- Eisai, Inc (Nutley, NJ)
- …pharmaceutical laws and industry guidelines including the Anti-Kickback Statute, False Claims Act, federal and state pricing-related laws and regulations, PhRMA Code ... in good standing of a state bar. Strong knowledge of FDA regulatory and fraud and abuse laws and/or pharmaceutical government price reporting laws. Ability to learn… more
- Wells Fargo (Chandler, AZ)
- **About this role:** Wells Fargo is seeking a Lead Analytics Consultant within Fraud & Claims Management (FCM) as part of Consumer and Small Business Banking ... cause analysis in the ACH and on-us check victim fraud space + Consult and perform complex analyses involving...interpreting and presenting results of analyses and recommendations to senior management + Ensure adherence to data… more
- TD Bank (Mount Laurel, NJ)
- …to maximize efficiency, effectiveness and scale + Monitors and communicates to Senior Management the effectiveness of strategies, programs, and practices related ... for this role. **Line of Business:** Financial Crimes & Fraud Mgmt **Job Description:** _The Check Fraud ...in-person office meetings._ **Depth & Scope:** + Provides people management leadership by hiring the best talent, setting goals,… more
- Wells Fargo (Chandler, AZ)
- …is seeking a Senior Lead Analytics Consultant for the Enterprise Internal Fraud Insights and Analysis Team. This role will support the Enterprise Internal ... Fraud (EIF) group in Fraud and Claims Operations. The Insights and...business + Directly interact and engage with independent risk management , legal, employee relations, audit, regulators and peer groups… more
- CVS Health (Hartford, CT)
- …heart, each and every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna ... will manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct high level, complex… more
- Wells Fargo (Charlotte, NC)
- …of management or leadership experience **Desired Qualifications:** + 8+ years fraud and or claims operational management experience supporting large ... **About this role:** Wells Fargo is seeking a Fraud & Claims Operations Director to...systemic transformation initiatives. **Required Qualifications:** + 8+ years of Fraud Claim Investigation or Policy Violations, Risk Management… more
- Citizens (Johnston, RI)
- …Citizens Fraud & Claims Organization is seeking a dynamic and experienced Senior Fraud Operations Manager to lead our OLB and Mobile Fraud Detection ... Description Job Title: Senior Fraud Operations Manager - OLB...fraud operations teams. Key Responsibilities: + Leadership and Management : Lead and manage a multi-state workforce of colleagues,… more
- PenFed Credit Union (Alexandria, VA)
- … Specialist at our Alexandria, Virginia service center. The primary responsibility of the Senior Fraud Specialist (SFS) will be to use sound reasoning and good ... irregularities to verify the accuracy of information. + Resolve fraud claims in accordance with government regulations...writing skills to interact and communicate with coworkers, members, senior management and the general public with… more
- Bank of America (Plano, TX)
- …process gaps and deliver on organizational loss goals. Device and Non Monetary Fraud and Innovation Senior Analyst- This job is responsible for performing ... + Advanced degree in Computer Science, Data Science, Statistics, or related field + Fraud or Claims background with focus on Online Banking, Account Takeover,… more
- City National Bank (Los Angeles, CA)
- …issues that may require ad hoc rule implementation; research and respond to escalated fraud claims ; malware alerts; review of department audit reports and other ... * FRAUD TEAM SUPPORT ANALYST* WHAT IS THE OPPORTUNITY?...support activities defined by management . This position requires subject matter expertise on all… more
- Cambridge Savings Bank (Waltham, MA)
- …audits, process improvement reviews, training events, and preparation for audits or senior management reports. Perform additional duties as required. + Perform ... and external contacts including law enforcement + Experience in investigative tactics, fraud analysis, claims , and recovery process + Experience with gathering,… more
- Kemper (Chesterfield, MO)
- …Operations team that helps support this strategic intent with a direct focus on risk, fraud , and field support management . This role is a great opportunity for ... in Growing for LIFE. **POSITION SUMMARY** : Kemper is seeking a Senior Accident & Health Claims Adjuster to support our organization's Health Claims team. As… more
- The Hartford (CA)
- …Identify and initiate mitigation, subrogation and other recovery opportunities on assigned claims + Identify fraud indicators and initiate investigation on ... open only to candidates who reside in the state of California. As a Senior Workers' Compensation Claim Representative, you are at the front lines for our customer.… more
- Capital One (New York, NY)
- …roadmap for our systems and platforms that power Fraud defenses and Fraud & Disputes claims processing + Partner cross-functionally with client, cloud ... Sr. Distinguished Engineer - Fraud Technology As a Sr. Distinguished Engineer at...on our customers' lives. We are looking for a Senior Distinguished Engineer to define, architect and drive the… more
- MetLife (San Juan, PR)
- …* Effectively and independently manages an assigned caseload of moderately complex claims which consists of pending, ongoing/active and appeal reviews * Provides ... timely, balanced and accurate claims reviews, documentation and recommended decisions in a time...when gathering information during claim evaluations and collaborates with Fraud Waste and Abuse resources as needed. Essential Business… more
- Global Patent Solutions, LLC (Scottsdale, AZ)
- …position will provide oversight, mentoring, and guidance for less senior Investigative Analysts. Specific accountabilities include: * Reviewing incident reports, ... such as fraud and other law violations, strategizing on effective ways...Collecting evidence, including documents and interviews to support their claims and record their findings * Working with attorneys,… more
- USAA (San Antonio, TX)
- …strong track record of communicating results, insights, and technical solutions to Senior Executive Management (or equivalent). + Deep technical skills, ... + ** Claims Domain Expertise** : Proven understanding of end-to-end claims processes, including FNOL, subrogation, fraud detection. + **Leadership** :… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The role of the Special Investigations Unit (SIU) Senior Investigator is to assist in the reduction and recuperation of losses ... the detection, investigation, and resolution of all levels (low to complex), of fraud , waste, and abuse schemes, resulting in the savings and recovery of funds.… more
- CVS Health (Carson City, NV)
- …we do it all with heart, each and every day. The SIU Senior Investigator conducts complex investigations to effectively pursue the prevention, investigation and ... prosecution of healthcare fraud and abuse, to recover lost funds, and to...prepayment environment - Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc. - Researches… more
- Ankura (Chicago, IL)
- …Life Sciences sector in matters relating to compliance with the federal False Claims Act; Anti-Kickback Statute; Food Drug and Cosmetic Act; Department of Justice ... operations, nursing, pharmacy, medical science, economics, accounting, and data science. As a Senior Director, you can expect to: . Demonstrate the highest degree of… more
