- Zurich NA (Boston, MA)
- Claims Fraud and Investigations Manager 117871 Zurich North America is seeking a Claims Fraud and Investigations Manager to support our ... role and can reside anywhere in the United States. The Claims Fraud and Investigations Manager is responsible for managing the daily activities of the … more
- CVS Health (Wellesley, MA)
- … Unit is seeking a Sr. Manager to lead our new ASO investigations team. The Healthcare Fraud Senior Manager is responsible for overseeing ... and external stakeholders and ensuring compliance with regulatory requirements. The Senior Manager develops strategies to mitigate fraud risks, analyzes complex… more
- Bank of America (Boston, MA)
- …to maximize client experience while managing fraud mosteffectively. As a Fraud Strategy Manager with the Client Protection organization, you will capitalize ... fraud prevention methodologies. + Analyze data and conduct investigations to identify patterns, trends, and anomalies indicative of...causes + Basic understanding of 1st and 3rd party fraud ( claims to charge-off timing, chargeback recovery… more
- Elevance Health (Woburn, MA)
- …in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to identify ... **Clinical Fraud Investigator II - SIU Fraud ...prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …its fast-paced and collegial in-house legal department. The attorney will oversee the fraud investigations unit and its work pursuing recoveries for fraud ... in administrative hearings concerning a wide variety of legal claims . The attorney will also interact with other business...abuse activity in FIP, work with the Pharmacy Benefit Manager on fraud waste and abuse work,… more
- Elevance Health (Woburn, MA)
- …for identifying issues and/or entities that may pose potential risks associated with fraud and abuse. **How you will make an impact:** + Examines claims ... relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control. + Reviews and...prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses… more