- PNC (PA)
- …to the company's success. We are looking to hire a Detection & Investigation Associate within PNC's Enhanced Due Diligence (EDD) organization. This is a remote ... OPT for this position. **Job Description** + Responsible for investigation and/or mitigation of suspicious bank activity, control and...bank activity, control and prevention of losses related to fraud , AML and /or organizational risk. + Based on… more
- CVS Health (Harrisburg, PA)
- …work from home anywhere in the United States. **Position Summary** The Special Investigations Unit (SIU) is looking for an analytically driven individual who is ... plan sponsor. The lead reviewer is accountable for the validation of existing fraud waste and abuse business rules and leads designed to detect aberrant billing… more
- CVS Health (Harrisburg, PA)
- …state and federal policies. - Identify potential billing errors, abuse, and fraud . - Identify opportunities for savings related to potential cases which may ... warrant a prepayment review. - Maintain appropriate records, files, documentation, etc. - Ability to travel for meetings and potential to testify **Required Qualifications** + AAPC Coding certification - Certified Professional Coder (CPC) + 3+ years of… more
- Highmark Health (Pittsburgh, PA)
- …accredited college or university baccalaureate program in Finance, Healthcare, or Fraud background preferred. + SQL and Programming skills **ESSENTIAL JOB ... FUNCTIONS** 1. Communicate effectively while interacting directly with colleagues, clientele, and/or other internal or external constituencies in the planning of assignments and the resolution of day-to-day operational problems. 2. Under supervision, provide… more
- System One (Pittsburgh, PA)
- …management of internal risks and controls + *Experience/familiarity with identity & fraud investigation platforms such as Actimize, LexisNexis Risk Solutions, ... excel, SharePoint + Enterprise Experience? + Experience/familiarity with identity & fraud investigation platforms such as Actimize, LexisNexis Risk Solutions,… more
- Highmark Health (Pittsburgh, PA)
- …years of relevant, progressive experience in the health insurance industry and/or healthcare fraud investigations **Preferred** + 1 year in Financial Analysis in ... project, potential fraud , waste and abuse case, conducting the initial investigations and coordinating the recovery/savings of money related to fraud , waste… more
- CVS Health (Harrisburg, PA)
- …high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high profile, those ... federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud and...or equivalent experience (3-5 years of working health care fraud , waste and abuse investigations ). **Anticipated Weekly… more
- Coinbase (Harrisburg, PA)
- …, identify patterns, and find the root cause. * A passion for fighting fraud . * The curiosity to self-drive investigations , identify patterns, and find the ... You will be fully responsible and accountable for the end-to-end investigation and resolution of risk-related escalations involving any of Coinbase's diverse… more
- Deloitte (Philadelphia, PA)
- Manager - Forensic Investigations and Fraud - Financial Services About Deloitte Regulatory, Risk & ForensicOur Deloitte Regulatory, Risk & Forensic team helps ... their path to value creation. Work you'll do As a Forensic Investigations and Fraud Manager you will supplement our team with deep expertise across key… more
- EFI Global (Harrisburg, PA)
- …A PLACE FOR YOU HERE EFI Global is a full-service engineering, fire investigation , environmental, health and safety, and specialty consulting services firm serving a ... decades, we have grown from a boutique firm specializing in handling insurance fraud and arson cases and providing expert witness testimony, into a recognized global… more