- Citizens (Johnston, RI)
- …and engage with business partner in related functional areas associated with fraud and claims investigations + Identify and recommend opportunities for ... Description Private Operations is committed to delivering a best-in-class experience...detection, investigation, recovery, and government or internal reporting of fraud and claims activity + Make decisions… more
- Wells Fargo (Wilmington, DE)
- …Internal Fraud Analytics Team. A part of the Chief Operating Office under Fraud and Claims Operations , the team provides analytic support and internal ... this role:** Wells Fargo is seeking a Senior Lead Analytics Consultant for the Enterprise... fraud detection capabilities for the Enterprise Internal Fraud program. Learn more about our career areas and… more
- Cambridge Savings Bank (Waltham, MA)
- POSITION: Fraud Operations Analyst Summary: At Cambridge Savings Bank, our purpose is to have a positive impact on our customers, employees, and community's ... having a strong commitment to diversity and inclusion. The Fraud Operations Analyst is responsible for supporting...contacts including law enforcement. + Experience in investigative tactics, fraud analysis, claims , and recovery process. +… 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
- USAA (Charlotte, NC)
- …complex healthcare fraud investigation reviews. + Knowledge of health insurance claims operations , particularly Medicare Supplement claims handling (eg, ... + Serves as the primary point of contact within Claims and Fraud for medical trends research...with senior leaders and staff to establish claims and fraud waste and abuse philosophy,… more
- Regions Bank (Charlotte, NC)
- …and/or decision-making purposes. Focusing on day-to-day deliverables, this role works with senior analysts and managers to gather and interpret data for leaders to ... and self-motivation **Highly Preferred Skills:** + **Previous experience with claims management or claims data analytics** +...Tools such as: Power Bi, Tableau, Qlik, etc.** + ** Fraud experience** _*This position may be filled at a… more
- OneMain Financial (Baltimore, MD)
- … Fraud Challenge o Ability to discuss feasibility and appropriateness of high dollar Fraud claims with Customers o Ability to differentiate Fraud types ... The Claims Analyst/ Investigator has an above average understanding,...a fast-paced and high-volume environment to support and assist Fraud Managers and Senior Investigators in detecting… more
- DXC Technology (Des Moines, IA)
- **Job Description:** + We are seeking a skilled Life Insurance Claims Manager to support multiple BPS clients and ensure the accurate and efficient processing of ... claims . In this role, you will oversee the entire...business process transactions and teams, ensuring efficient and compliant operations .* Implement process improvements to drive productivity and quality… 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
- VNS Health (Manhattan, NY)
- …Health pays our providers appropriately and contains cost. + Investigates utilization and claims coding patterns to identify potential fraud , waste or abuse and ... with payment recoveries disseminating findings for affordability initiatives. Conducts analysis of claims and payment data across health plans in support of ensuring… more
- Otsuka America Pharmaceutical Inc. (Washington, DC)
- …and caregivers). + Regularly presents strategic plans and policy updates to senior executives, including the CEO, head of Market Access, and Commercial leads. ... FDA, PBM reform, 340B reform), the potential impact on Otsuka's business and operations , and possible strategies to prepare the business. + Co-Leads internal IRA… more
- Ankura (New York, NY)
- …Life Sciences sector in matters relating to compliance with the federal False Claims Act; Anti-Kickback Statute; Food Drug and Cosmetic Act; Department of Justice ... guidance; and international compliance standards governing pharmaceutical and medical device operations . You will be joining a team of industry experts with… more
- Walmart (Bentonville, AR)
- …you'll do ** **Position Overview:** The Supply Chain Asset Protection Divisional ** Senior Manager** of Grocery Automation will play a critical role in overseeing ... including inventory, equipment, and facilities. Implement strategies to prevent theft, fraud , and other security risks. + **Compliance:** Ensure all operations… more
- Bausch Health (Bridgewater, NJ)
- …Access Analytics within Bausch Health's Commercial Insights, Analytics & Operations department. Responsibilities: + Provides market insights across all therapeutic ... areas by utilizing knowledge of the Market Access landscape, PlanTrak data, Patient Claims data, and Formulary data. + Conducts analytics in Market Access space… 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
- Walmart (Olathe, KS)
- …process to consistently protect the company's interests, with regards to claims management). Maintain and continuously improve operations standards. Gauge ... on the most significant problems to maximize efficiency gains. Measure standardized operations ; find inefficiencies caused due to systems, tools, processes and work… more
- Leonardo DRS, Inc. (San Diego, CA)
- …standards of conduct to include: conflicts of interests; improper practices; liabilityand fraud + Understand contract design and structure to include: FFP; CPIF; ... IT utilization through electronic commerce and ERP/Oracle implementation + Provide claims and litigation support involving ASBCA and USCFC + General business… more
- EFI Global (Tallahassee, FL)
- …analysis and engineering projects for clients.** **Collaborates with sales and operations managers, architects, developers, insurance adjusters, claims managers ... decades, we have grown from a boutique firm specializing in handling insurance fraud and arson cases and providing expert witness testimony, into a recognized global… more
- Regions Bank (Atlanta, GA)
- …of supervisory/management experience **Preferences** + Bachelor's degree + Financial Crimes/ Fraud Operations experience **Skills and Competencies** + Ability ... Operations , including but not limited to monitoring, investigating, and resolving fraud alerts/ claims for credit/debit cards, checks, online banking, and/or… more
- AAA Mid Atlantic (Wilmington, DE)
- …in place. + Assists with investigations into Workers Compensation and general liability claims , vehicle accidents and fraud with Corporate Legal, Internal Audit, ... Club Alliance (ACA) is hiring for a Director, Facilities Operations to join our team! What We Offer You:...+ Establishes, implements, and monitors incident response to theft, fraud , and other criminal behaviour. Provide guidance to the… more
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