- CareFirst (Baltimore, MD)
- …both prepayment reviews and/or post-payment investigations. **ESSENTIAL FUNCTIONS:** + Review of medical records and claims. + Investigate potential fraud and ... and/or recuperation of losses to CareFirst through the clinical review of medical records and claims, resulting in the...over- utilization by performing complex medical reviews of claims and… more
- Elevance Health (Columbus, OH)
- …of utilization and/or fraudulent activities by health care providers through prepayment claims review , post payment auditing, and provider record review ... goals, policies and procedures. + Investigates potential fraud and over- utilization by performing the most complex medical reviews via... by performing the most complex medical reviews via prepayment claims review and post payment auditing.… more