- CNA (Chicago, IL)
- …works under direct supervision, and within defined authority limits, to manage commercial claims with low to moderate complexity and exposures for Defense Based Act ... (DBA) Workers' Compensation claims . DBA experience is a plus but not required....Exercises judgement to determine liability and compensability by conducting investigations to gather pertinent information, taking recorded statements from… more
- The Travelers Indemnity Company (Downers Grove, IL)
- …. 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
- Syntricate Technologies (San Antonio, TX)
- …execute Fraud Investigation Case consisting of 4 types of investigations : Claims Investigation/Life Annuity Investigation, Financial Crime/ Fraud , ... Medicare Supplement Claims , Overall Life company Product Fraud . Complete Regulatory Reporting Requirements. Develop, maintain, monitor Life company Fraud … more
- Vallarta Supermarkets (Modesto, CA)
- …federal, state, and local laws and regulations. *To manage workers' compensation claims and conduct workplace investigations . Third-Party Collection of Personal ... Description: Title: 3rd Assistant Meat Manager Classification: Non-Exempt 3rd Assistant Meat Manager is responsible for assisting the Meat Manager in… more
- Nationwide Mutual Insurance Company (Columbus, OH)
- …perform other responsibilities as assigned. Reporting Relationships : Reports to Claims Manager . Typical Skills and Experiences: Education: Undergraduate degree ... as Special Investigations and Subrogation may be required to identify fraud or recovery opportunities. Staying current on industry repair practices, local market… more
- Vallarta Supermarkets (Canoga Park, CA)
- …state, and local laws and regulations. 7. To manage workers' compensation claims and conduct workplace investigations . D. Third-Party Collection of Personal ... of day for potential repairs and report need for repairs to Bakery Manager . *Prepare breads, pastries, etc. *Ensure that breads, pastries, etc. are cooked at… more
- Citizens (Boston, 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
- MyFlorida (Tallahassee, FL)
- …broad scope of data analytics to proactively identify qualified leads for potential fraud , waste, and abuse (FWA) investigations . The selected candidate will be ... similar professional medical environment. + Experience in auditing, data analysis, or fraud detection. + Knowledge of claims processing and medical terminology.… more
- Elevance Health (Norfolk, VA)
- …in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to identify ... **Clinical Fraud Investigator Senior** **Location:** _Hybrid1:_ This role requires...prevention and control. + Review and conducts analysis of claims and medical records prior to payment. + Researches… more
- Elevance Health (Gilbert, MN)
- …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
- Truist (Orlando, FL)
- …analytical capabilities. Perform sophisticated analytics and investigations into large dollar claims and overdraft accounts as well as fraud trends through ... review the following job description:** Looking for a strong fraud fighter with experience in Deposit fraud ...work all hours scheduled, including overtime as directed by manager /supervisor and required by business need. **Travel** Minimal and… more
- Corewell Health (Grand Rapids, MI)
- Job Summary - Manager Special Investigation Unit The SIU Manager is responsible for leading and managing the Special Investigation Unit (SIU) with a focus on ... identifying, investigating, and resolving health insurance fraud , waste, and abuse (FWA). This role provides operational oversight to the SIU team, ensuring the… 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
- Peak Vista (Colorado Springs, CO)
- …+ Develops and provides training on the Compliance & Risk Management Programs, HIPAA, Fraud and Abuse, FTCA, False Claims , and other compliance and risk areas ... Manager of Compliance & Risk Summary Title: Manager...monthly, quarterly, and annual C ompliance reports and insurance claims updates for the Board of Directors and provides… more
- Travelers Insurance Company (Irvine, CA)
- …. 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
- 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
- Elevance Health (Hanover, MD)
- …for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. **How will you 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 (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
- Elevance Health (Atlanta, GA)
- …the identification, investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on fraudulent ... claims . **How you will make an impact:** + Claim...+ Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company health… more
- Elevance Health (Metairie, LA)
- …identification, investigation and development of complex cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on ... fraudulent claims . **How you will make an impact:** + Claim...Responsible for independently identifying and developing enterprise-wide specific healthcare investigations and initiatives that may impact more than one… more
