- Wells Fargo (San Antonio, TX)
- …or consultants, and engage management, vendors or related functional areas associated with fraud and claims investigations and detections + Identify and ... **About this role:** Wells Fargo is seeking a Fraud & Claims Operations Manager...in hiring talent **Required Qualifications:** + 4+ years of Fraud Claim Investigations /Detections or Policy Violations, Risk… 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
- Citizens (Westwood, MA)
- Description The Manager of Fraud Risk Oversight will support the independent Risk Oversight of the Fraud and Claims divisions and all aspects of Fraud ... including the effectiveness of Fraud Strategy/Analytics, the efficiency of Fraud Alert Review and Investigations and effectiveness of Front-Line Controls… 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
- 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
- Walmart (Prince George, VA)
- …with specific types of tools used for theft prevention Conducts investigations Recognizes and investigates security breaches thefts shortages loss and vandalism ... management Responds to inquiries by regulatory authorities Consults on complex claims and settlements Designs preventative claims management processes for… 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
- 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
- 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
- Elevance Health (Grand Prairie, TX)
- …+ Reviews provider medical record documentation to determine if there is potential fraud , waste, or abuse that warrants further investigations . + Conducts ... audits, and participates in developing an investigation team that focuses on potential fraud , waste and abuse in the provider population. **How will you make an… 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
- 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
- CVS Health (Hartford, 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 (Somerset, PA)
- … investigations including, but not limited to: Internal/External theft, fraud , falsification of company records, misappropriation of company assets, safety ... employees, building, product, supplies, etc.), conducting internal and external investigations , overseeing Environmental Health and Safety programs, conducting operational… more
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