- 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 (Olympia, WA)
- …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....digital channels. *Controls access to and integrity of CVS Health Fraud Mitigation systems. *Reviews fraud… 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
- Commerce Bank (Kansas City, MO)
- …and corporate cards + Complete intake for Reg E and Reg Z dispute and fraud cases for all card products + Review account activities, taking appropriate measures ... and making sure people and their money are taken care of. And our commitment doesn't stop there. Our...and let's talk. About This Job This Commerce Bank Fraud Team is an integral part of our ongoing… 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
- JPMorgan Chase (Chicago, IL)
- …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 team is the first line of...factor in leading you to success. **Job responsibilities:** + Review transactions submitted on all channels available for the… 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
- NBT Bank (Lakeville, CT)
- Pay Range: $27.48 - $36.65 The Senior Fraud /AML Investigator will work fraud and money laundering cases as assigned by the BSA Officer and Security Officer as ... as cases arising from independent reviews of transaction and fraud monitoring reports. Education and Experience: + 3 years...subpoenas, etc., and complete SARs when appropriate. + 10% Review and analyze MIS reports generated from BAM 2.0… 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
- New York State Civil Service (Albany, NY)
- …by investigating reports of abuse and neglect in nursing homes and other residential health care facilities in the state. Possessing both civil and criminal ... and the recent filing of four major lawsuits against nursing homes, including Centers Health Care , Cold Spring Hills Center for Nursing and Rehabilitation, The… 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
- Molina Healthcare (AZ)
- …**Preferred Education** * Master's degree **Preferred Experience** * Formalized training/experience in Health Care Insurance Fraud * Experience with Power ... escalations are achieved. Coordinates with both the Associate Vice President of Fraud , Waste and Abuse (FWA) and Associate Vice President of Special Investigations… more
- State of Minnesota (St. Paul, MN)
- …well-being of Minnesotans and our state. Investigators conduct criminal investigations into health care providers suspected of defrauding the Minnesota Medicaid ... **Working Title: INVESTIGATOR - MEDICAID FRAUD DIVISION** **Job Class: Legal Assistant 5, 6,...program. The investigator reviews complaints against public health care providers; evaluates and analyzes claims… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …will be a dedicated coding specialist reviewing medical records to identify instances of health care fraud , waste, and abuse and to facilitate accurate ... our FLEX persona. The position serves as a Prepayment Review Coding Specialist within the Fraud Investigation...adjudication by health insurers + Knowledge of health care delivery systems with an emphasis… more
- CVS Health (Columbus, OH)
- …situation. **Education** + Bachelor's degree or equivalent experience (3-5 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
- Highmark Health (Dover, DE)
- …incumbent is also responsible for the field investigative work necessary to complete a review of a special project, potential fraud , waste and abuse case, ... + 3 years of relevant, progressive experience in the health insurance industry and/or healthcare fraud investigations...+ 1 year in Financial Analysis in an acute care hospital or health insurance setting +… 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 (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....affordable. As the Manger of Business Compliance of Quality Review , Training, and Program Integrity. You will lead a… more