- Zurich NA (Washington, DC)
- 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
- Elevance Health (Hanover, MD)
- …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
- Elevance Health (Hanover, MD)
- …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
- Travelers Insurance Company (Hunt Valley, MD)
- …. Coordinate medical and indemnity position of the claim with a Medical Case Manager . Independently handles assigned claims of low to moderate complexity where ... all offset opportunities, including apportionment, contribution and subrogation. Evaluate claims for potential fraud .Proactively manage inventory with documented… more
- Elevance Health (Hanover, MD)
- …for identifying issues and/or entities that may pose potential risk 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
- Ankura (Washington, DC)
- …involving False Claims Act, Anti-kickback, Stark, and FDA disputes and investigations . We work with Chief Compliance Officers to build and mature their ... innovation and growth. Practice Overview Ankura's Health Care Disputes, Compliance and Investigations practice advises outside counsel and their clients on a wide… more
- Elevance Health (Washington, DC)
- …identification, investigation and development of complex cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on ... fraudulent claims . Health insurance experience required with understanding of health...Responsible for independently identifying and developing enterprise-wide specific healthcare investigations and initiatives that may impact more than one… more
- US Capitol Police (Washington, DC)
- …(CISSP), Certified Public Accountant (CPA), Certified Internal Auditor (CIA), Certified Fraud Examiner (CFE), or Certified Government Financial Manager (CGFM). ... oversight responsibility includes conducting and reporting on audits, inspections, investigations , and special inquiries of all USCP organizational entities. These… more