- CVS Health (Trenton, NJ)
- …innovate and deliver solutions to make health care more personal, convenient and affordable. The Special Investigations Unit is seeking a Manager to lead our ... responsible for overseeing and managing coding reviews for fraud detection, investigation , and prevention efforts to safeguard the organization's resources and… more
- Travelers Insurance Company (Philadelphia, PA)
- …internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit . + ... handling throughout the claim life cycle (customer contacts, coverage, investigation , evaluation, reserving, negotiation and resolution) including maintaining full… more
- NJM Insurance (Trenton, NJ)
- Reporting to the Premium Audit Supervisor, the Premium Audit...if a case warrants investigation by the Special Investigations Unit (SIU). + Prepare ... and issue monthly audit assignments for NJM auditors and independent audit vendors. Include relevant policy information and instructions as required to ensure efficient audit processing. + Identify and process estimated audits for policyholders who are… more
- AmeriHealth Caritas (Newtown Square, PA)
- …our Newtown Square headquarters quarterly **Responsibilities:** Reporting to the Director, Special Investigations Unit , the Manager, SIU Data & Analytics ... a team of data analysts responsible for claim quality analytics and reporting oversight. This position requires complex problem solving skills, the ability to… more