• Fraud & Recovery TPA Analyst

    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
    AIG (08/17/24)
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  • Director, Special Investigations Unit (SIU) - Life…

    USAA (San Antonio, TX)
    …analytical and decision-making acumen. + Certified Fraud Examiner (CFE) or Accredited Health Care Fraud Investigator (AHFI) designation is a plus. The ... Special Investigations Unit (SIU),** you will be responsible for Life, Annuity & Health claims and fraud investigation programs and management of the Life… more
    USAA (10/24/24)
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  • Manager, Operations - Fraud Operations

    Walmart (Bentonville, AR)
    Position Summary What you'll do The Manager, Operations - Fraud Operations provides senior leadership and stakeholders oversight in the operations for on-trip ... fraud . This role involves assisting in the execution and...operational processes including report/data pulls that require operational support/manual review . + Assist in tracking and reporting for on-trip… more
    Walmart (09/26/24)
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  • LTC Fraud Investigator

    Manulife (Boston, MA)
    …We are looking for a candidate with experience in insurance, Medicare, Long-Term Care or Disability fraud with expertise assessing and investigating suspicious ... will be a thought leader identifying and preventing suspicious fraud activity in our US Long-Term Care ...family members + Presents case findings to management for review and offers next-step recommendations + Gathers and verifies… more
    Manulife (10/31/24)
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  • Victim Advocate - Identity Theft & Fraud

    State of Colorado (Lakewood, CO)
    Victim Advocate - Identity Theft & Fraud Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4708422) Apply  Victim Advocate - Identity Theft & ... Fraud Salary $57,708.00 - $92,340.00 Annually Location Lakewood, CO...includes legal resources and discounts. + State contribution into Health Savings Account when enrolled in HDHP. + Job… more
    State of Colorado (10/31/24)
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  • Fraud Operations Specialist

    Zions Bancorporation (Midvale, UT)
    …for a few hours approximately once a week. + Responsible to monitor and review exceptions derived from various fraud prevention filters. + Responsible for ... potential loss. + Monitors exception activity identified through various fraud detection filters and systems. + Review ...Health Savings (HSA), Flexible Spending (FSA) and dependent care accounts + Paid Training, Paid Time Off (PTO)… more
    Zions Bancorporation (11/03/24)
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  • Customer Service Representative- Fraud

    TEKsystems (Las Vegas, NV)
    …signs of fraud and report in the system - not responsible for formal reporting of fraud - they will review the profile, do some research in the system to see ... Description: Customer Fraud Specialist - will support dating website customer...Life & AD&D) + Short and long-term disability + Health & Dependent Care Spending Accounts (HSA… more
    TEKsystems (11/02/24)
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  • Fraud Investigations Analyst

    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
    Guidehouse (10/07/24)
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  • Quantitative Analytics and Model Consultant…

    PNC (Pittsburgh, PA)
    …onto the complex quantitative analysis mainly on PNC's CECL and CCAR models and fraud models. You will be responsible for the implementation and maintain of these ... and drive the growth and mitigate credit risk and fraud risk across PNC's balance sheet. Preferred Skills &...owners and model developers during the course of the review . Works with large data to create models. +… more
    PNC (10/16/24)
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  • Consultant II - Technology - (Financial Crimes,…

    Guidehouse (New York, NY)
    …Plan + Group Term Life and Travel Assistance + Voluntary Life and AD&D Insurance + Health Savings Account, Health Care & Dependent Care Flexible Spending ... covering transaction monitoring, sanctions compliance, KYC/CDD, blockchain analysis, and fraud prevention solutions. + Work on technical projects that evaluate,… more
    Guidehouse (10/12/24)
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  • Sr. Quantitative Analytics/Modeling Consultant…

    PNC (Pittsburgh, PA)
    …rigorous independent reviews of some of PNC's most important models including fraud models, anti-money laundering models, as well as various types of ... machine-learning models. Key Responsibilities: 1. Independent Model Review : Perform qualitative and quantitative assessments of all aspects of models including data… more
    PNC (09/21/24)
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  • Audit Evaluation & Review Analyst - 1

    MyFlorida (Miami, FL)
    AUDIT EVALUATION & REVIEW ANALYST - 41000827 1 Date: Oct 11, 2024 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... of the Attorney General Working Title: AUDIT EVALUATION & REVIEW ANALYST - 41000827 1 Pay Plan: Career Service...the Office of the Attorney General within the Medicaid Fraud Control Unit in Miami, Florida and involves auditing… more
    MyFlorida (10/13/24)
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  • Assistant Director of Nursing (ADON) RN

    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
    Bear Mountain Health Care (10/02/24)
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  • Executive Director, Office of Mail Renewal (OMR),…

    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
    City of New York (10/25/24)
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  • Management Review Specialist - SES

    MyFlorida (Tallahassee, FL)
    MANAGEMENT REVIEW SPECIALIST - SES - 60072435 Date: Oct 28, 2024 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... . Requisition No: 840111 Agency: Children and Families Working Title: MANAGEMENT REVIEW SPECIALIST - SES - 60072435 Pay Plan: SES Position Number: 60072435… more
    MyFlorida (10/29/24)
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  • Health Care Coordinator 2 - Nurse

    State of Nevada (NV)
    care to Medicaid eligible clients to validate and ensure adequacy of services and resident care . Review health care providers and fiscal agents to ... generated reports in order to identify abuse and potential fraud and to ensure claims were paid properly by... review programs and participate in program development. Health Care Coordinators in this position use… more
    State of Nevada (11/02/24)
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  • Health Care Coordinator 3 - Nurse

    State of Nevada (NV)
    care to Medicaid eligible clients to validate and ensure adequacy of services and resident care . Review health care providers and fiscal agents to ... generated reports in order to identify abuse and potential fraud and to ensure claims were paid properly by...and review complex cases with lower level Health Care Coordinators. In addition to ongoing… more
    State of Nevada (10/23/24)
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  • Health Care Coordinator 3 - Nurse…

    State of Nevada (NV)
    care to Medicaid eligible clients to validate and ensure adequacy of services and resident care . Review health care providers and fiscal agents to ... generated reports in order to identify abuse and potential fraud and to ensure claims were paid properly by...and review complex cases with lower level Health Care Coordinators. In addition to ongoing… more
    State of Nevada (09/21/24)
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  • Health Care Services Trainee - Grand…

    State of Colorado (Grand Junction, CO)
    Health Care Services Trainee - Grand Junction Regional Center (Western Slope) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4668902) Apply ...  Health Care Services Trainee - Grand Junction...check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure requirements),… more
    State of Colorado (09/24/24)
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  • Customer Solution Center Appeals and Grievances…

    LA Care Health Plan (Los Angeles, CA)
    …for Centers for Medicare and Medicaid Services (CMS), Department of Health Care Services (DMHC), and external review organization (QIO or IRE). Process the ... Range: $67,186.00 (Min.) - $87,342.00 (Mid.) - $107,498.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created by the state… more
    LA Care Health Plan (11/04/24)
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