- Fallon Health (Worcester, MA)
- …leadership of the Fraud , Waste and Abuse (FWA) program. The FWA Manager will be responsiblefor general supervisionover a number of staff engaged in FWA auditing ... fraud investigation and/or detection and analysis, and laws/regulations related to fraud and general risk management.Medical claim terminology, coding, and… more
- Elevance Health (Washington, DC)
- **Nurse and CPC - Clinical Fraud Investigator II - SIU Fraud & Abuse** **Location:** This position will work a hybrid model (remote and office). The ideal ... **Hybrid Workplace Strategy:** 1-2 days in office per week The **Clinical Fraud Investigator II** is responsible for identifying issues and/or entities that may… more
- AIG (Lenexa, KS)
- At AIG, we are reimagining the way we help customers to manage risk . Join us as a Claims Examiner IV, Accident & Health to play your part in that transformation. ... the team. Make your mark in Accident and Health Claims Our Claims teams are the proven...pursue subrogation where warranted. + Recognize and make appropriate Risk and Fraud referrals. + Handle high… more
- AIG (Lenexa, KS)
- At AIG, we are reimagining the way we help customers to manage risk . Join us as a Claims Examiner II, Accident & Health to play your part in that transformation. ... Recognize and pursue subrogation where warranted and make appropriate Risk and Fraud referrals. + Increased responsibility...+ Increased responsibility with an expectation of managing higher claims volumes and assist manager with customer… more
- Catholic Health Services (Melville, NY)
- …escalates to the team manager . Works with the Patient Financial Systems Manager to actively resolve issues and apply risk mitigation strategies Ability to ... Job Details Under minimal supervision, formulates and defines Resolute Hospital Billing/ Claims scope and objectives through research and fact-finding to develop or… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …as a result of claims audit or investigation. + Maintains awareness of fraud , waste and abuse laws and regulations and current industry changes that may impact ... clinical and operational excellence. **Summary** Works collaboratively with the Compliance Manager on creating auditing protocols which align with Bon Secours Mercy… more
- CareOregon (Portland, OR)
- …+ Support the Director of Compliance and Quality Oversight with the Compliance, fraud , waste, and abuse and Enterprise Risk Management process. + Manage ... 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
- AIG (Atlanta, GA)
- Make your mark in Claims Our Claims teams are the...create an impact As Claim Intake Department (C ID) Manager , you will be responsible for managing a staff ... and showcasing our service differentiation to create an unparalleled global claims handling experience. Through a robust stakeholder feedback loop and supported… more
- RELX INC (Duluth, GA)
- …. You can learn more about LexisNexis Risk at the link below. https:// risk .lexisnexis.com/insurance About the team: Claims Record Unit (CRU) is a division of ... About the business: LexisNexis Risk Solutions is the essential partner in the...use these records to aide in the adjudication of claims . We process 8 million requests annually and foster… more
- Sedgwick (Dallas, TX)
- …subrogation, fraud evaluation or case management review to resolve claims . + Establishes and maintains effective relationship with internal and external ... Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Account Manager **PRIMARY PURPOSE** **:** To manage claim caseload of basic to highly… more
- CVS Health (Columbus, OH)
- … claims processing, and regulatory requirements related to healthcare fraud . Proficient in researching information and identifying information resources AAPC ... more personal, convenient and affordable. The Special Investigations Unit is seeking a Manager to lead our team of Certified Professional Coders (CPC). The … more
- Walmart (Lebanon, PA)
- …process design. Interprets and evaluates compliance status reports and relevant risk management practices. Assists in the development of company policies, practices, ... management. Responds to inquiries by regulatory authorities. Consults on complex claims and settlements. Designs preventative claims management processes (for… more
- Zurich NA (Columbus, OH)
- …potential subrogation and fraud . + Contributing to profitable growth by providing risk insight, information and trends to Business Unit or customer as needed. + ... a Property Executive General Adjuster to support our Property Claims division. At Zurich North America Claims ...assigned to outside contractors. Depart from approved vendors with manager approval, where in the best interests of the… more
- American Express (Phoenix, AZ)
- …is a challenge we gladly accept. Whether you're finding new ways to prevent identity fraud or enabling customers to start a new business, you can work with one of ... and define your own path. Find your place in risk and analytics on #TeamAmex. **How will you make...associated with new products and features, review of marketing claims and disclosures, procedures, training, and other business-owned collateral.… more
- RELX INC (Alpharetta, GA)
- About the Business LexisNexis Risk Solutions is the essential partner in the assessment of risk . Within our Insurance vertical, we provide customers with ... with advanced technology and analytics to assist them in evaluating and predicting risk and enhancing operational efficiency. Our insurance risk solutions help… more
- Lifetime Assistance, Inc. (NY)
- …with workers' compensation laws and regulations. + Maintain accurate, confidential records of claims . + Monitor claims for fraud and policy alignment. ... 8am-1pm. This is a fully in-office position. Reports To: Sr. Benefits Manager Why Join Lifetime Assistance, Inc.? At Lifetime Assistance, Inc., we're committed… more
- Travelers Insurance Company (New York, NY)
- …specific activities required to effectively evaluate claims , such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators, and other ... resolving assigned Specialty Liability Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim life...facts or allegations of each case. + Consults with Manager on use of Claim Coverage Counsel as needed.… more
- Travelers Insurance Company (Melville, NY)
- …specific activities required to effectively evaluate claims , such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators, and other ... assigned Specialty Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim life...facts or allegations of each case. + Consults with Manager on use of Claim Coverage Counsel as needed.… more
- Travelers Insurance Company (Melville, NY)
- …internal and/or external resources for specific activities required to effectively evaluate claims , such as Subrogation, Risk Control, nurse consultants nurse ... reserving, negotiating and resolving assigned serious and complex Specialty claims . Provides quality claim handling throughout the claim life...facts or allegations of each case. + Work with Manager on use of Claim Coverage Counsel as needed.… more
- Travelers Insurance Company (Tampa, FL)
- …specific activities required to effectively evaluate claims , such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators, and other ... Auto and Homeowner related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim life...facts or allegations of each case. + Consults with Manager on use of Claim Coverage Counsel as needed.… more