- Wells Fargo (Charlotte, NC)
- …all begins with you. **About this role:** Wells Fargo is seeking a Senior Fraud & Claims Operations Representative in Account Takeover Operations as ... a part of Detection Operations within Fraud & Claims Management. Learn more about the career areas and lines of business at wellsfargojobs.com… more
- USAA (Tampa, FL)
- …resolution in support of risk-based assurance and advisory engagements of Bank Fraud Management, Dispute Operations , and general banking engagements involving ... Come be a part of what makes us so special! **The Opportunity** As a dedicated ** Senior Auditor,** you'll perform internal audit assignments. Identify problems for… more
- USAA (Plano, TX)
- …As a dedicated ** Senior ** **Audit Manager,** you'll manage Bank Fraud Management, Dispute Operations , and general banking engagements involving ... the development and implementation of a risk-based audit plan for Bank Fraud ( Operations , Investigations, Disputes, Detection). Serves, and/or partners with… more
- USAA (Phoenix, AZ)
- …with IT, analytics, and projects and reviewing work papers. May lead Bank Fraud Management, Dispute Operations , and general banking engagements involving ... fraud as Auditor-In-Charge (AIC). Continuously enhances knowledge of fraud , financial crimes, and related consumer regulations and applies that knowledge to audit… more
- Citigroup (San Antonio, TX)
- The Ops Sup Sr. Manager is a senior management level position responsible for accomplishing results through the management of a team or department in an effort to ... provide operations support services in coordination with the ...of judgement and autonomy. + Acts as SME to senior stakeholders and /or other team members. + Ability… more
- The Cigna Group (Bloomfield, CT)
- The Claims Strategy and Payment Integrity Senior ...a small team and report directly to the IFP Senior Director of Operations . The role is ... experience, including a minimum of 5 years' experience in ACA Claim Operations and/or Payment Integrity functions, such as claims editing, claim coding,… 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
- USAA (Tampa, FL)
- …Senior ** that will support Medicare Supplement Claims for USAA Life Company Claims Operations . This employee will report to the Life Company Chief ... Claims & Fraud Officer and will work on Medicare Supplement Claims activities and ensure a flawless execution of business-related processes, procedures,… more
- CVS Health (Hartford, CT)
- …+ Review pre-specified claims for potentially fraudulent activity and return those claims to the claim operations team for proper adjudication. + Responsible ... prevent, detect and investigate known or suspected acts of fraud , and acts of a criminal nature that involve...state timelines requirements **Required Qualifications** + 2+ years of claims processing or prior medical claim analyst experience. +… 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
- Citigroup (Florence, KY)
- …development of advanced statistical models + Proven experience in the Investigation and Fraud claims process + Experience in trend analysis and data knowledge ... The Fraud Ops Sr Analyst is a senior...Family Group:** Operations - Services **Job Family:** Fraud Operations **Time Type:** Full time **Primary… more
- Bank of America (Richmond, VA)
- …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 ... upon request for candidates taking part in the selection process. AXIS Capital Claims Compliance Specialist, Claims Shared Services- Job Description AXIS is… 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
- USAA (Orlando, FL)
- …you will help protect USAA and our members from potential fraudulent claims by investigating complex fraud investigations with significant financial impact ... position. **What you'll do:** + Leads the execution of fraud prevention strategies and investigative operations . +...knowledge of state laws and regulations pertaining to insurance fraud in investigating claims . + Processes large… more
- CareFirst (Columbia, 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
- 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
- JPMorgan Chase (Wilmington, DE)
- … & Customer Protection Services (FCPS) Operations organization. FCPS consists of Fraud Prevention and Claims & Dispute Call Centers and Back office functions ... located across domestic and international locations. As a Senior Analytics Solutions Associate in our Fraud ...and decision quality. You will collaborate with leaders across Fraud Operations , Risk, Product and Controls to… more