- 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 - Registered Nurse and CPC...prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new… more
- Bank of America (Plano, TX)
- …enhance fraud prevention methodologies. + Analyze data and conduct investigations to identify patterns, trends, and anomalies indicative of potential fraud ... Fraud Analytics and Innovation Lead Analyst - ...improvements and efficiencies via data analysis. + Partner with claims , policy, strategy, and product teams to deliver data… more
- Zurich NA (Austin, TX)
- …and internal controls throughout the claims process. + Identify and refer claims with subrogation or fraud potential to the appropriate internal teams for ... organizations. **This role will be filled at either the** **Senior or AVP Claims Professional** **Level.** **The hiring manager will determine the appropriate… more
- Molina Healthcare (Houston, TX)
- …from opinions + Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations + Knowledge of Managed Care and the Medicaid and ... company + Minimum of two (2) years' experience working on healthcare fraud related investigations /reviews + Proven investigatory skill; ability to organize,… 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
- Bank of America (Dallas, TX)
- … Fraud and claims risk management activities (eg fraud claims , prevention and detection, fraud investigations , etc.). Additional activities would ... and/or front-line wealth management experience + Prior experience in fraud risk management is definitely a plus. **Skills:** +...offered a role with Bank of America, your hiring manager will provide you with information on the in-office… more