- Blue KC (Kansas City, MO)
- …discount program** **Job Description Summary:** As part of Blue KC's Special Investigations Unit (SIU), the Fraud Investigator conducts reviews to identify ... and other resources for potential FWA schemes. + Conduct investigations of fraud , waste and abuse in...Manager and/or Senior Investigator on larger, more complex, investigations . + Create and maintain detailed case files in… more
- Elevance Health (Atlanta, GA)
- …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
- Bank of America (Jacksonville, FL)
- …enhance fraud prevention methodologies. + Analyze data and conduct investigations to identify patterns, trends, and anomalies indicative of potential fraud ... Fraud Analytics and Innovation Lead Analyst - ...improvements and efficiencies via data analysis. + Partner with claims , policy, strategy, and product teams to deliver data… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Cross and Blue Shield of Minnesota Position Title: Supervisor - Special Investigations Unit Clinical Location: Hybrid | Eagan, Minnesota Career Area: Legal About ... In this position, you will be responsible for the daily supervision of fraud investigation activities including ensuring that key steps are being documented to meet… more
- Zurich NA (Rocky Hill, CT)
- …and internal controls throughout the claims process. + Identify and refer claims with subrogation or fraud potential to the appropriate internal teams for ... organizations. **This role will be filled at either the** **Senior or AVP Claims Professional** **Level.** **The hiring manager will determine the appropriate… more
- Banco Popular Puerto Rico (San Juan, PR)
- … Investigations Manager is responsible for overseeing the Special Investigations unit, which handles inquiries into customer claims , allegations, and ... improvement. Special Investigations & Audit Collaboration + Oversee investigations of customer claims , internal irregularities, and whistle-blower cases,… more
- Lundbeck (Deerfield, IL)
- Manager , Field Compliance Requisition ID: 7092 Location: Deerfield, IL, US Do you want to join a team where the mission is meaningful, the challenges are complex, ... and transform lives. Join us on our journey of growth! **Summary:** The Manager , Field Compliance will support the Director, Field Compliance and Investigations … more
- MyFlorida (Tallahassee, FL)
- …Investigator II performs work that may include performing all aspects of Medicaid fraud investigations . This work includes but is not limited to entering ... Statutes. These matters include but are not limited to fraud against the Medicaid Program, false claims ...or five (5) years of work experience conducting healthcare fraud investigations . Note: All newly hired employees… more
- Tennessee Valley Authority (Chattanooga, TN)
- Program Manager , Fuel Assurance Field Inspector Senior - 517893 Job ID:517893Location:CHATTANOOGA, TNRegular/Temporary:Regular External - Posting Description Program ... Manager , Fuel Assurance Field Inspector Senior - 517893 Organization:...on candidate's duty location). Position Purpose Responsible for monitoring, fraud detection, contractual compliance and efficiency improvement activities related… more
- American Family Insurance - Corporate (Los Angeles, CA)
- …internal and external partners, agents and customers. You will report to a Special Investigations Manager . In this primarily home-based role, you will spend 80% ... You will Investigate low to moderately complex insurance fraud activity involving property claims , develop..., develop meaningful industry social network and assist special investigations leadership in promoting fraud awareness and… 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
- Point32Health (Canton, MA)
- …responsible for conducting high-volume Pre-Payment Fraud Waste & Abuse ("FWA") investigations under the direction of the Manager , FWA Prepayment Review. The ... + Required (minimum): 1-3 years' related experience in health insurance fraud investigations . + Preferred: Related experience in audits/ investigations… more
- Travelers Insurance Company (Indianapolis, IN)
- …. 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
- Travelers Insurance Company (St. Paul, MN)
- …. 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
- Bon Secours Mercy Health (Cincinnati, OH)
- …as a result of claims audit or investigation. + Maintains awareness of fraud , waste and abuse laws and regulations and current industry changes that may impact ... operational excellence. Job Description **Summary** Works collaboratively with the Compliance Manager on creating auditing protocols which align with Bon Secours… more
- Elevance Health (Grand Prairie, TX)
- …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
- Bank of America (Newark, DE)
- … Fraud and claims risk management activities (eg fraud claims , prevention and detection, fraud investigations , etc.). Additional activities would ... and/or front-line wealth management experience + Prior experience in fraud risk management is definitely a plus. **Skills:** +...offered a role with Bank of America, your hiring manager will provide you with information on the in-office… more
- CVS Health (Annapolis, MD)
- …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
- Covenant Health Inc. (Knoxville, TN)
- …organization's management and staff and may participate in requested investigations . Maintains all organizational and professional ethical standards. Works ... Performs other duties as needed. Reports to the Revenue Integrity Manager . Recruiter: Suzie McGuinn || ###@covhlth.com Responsibilities Integrity + Identifies and… more
- Covenant Health Inc. (Knoxville, TN)
- …to the organization's management and staff and may coordinate requested coding investigations . Responsible for education and training for all Covenant coders, CDI, ... initiative and independent judgment. Reports to the Corporate Coding Manager or CFO of CMG as appropriate. Recruiter: Brittany...by CMS and the OIG via the Federal Register, fraud alerts, OIG advisory opinions, and other publications relative… more
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