- Crawford and Company (Dallas, TX)
- …and ensures proper and timely closing of files. Makes decisions on claims within delegated limited authority. Responsibilities Conducts investigations of ... to, but not exceeding, $2,500 after compensability has been determined. Evaluates medical claims for potential fraud issues, loss control and recovery in… more
- Dick's Sporting Goods (Roosevelt, NY)
- …files for repeat external theft perpetrators and minimize exposure to loss and fraud . This position will further support the District Loss Prevention Manager (s) ... company Loss Prevention programs to ensure compliance. Conduct Loss Prevention assessments/ investigations . Ensure the physical security of the building and Company… more
- Vallarta Supermarkets (Valencia, CA)
- …federal, state, and local laws and regulations. *To manage workers' compensation claims and conduct workplace investigations . Third-Party Collection of Personal ... Title: Security Officer. Classification: Non-Exempt. Reports To: District Security Manager . Job Description: Position Summary: The Security Officer's responsibility… more
- Vallarta Supermarkets (Valencia, CA)
- …federal, state, and local laws and regulations. *To manage workers' compensation claims and conduct workplace investigations . Third-Party Collection of Personal ... Title: Security Officer Classification: Non-Exempt Reports To: District Security Manager Job Description Position Summary: The Security Officer responsibility is… 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
- CNO Financial Group (Carmel, IN)
- …to implement new tools and/or software to advance the maturity of Corporate Investigations & Support, Governance & Oversight and the effectiveness of controls. This ... analyzing data from internal and external sources to proactively identify potential Fraud , Waste, and Abuse (FWA) activity. This role is responsible for initiating,… 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
- 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
- Ankura (Chicago, IL)
- …to Life Sciences clients and external counsel through compliance, disputes, investigations and advisory services. The position has tremendous growth potential with ... be working with practice leadership to provide exemplary compliance, disputes, investigations and litigation support (eg, expert witness) services across the Life… 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
- American Family Insurance - Corporate (Seattle, WA)
- …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
- 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
- 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
