- Capital One (Richmond, VA)
- …United States of America, Richmond, Virginia Manager, Operations Servicing Strategy, Fraud and Disputes Claims Experience (Hybrid) As a **Manager, ... Operations Servicing Strategy, Fraud and Disputes Claims Experience** , you...and improving processes + Create and deliver presentations to senior management. Guide and influence senior management… more
- Humana (Indianapolis, IN)
- **Become a 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 and detect potential FWA activities pursuant to… more
- Fallon Health (Worcester, MA)
- …in the healthcare industry. **Experience:** + Advanced knowledge of FWA operations , fraud investigation and/or detection and analysis, and laws/regulations ... summary of purpose:** Under the general direction of the Senior Internal Audit Manager, theAnalyze and interpret patient medical...to FWA investigations Compare to information submitted on the claims in order to determine amount and nature of… more
- Bank of America (Charlotte, NC)
- …key stakeholders in product, strategy, servicing, detection, authentication, operations , and claims , and review and understand the latest fraud trends and ... risk leadership to drive performance. This role will conceptualize, design and implement fraud prevention, fraud detection, and claims strategies; understand… more
- Bank of America (Tampa, FL)
- …key stakeholders in product, strategy, servicing, detection, authentication, operations , and claims , and review and understand the latest fraud trends and ... Fraud Analytics and Innovation Leader - Check &...with key stakeholders in product, strategy, servicing, detection, authentication, operations , and claims . **Responsibilities:** + Coordinates with… more
- Truist (Charlotte, NC)
- …which support fraud management practices, and the operational execution of claims handling, alerts management, and investigations of fraud and suspect ... for the overall planning, administration, coordination and general management of Fraud and Transaction Services functions. Leads the oversight and end-to-end… more
- Bank of America (Plano, TX)
- …metrics to identify root causes ▪ Basic understanding of 1st and 3rd party fraud ( claims to charge-off timing, chargeback recovery rights, etc.) ▪ Proven strong ... Consumer Product Strategy Analyst III - Digital Fraud Strategies Analyst Charlotte, North Carolina;Belfast, Maine; Plano,...the production of product performance reports and updates for senior management LOB Job Description: As a Client Protection… more
- Axis (New York, NY)
- …other departments and stakeholders (eg, Legal & Compliance, Internal Audit, Finance, North America Claims and Claims Operations etc.) to ensure that Quality ... part in the selection process. AXIS is seeking a Claims Quality Assurance & Audit Coordinator, Claims ...Medicare reporting program. * Assisting with maintenance of SIU, Fraud reporting and other Compliance reporting and procedures as… more
- DXC Technology (Baton Rouge, LA)
- …excellence for our customers and colleagues at DXC.com. This position is a for a Senior Business Analyst to join our Assure Claims Delivery team and work ... (NYSE: DXC) helps global companies run their mission critical systems and operations while modernizing IT, optimizing data architectures, and ensuring security and… more
- Catholic Health Services (Melville, NY)
- …Job Details Under minimal supervision, formulates and defines Resolute Hospital Billing/ Claims scope and objectives through research and fact-finding to develop or ... will be implemented. Builds, tests, documents and maintains the EPIC Resolute Hospital Billing/ Claims program. Is competent to work on all phases of Epic Resolute… 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
- 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
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …all clients benefit documentation into an internal source document and work with IT and Operations to ensure claims are properly coded into the claims ... into an internal source document. Primary Responsibilities + The Senior Benefits Analyst's job responsibilities include, but are not...benefits and plan rules, as well as ensure internal claims system is correctly adjudicating claims . +… more
- Elevance Health (MD)
- **Clinical Provider Auditor Senior ** **Supports Payment Integrity line of business** _Location: This position will work a hybrid model (remote and office). The ideal ... eliminate and prevent unnecessary medical-expense spending. The **Clinical Provider Auditor Senior ** is responsible for identifying issues and/or entities that may… more
- Wellpath (Nashville, TN)
- …world, one patient at a time. **How you make a difference** The Senior Vice President, Associate General Counsel, Risk Management and Litigation provides strategic ... 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. ... payments. The coding specialist will conduct pre-payment reviews of claims submitted by providers and members to determine if...waste, and abuse. The Unit includes a team of Senior managers, data analysts, fraud investigators, certified… more
- Leonardo DRS, Inc. (Bridgeton, MO)
- …Louis area. **Job Summary** Leonardo DRS Land Systems is seeking a full time Senior Program Financial Analyst for our Bridgeton, MO facility. This role will analyze, ... (EAC), variance analysis, workforce projections and the revenue/profit forecasting. The Senior Program Financial Analyst will provide support to the Program… more
- Prime Therapeutics (Columbus, OH)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Senior Internal Auditor - SOC1 - Remote **Job Description** The Senior Internal ... projects that provide independent, objective assurance over the organization's operations . This position assesses compliance with internal policies and procedures,… more
- Abbott (Santa Clara, CA)
- …to health care professionals and reimbursement by government programs, for example, fraud and abuse (Anti-Kickback Statute, False Claims Act), FDA regulation ... medicines. Our 114,000 colleagues serve people in more than 160 countries. ** Senior Counsel, Commercial - Structural Heart** **The Opportunity** This position works… more
- Deloitte (San Francisco, CA)
- …Infrastructure and Capital Projects practice. We are seeking individuals at the Senior Consultant level to join our Infrastructure & Capital Projects practice. ... across many different industries and with colleagues from around the globe. As a Senior Consultant in our practice, you will: + Provide expert guidance to clients on… more
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