- Allied Solutions (Plano, TX)
- …and exceed all established recovery and claim service standards and benchmarks for a Claims Investigator . + Promptly and effectively respond to both carrier and ... is responsible for the initial setup and investigation of claims prior to the assignment of the claim to...Total Losses ; refer timely and accurately to more senior level adjusting staff for adjudication and collection; +… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** **Position Summary:** The FWA Investigator Coder Sr . Associate is an integral part of the Fraud, Waste & Abuse (FWA) ... with providers, and other CCA departments related to review processes and results. Sr Associate, FWA Investigator Coder utilizes claim analysis, document review,… more
- Elevance Health (Norfolk, VA)
- ** Investigator Sr ** **Schedule:** 1-2 days per week in the office (Hybrid 1) **Location:** This position will work a hybrid model (remote and office). The ideal ... of one of our Elevance Health PulsePoint locations. The ** Investigator Sr .** position is responsible for the...to recover corporate and client funds paid on fraudulent claims . Candidate will need a strong Medicare/Medicaid background with… more
- Elevance Health (Columbus, OH)
- ** Senior Investigator ( Investigator Sr )** _Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 ... to recover, eliminate, and prevent unnecessary medical-expense spending. The ** Senior Investigator ** is responsible for the independent...to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim… more
- State of Massachusetts (Boston, MA)
- …the misuse of public funds, even when no crime or civil action is involved. * Senior Investigator : Position Overview* The Senior Investigator reports to ... case closing reports, and administrative document requests and summonses. Additionally, the Senior Investigator will also recommend improvements to internal and… more
- EFI Global (Edina, MN)
- …requirements for consideration.** **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** **Investigates assigned claims suspected of insurance fraud, this includes large loss, ... large fire loss, and multiple claims .** **Ensures that assigned cases are investigated and reported back to the requesting party in adherence to best practices.… more
- City of New York (New York, NY)
- …in their agreement to repay. Claims &Collection is recruiting for (4) four Fraud Investigator II to function as a Senior Fraud Investigator , who will: - ... Job Description Claims and Collections pursues monetary recoveries owed to...and one year of satisfactory, full-time experience as an investigator as described in "1" above; or 3. A… more
- Manulife (Boston, MA)
- …with all squads to drive savings associated with fraud, waste & abuse. The Senior LTC Investigator will conduct desktop investigations of high complexity related ... to LTC customers on claim. They will assist and support junior investigators on complex cases. The incumbent will also provide insights to Data and AI Team on how to evolve data and consider new data sources to drive a greater degree of fraud detection.… more
- CVS Health (Baton Rouge, LA)
- …to make health care more personal, convenient and affordable. Position SummaryAs a Senior Investigator you will conduct high level, complex investigations of ... intricate healthcare fraud schemes. - Investigates to prevent payment of fraudulent claims submitted to the Medicaid lines of business- Researches and prepares cases… more
- CVS Health (Springfield, IL)
- …make health care more personal, convenient and affordable. Position Summary: As a Senior Investigator you will conduct high level, complex investigations of ... or intricate healthcare fraud schemes * Investigates to prevent payment of fraudulent claims submitted to the Medicaid lines of business * Researches and prepares… more
- State of Colorado (Denver, CO)
- …Unit of the Division of Labor Standards and Statistic is hiring three Senior Compliance Investigator II ("CI II") positions. The Strategic Enforcement Policy ... Labor Law - Compliance Investigator II Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4496216) Apply Labor Law - Compliance Investigator … more
- University of Rochester (Rochester, NY)
- GENERAL PURPOSE: The Equal Employment Opportunity and Title IX Investigator (EEO/Title IX Investigator ) serves as part of a team investigating and resolving ... the University's legal obligations to address discrimination and harassment claims and sexual misconduct. Document findings as to the...Officer and Associate VP for Equity & Inclusion and Sr . Associate Dean for Equity & Inclusion SMD, the… more
- CVS Health (Tallahassee, FL)
- …(8:00 am - 5 pm ET) Conducts high level, complex analysis of claims and correspondence to effectively pursue the prevention, investigation and prosecution of health ... healthcare fraud schemes. - Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, members, etc. - Researches and… more
- CVS Health (Richmond, VA)
- …healthcare fraud cases. - Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, customer members, etc. - Facilitates ... the recovery of company and customer money lost as a result of fraud matters. - Provides input regarding controls for monitoring fraud related issues within the business units. - Delivers educational programs designed to promote deterrence and detection of… more
- Elevance Health (Columbus, OH)
- ** Investigator ll** **Location** : This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance ... Health PulsePoint location. The ** Investigator ll** is responsible for the identification, investigation, and...to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim… more
- Elevance Health (Columbus, OH)
- Job Description ** Investigator II** Schedule: 1-2 days per week in the office (Hybrid 1) **Location:** This position will work a hybrid model (remote and office). ... 50 miles of an Elevance Health PulsePoint location. The ** Investigator II** position is responsible for the identification, investigation...to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim… more
- Elevance Health (Indianapolis, IN)
- ** Investigator II** **Supporting the Payment Integrity line of business** _Location: This position will work a hybrid model (remote and office). The ideal candidate ... to recover, eliminate and prevent unnecessary medical-expense spending. The ** Investigator II** is responsible for the identification, investigation and development… more
- Aflac (GA)
- Investigator I (Bilingual Preferred) The Company: Aflac Columbus The Location: GA, US, 31999 The Division: Compliance Job Id: 6317 Salary Range: $42,000 - $98,000 ... written, and interpersonal communication skills to effectively interact with senior management, internal and external customers, and agency representatives Education… more
- City of New York (New York, NY)
- …Safety seeks to hire an Environmental, Health and Safety Incident/Workplace Violence Investigator located in Flushing, New York. Under general direction, but with ... selected candidate will be responsible for the following: 1) As a lead Investigator or part of an investigation team conduct investigations into incidents such as… more
- Johns Hopkins University (Baltimore, MD)
- …faculty, staff, and students on discrimination, harassment, sexual misconduct and retaliation claims . + Receive complaints from various members of the JHU community ... and educational programs to various University community members, including senior management on discrimination, harassment, sexual misconduct and retaliation. +… more