- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- The Manager , Fraud , Waste & Abuse (FWA) provides leadership and oversight of the FWA area. The position involves the management of the FWA Program in compliance ... the FWA Program and work plan + Lead special investigations + Research, investigate and report fraud ,...and AHCA regulatory requirements + Expertise in FWA, Special Investigations , claims processing, coding and medical terminology… more
- Bank of America (Newark, DE)
- …to maximize client experience while managing fraud most effectively. As a Fraud Strategy Manager with the Client Protection organization, you will capitalize ... fraud prevention methodologies. * Analyze data and conduct investigations to identify patterns, trends, and anomalies indicative of...causes. * Basic understanding of 1st and 3rd party fraud ( claims to charge-off timing, chargeback recovery… more
- Elevance Health (Grand Prairie, TX)
- …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** **Location** : _Hybrid1:_ This role...prevention and control. + Review and conducts analysis of claims and medical records prior to payment. + Researches… more
- Ankura (Washington, DC)
- …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
- Banco Popular Puerto Rico (San Juan, PR)
- …Hybrid Manager I General Description The Continuous Audits & Special Investigations Manager is responsible for leading the Continuous Audits and Special ... with business processes and develop risk mitigation strategies. + Special Investigations : Oversee the investigation of customer claims , allegations, and… more
- Kemper (San Diego, CA)
- …oral and written communications skills and promote a favorable company image to the public. + Fraud Claims Law Specialist (FCLS) or Fraud Claims Law ... SIU Investigator will conduct field as well as desk investigations of insurance claims referred to and...of all critical situations. + Reports findings of all investigations and makes recommendations to the responsible manager… more
- Otsuka America Pharmaceutical Inc. (Princeton, NJ)
- The Sr. Manager Quality Management System is responsible for monitoring the effectiveness of the GxP Quality Management Systems regarding CAPA, Deviations, ... Investigations , and Change Management for OPDC/OAPI. S/he is the...contacting Accommodation Request (EEAccommodations@otsuka-us.com) . **Statement Regarding Job Recruiting Fraud Scams** At Otsuka we take security and protection… more
- Walmart (Riverside, CA)
- …with specific types of tools used for theft prevention Conducts investigations Recognizes and investigates security breaches thefts shortages loss and vandalism ... management Responds to inquiries by regulatory authorities Consults on complex claims and settlements Designs preventative claims management processes for… 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
- City and County of San Francisco (San Francisco, CA)
- …In addition to the general duties above: + Detects, investigates, and prevents fraudulent claims for public assistance to avoid welfare fraud and other financial ... CalWORKs, Workforce Development (WDD), Family and Children's Services (FCS), Investigations , SF Benefits Net, Program Support Operations, Alignment & Guidance… more
- LifePoint Health (Richlands, VA)
- …ever-changing legislation and safety regulations. Is a liaison to the Risk Manager /Coordinator, facilities legal team and out-side agencies to mitigate and manage ... and the risk management, mediates patient and employee complaints and investigations * Coordinates Quarterly Rural Health Audits and compliance for accreditation.… more
- Robert Half Finance & Accounting (Horsham, PA)
- …already solid foundation. Responsibilities: + Oversee and direct forensic accounting investigations involving fraud detection, financial disputes, and asset ... Description Robert Half is seeking an experienced and driven professional Audit Manager to lead and grow our client's Forensics, Litigation, and Valuation practice.… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …as a result of claims audit or investigation. + Maintains awareness of fraud , waste and abuse laws and regulations and current industry changes that may impact ... clinical and operational excellence. **Summary** Works collaboratively with the Compliance Manager on creating auditing protocols which align with Bon Secours Mercy… more
- Dickinson Financial Corporation (Kansas City, MO)
- …Analyst I will work semi-independently under the direction of the Physical Security & Investigations Manager and is responsible for the ongoing review of daily ... on new account review, large check deposit review, Zelle investigations , fraudulent activity claims from clients to...to the FIU Alert Analysts 1 & 2 on BSA/AML/ Fraud system-generated alerts, reviewing all alerts and evaluate any… more
- Travelers Insurance Company (Indianapolis, IN)
- …. 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
- Travelers Insurance Company (Walnut Creek, 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 (Atlanta, GA)
- …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 (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 (Atlanta, GA)
- …develop, and maintain complex data analyses to support investigations of potential fraud , waste, and abuse in Medicaid claims and provider activity. + ... who can transform complex healthcare data into actionable insights to support fraud , waste, and abuse (FWA) detection and Medicaid regulatory & compliance reporting.… more
- Elevance Health (Houston, TX)
- …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 your impact:** + Claim...+ Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company health… more
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