- Collectors Holdings, Inc. (Santa Ana, CA)
- …process through effective communication via both phone and email. You'll report to the Claims Manager and work from our Santa Ana, CA corporate headquarters. ... Toronto, Guadalajara, Dallas, and Paris. We're looking for a Claims Investigator to join our Collectors Claimsteam, providing essential...the cause of any damage. Conduct chain of custody investigations to trace each stage of an item's handling,… more
- Citizens (Pittsburgh, PA)
- …regulations and standards. Qualifications: + Experience: Extensive experience in either fraud detection management, fraud investigations , strategy or ... Description Job Title: Senior Fraud Operations Manager - OLB and...OLB and Mobile Fraud Detection Description: Citizens Fraud & Claims Organization is seeking a… more
- Humana (Montpelier, VT)
- …a part of our caring community and help us put health first** The Special Investigations Unit Manager leads and monitors investigations of allegations of ... fraudulent and abusive practices. The Manager , Fraud and Waste works within specific...schedules and goals. **Where you Come In** The Special Investigations Unit Manager assists coordinating investigation with… more
- State of Colorado (Denver, CO)
- …embezzlement of patient trust funds). This position may also be assigned to civil investigations in support of the Colorado False Claims Act. Additionally, the ... Medicaid Fraud Investigator (Special Agent III) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5057010) Apply Medicaid Fraud Investigator… more
- Elevance Health (Chicago, IL)
- …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 - Registered Nurse and CPC...prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new… more
- Capital One (Richmond, VA)
- …to include Fraud Strategy and Prevention, Fraud Investigations , Claims and Disputes. **The Senior Manager supports the line of business by:** + ... Senior Manager , Compliance Advisor - Retail Bank The Senior Manager , Compliance Advisor - Retail Bank performs a key risk management role (second line of… more
- ICF (Baltimore, MD)
- …detect fraud , waste, and abuse, and in support of ongoing healthcare fraud investigations by internal staff and law enforcement. + Collaborate with ... deep understanding of healthcare data systems, Medicare and Medicaid claims , and the government's healthcare fraud , waste,...CMS fraud workflow and processes for healthcare fraud investigations , such as contractors for the… more
- MyFlorida (Fort Lauderdale, FL)
- …law enforcement experience, or five (5) years of work experience conducting healthcare fraud investigations . Note: All newly hired employees must obtain CJSTC ... Statutes. These matters include but are not limited to: fraud against the Medicaid Program, false claims ...work which may include performing all aspects of Medicaid fraud investigations . This work includes but is… more
- Centene Corporation (Indianapolis, IN)
- …program integrity and disclosure requirements. Develop, implement and manage strategic fraud , waste and abuse activities by maintaining state and federal ... Medicaid product lines. + Safeguard against the potential for fraud , waste and abuse and coordinate with, the Special..., waste and abuse and coordinate with, the Special Investigations Unit and state agencies to promptly investigate reports… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …FWA investigations and audits; or five years of insurance claims investigation experience or professional investigation experience with law enforcement agencies; ... for the accurate and thorough clinical investigation of potential fraud , waste and abuse (FWA) for all lines of...and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. +… more
- Parsons Corporation (Centreville, VA)
- …looking for. **Job Description:** Parsons is looking for an amazingly talented **SH&E Systems Manager ** to join our team! In this role you will get to provides ... and timely case management. + Initiates and conducts thorough incident investigations and root cause analyses using defensible protocols. Works collaboratively with… more
- Travelers Insurance Company (Meridian, ID)
- …. 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… more
- Travelers Insurance Company (Richmond, VA)
- …. 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
- CDM Smith (Raleigh, NC)
- …CDM Smith is seeking a Forensic Accounting Specialist with expertise in disaster fraud claims . This role is critical in evaluating and analyzing financial ... data related to disaster-related claims , including property damage, business interruption, and other loss...other loss categories. The specialist will conduct thorough forensic investigations to identify discrepancies, detect potential fraud ,… more
- Elevance Health (Norfolk, VA)
- …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
- Elevance Health (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
- CVS Health (CT)
- …within the Special Investigations Unit (SIU) plays a key role in supporting fraud , waste, and abuse investigations by managing and responding to Requests for ... best practices. The analyst will also provide **leadership support** to the Manager by assisting with team coordination, reporting, and strategic planning efforts.… more
- CVS Health (FL)
- …develop, and maintain complex data analyses to support investigations of potential fraud , waste, and abuse in Medicaid claims and provider activity. + ... who can transform complex healthcare data into actionable insights to support fraud , waste, and abuse (FWA) detection and Medicaid regulatory & compliance reporting.… more
- Elevance Health (Indianapolis, IN)
- …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
- Walmart (Battle Ground, WA)
- …violations of company policies and criminal activities by investigating alleged fraud and other alleged illegal activities conducting investigations relating ... facility level training and execution of asset protection safety functions and claims and receiving procedures by reviewing the application of policies procedures… more
