...decisions often involve resource allocation, project approaches, and tactical operations within their department. The role requires cross-departmental collaboration,… more
- Humana (Indianapolis, IN)
- …part of our caring community and help us put health first** This Senior Fraud and Waste Investigator will serve as Humana's Program Integrity Officer, who will ... oversee the monitoring and enforcement of the fraud , waste, and abuse (FWA) compliance program to prevent...closely with internal and external auditors, financial investigators, and claims processing areas + Adequately staff and manage the… more
- Molina Healthcare (AZ)
- …to, and the appropriate approvals and escalations are achieved. Coordinates with both the Associate Vice President of Fraud , Waste and Abuse (FWA) and ... **Knowledge/Skills/Abilities** Acts as liaison between Special Investigations Unit (SIU) operations and contracted vendor(s) to assure a smooth workflow exists,… more
- Humana (Madison, WI)
- …a part of our caring community and help us put health first** The Fraud and Waste Professional 2 conducts investigations of allegations of fraudulent and abusive ... practices. The Fraud and Waste Professional 2 work assignments are varied...AHFI). + Bachelor's degree + Understanding of healthcare industry, claims processing and investigative process development. + Experience in… more
- Wells Fargo (Tempe, AZ)
- …scalability, and security for Wells Fargo. Services include deposits, payments and ATM operations , global fraud and claims , account reconciliation, wire ... Customer Excellence, Controls and Enablement; Customer Service; Fraud and Claims Management; Retail Core Operations ; and Workforce Management, Capacity… more
- JPMorgan Chase (Columbus, OH)
- …solve key business questions or respond to customer initiatives. + Partner with Fraud Risk, Authentication, Fraud Operations , Account Opening, Payments, ... Prevention, Claims Management + Coordinate with Technology, Systems and Operations partners to implement new projects as required. Participate in developing and… more
- Wellpath (Nashville, TN)
- …a time. **How you make a difference** The Senior Vice President, Associate General Counsel, Risk Management and Litigation provides strategic leadership, tactical ... insights, and substantive expertise in managing a diverse range of professional liability claims . Reporting to the Chief Legal Officer, this role oversees the … more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …regulatory and state guidelines, and policies. 4. Provide instructions to the claims operations department prepayment reviews to initiate claim adjustments 5. ... persona. The position serves as a Prepayment Review Coding Specialist within the Fraud Investigation & Prevention Unit ("FIP"). The position will be a dedicated… more
- CareFirst (Baltimore, MD)
- …offsite audits/investigations with interviews when appropriate. Researching provider/subscriber claims activity, operations manuals, data systems, medical ... the detection, investigation, and resolution of all levels (low to complex), of fraud , waste, and abuse schemes, resulting in the savings and recovery of funds.… more
- Kemper (Miami, FL)
- …company image to the public. + Fraud Claims Law Specialist (FCLS) or Fraud Claims Law Associate (FCLA) designations and Certified Insurance Fraud ... The SIU Investigator will conduct field and desk investigations of insurance claims referred to and accepted for investigation by the Special Investigative Unit.… more
- Walmart (Manchester, CT)
- …versustraining. Determines training needs. Develops and delivers training as needed. Manages claims and receiving operations by ensuring proper policies and ... and collaborating with all levels of associates regarding store operations , utilizing technology, business initiatives,merchandising, and company direction; introducing… more
- Walmart (Vidalia, GA)
- …training. Determines training needs. Develops and delivers training as needed. Manages claims and receiving operations by ensuring proper policies and procedures ... and collaborating with all levels of associates regarding store operations , utilizing technology, business initiatives, merchandising, and company direction;… more
- University of Utah Health (Salt Lake City, UT)
- …University of Utah Health, Hospitals and Clinics, is seeking an experienced new Associate Executive Director for Revenue Cycle! The Associate Executive Director, ... This roleensures seamless management of patient billing, insurance verification, claims processing, collections, health information, denials management and others.The… more
- Walmart (Prairieville, LA)
- …training needs; and developing and delivering the training where needed. Manages claims and receiving operations by ensuring proper policies and procedures ... violations of company policies and criminal activities by investigating alleged fraud and other alleged illegal activities; conducting investigations relating to the… more
- Walmart (Santa Fe, NM)
- …training needs; and developing and delivering the training where needed. Manages claims and receiving operations by ensuring proper policies and procedures ... violations of company policies and criminal activities by investigating alleged fraud and other alleged illegal activities; conducting investigations relating to the… more
- Wells Fargo (Raleigh, NC)
- …scalability, and security for Wells Fargo. Services include deposits, payments and ATM operations , global fraud and claims , account reconciliation, cash ... **About this role:** Wells Fargo is seeking an Associate Customer Service Representative in **Everyday Banking** ....services company to grow YOUR career. Apply today. CSBB Operations delivers a diverse set of foundational operational and… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- **Overview** Assist in centralized billing of all claims **Responsibilities** **Job Duties:** + Responsible for accurate data entry of resident insurance ... claim denial on a daily basis + Correct all necessary data + Re-bill claims as needed + Interact with Kinney Employees (Store and Corporate) and various outside… more
- Walmart (Lebanon, PA)
- …Consults on complex claims and settlements. Designs preventative claims management processes (for example, associate engagement efforts, return-to-work ... or More Certifications such as Loss Prevention Certification (LPC), Certified Fraud Examiner (CFE), Associate Safety Professional; Certified Safety Professional;… more
- BeiGene (San Mateo, CA)
- …US healthcare fraud and abuse laws (eg, Anti-kickback statute, False Claims Act), FDCA, FDA guidance, OIG Compliance Program Guidance, OIG advisory opinions, and ... is actively seeking a seasoned compliance professional at the associate director level who thrives in fast-paced settings, brings...role will report to the Senior Director of Compliance Operations and will play a critical role in BeiGene's… more
- AIG (Atlanta, GA)
- …changes to laws and regulations regarding fraud matters and report to the claims team on those matters. + Assist Associate General Counsel in reviewing ... risk managers and customer's in-house counsel to negotiate and draft claims service agreements for large commercial risks with complex workers' compensation,… more
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