- Wells Fargo (Chandler, AZ)
- **About this role:** Wells Fargo is seeking Fraud & Claims Operations Associate for Cards & Merchant Services (CMS) as part of Consumer Lending. Learn ... policy violations, and merchant disputes with low to high risk within fraud and claims functional area + Review complex transactions and referrals to prevent and… more
- Regions Bank (Hoover, AL)
- …**Job Description:** At Regions, the Financial Crimes Fraud Specialist monitors fraud prevention reports and/or reviews and resolves claims to address ... or other bank products + Identifies valid and fraudulent charges, sets up fraud files, uses multiple research techniques to resolve issues, reconciles and summarizes… more
- Humana (Oklahoma City, OK)
- …us put health first** Humana Healthy Horizons in Oklahoma is seeking a Fraud and Waste Professional 2 who conducts investigations of allegations of fraudulent and ... abusive practices. The Fraud and Waste Professional 2 work assignments are varied...AHFI) + Analytical background + Understanding of healthcare industry, claims processing and investigative process development + Experience in… more
- Raymond James Financial, Inc. (Pittsburgh, PA)
- …institutional, and high-net-worth (HNW) clients.** **Job Summary:** The Senior Wire Operations Associate will deliver high quality customer service and ... time sensitive operations environment. The Senior Wire Operations Associate will conduct all aspects of...status queues. The incumbent will also be responsible for fraud monitoring and investigation, working closely with internal and… more
- Walmart (Greenville, SC)
- …training. Determines training needs. Develops and delivers training as needed. Manages claims and receiving operations by ensuring proper policies and procedures ... and collaborating with all levels of associates regarding store operations , utilizing technology, business initiatives, merchandising, and company direction;… more
- Walmart (Hayward, WI)
- …training needs; and developing and delivering the training where needed. Manages claims and receiving operations by ensuring proper policies and procedures ... violations of company policies and criminal activities by investigating alleged fraud and other alleged illegal activities; conducting investigations relating to the… more
- System One (Baltimore, MD)
- …Baltimore, MD (Hybrid) twice a week Job Duties: + Research provider/subscriber claims activity, operations manuals, data systems, medical policies, job duties ... ALTA IT is hiring an Associate Investigator to support a leading health insurance...losses. You will research and analyze data using company anti- fraud software, Excel, and other tools to proactively identify… more
- Regions Bank (Hoover, AL)
- …of supervisory/management experience **Preferences** + Bachelor's degree + Financial Crimes/ Fraud Operations experience **Skills and Competencies** + Ability ... Operations , including but not limited to monitoring, investigating, and resolving fraud alerts/ claims for credit/debit cards, checks, online banking, and/or… more
- University of Washington (Seattle, WA)
- …an outstanding opportunity for a Director of Clinical Regulatory Affairs and Associate General Counsel to join their team.** **GENERAL DESCRIPTION AND PURPOSE** The ... Director of Clinical Regulatory Affairs (Director), Associate General Counsel for UW Medicine Nonprofit Entities and...This position will advise on all aspects of specific operations , including legal issues related to hospital and medical… more
- CareFirst (Baltimore, MD)
- …billing and/or other related systems and procedures to determine the integrity of claims payments and business operations within CareFirst or previous experience ... and external data bases and systems to support leads. Analyzes detailed claims files and performs financial calculations to assess financial impact of potential… more
- Walmart (Macclenny, FL)
- …Consults on complex claims and settlements. Designs preventative claims management processes (for example, associate engagement efforts, return-to-work ... or More Certifications such as Loss Prevention Certification (LPC), Certified Fraud Examiner (CFE), Associate Safety Professional; Certified Safety Professional;… more
- KPH Healthcare Services, Inc. (Williston, VT)
- …- possibly you! **Job Summary:** + Assist in centralized billing of all claims **Responsibilities** **Job Duties:** + Responsible for accurate data entry of resident ... claim denial on a daily basis + Correct all necessary data + Re-bill claims as needed + Interact with Kinney Employees (Store and Corporate) and various outside… more
- State of Massachusetts (Boston, MA)
- * Claims Examiner/Job Service Representative I| Department of Family & Medical Leave* The Program Integrity Claims Examiner/Job Service Representative I is ... within the Department of Family Medical Leave (DFML). The Claims Examiner/Job Service Representative I will review claims...I, who reports to the Senior Manager of Benefit Operations & Program Integrity is based in Boston, MA,… more
- Millennium Challenge Corporation (District Of Columbia, DC)
- …position is located in the in the Program Financial Services Unit, Sector Operations Division within the Department of Compact Operations , Millennium Challenge ... to implement the program. Ensuring that measures to prevent fraud , waste and abuse are implemented. Coordinating with the...closing date of the announcement. Please note that qualification claims will be subject to verification. Pay: Your pay… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …controls and policies and procedures for both acute and provider Revenue Cycle operations including the development of SOPs. + Develops acute and provider compliance ... Office of Inspector General (OIG), Medicare, State Medicaid, State Insurance Fraud , Managed Care or Governmental Value-Based payment programs or other enforcement… more
- Beth Israel Lahey Health (Burlington, MA)
- …and Revenue Cycle Leadership. 2. Responsible to advise and assist with revenue operations as they relate to Epic build decisions, in-depth analysis of denials, ... appeals, audits, credits, cash, coding, workflows, data collection, report details, claims and remittance set up, logic and processing and applicable technical… more
- The Cigna Group (Bloomfield, CT)
- …dispute decision as it relates to Payment Integrity Program Claim disputes (ie Claims XTEN, Prepay Vendors, etc.). + Utilize clinical data and/or coding guidelines, ... evolving department. + Collaborate with matrixed partners such as Physicians, Operations , Vendors, etc. + Adheres to production and quality metric goals.… more
- First Horizon Bank (Knoxville, TN)
- …This leader oversees direct support staff who handle adjudication of various types of fraud and dispute claims . Direct report associates are responsible for ... ensuring policies, procedures, and other efforts designed to effectively resolve client claims are adhered to without fail. They are also responsible for schedule… more
- MAPFRE Insurance (Webster, MA)
- …Ensure timely and comprehensive responses to complaints with supervisory oversight. + Fraud Identification - Identify potentially fraudulent claims for transfer ... Claim Rep, you will be responsible for adjusting 1st party Express claims for Auto Physical Damage through screening losses, determining coverage exposures, and… more
- Walmart (Bentonville, AR)
- …across platforms. (for example, ensuring that the reason for termination of an associate updated in the system reflects in all upstream and downstream systems to ... ensure claims are processed seamlessly). **Governance & Control:** **Requires knowledge...regulatory; Tax, Transfer Pricing guidelines, international regulatory guidelines + Fraud detection frameworks regarding siphoning of funds, AML, leakage… more