- 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
- USAA (Phoenix, AZ)
- …NC, or Tampa, FL. Relocation assistance is not available for this position. The Senior Data Scientist - Fraud Identity Analytics is responsible for development ... of Fraud Identity Analytics and Director of Fraud Model Management and Model Users on...and graph techniques to identify criminal networks engaging in fraud , scams, disputes/ claims and AML and deliver… more
- Optum (San Juan, PR)
- …accuracy. They must demonstrate an ability to maneuver through all applicable claims applications (COSMOS, UNET, Facets, Pulse, etc.), and over 19 internal ... medical records / documentation on a daily basis to understand historical claims activity, determine validity, and demonstrate their ability to provide written or… more
- Crossmint (Brooklyn, NY)
- …any payment at any point during your interview process. Please stay vigilant about potential fraud . If you receive an email that claims to be from Crossmint but ... City or Miami Type of Employment Full-time Salary range Senior level: $190,000 - $200,000 Principal level: $215,000 -...during the interview process. Seniority 5+ years of product management experience, with a strong track record in driving… more
- EPIC Brokers (San Francisco, CA)
- …of a wide variety of client questions regarding risk management , coverage/eligibility, contractual issues, and government reporting compliance. Prepares endorsements ... renewal information and obtaining quotes, strategizes with clients (typically senior -level executives and managers), makes recommendations to clients regarding… more
- Adams & Martin Group (Minneapolis, MN)
- …experience to join their busy Real Estate and Construction Practice Group. This senior associate or partner-level role is ideal for someone who thrives in litigation ... payment issues, insurance coverage) and broader commercial litigation such as fraud , defamation, and business torts. Manage commercial litigation matters from… more
- USAA (Phoenix, AZ)
- …or Tampa, FL. Relocation assistance is **not** available for this position. The ** Senior Data Scientist - Fraud Identity Analytics** is responsible for ... of Fraud Identity Analytics and Director of Fraud Model Management and Model Users on...and graph techniques to identify criminal networks engaging in fraud , scams, disputes/ claims and AML and deliver… 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 (Pittsburgh, PA)
- …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
- 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
- Southern California Edison (Rosemead, CA)
- …programs, and 3rd Party Recovery. + Demonstrated proficiency in a variety of Claims Management computer programs and systems. Strong oral and written ... Join the Clean Energy Revolution Become a Senior Workers' Compensation Claims Adjuster at...assigned + May conduct initial/formal investigations with organizational unit management , medical providers, injured workers, and witnesses on complex… 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
- 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
