• Manager Special Investigations Pharmacy Unit

    AmeriHealth Caritas (Newtown Square, PA)
    …; The manager must have the ability to determine correct coding, review claims , medical records and billing data from all types of healthcare providers for ... performance goals. + Proactively identify and analyze patters or anomalies in pharmacy claims and operations indicative of fraud, waste and abuse.; + Lead and manage… more
    AmeriHealth Caritas (08/02/25)
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  • Special Investigation Unit: Coordinator

    Kemper (Dallas, TX)
    …College Degree or equivalent work experience * Three years of insurance claims experience or related fraud analytics background. **Position Requirements:** + Strong ... are desirable. + Certified Insurance Fraud Analyst (CIFA), Fraud Claims Law Specialist (FCLS) or Fraud Claims ...and Certified Insurance Fraud Investigator (CIFI) or Certified Fraud Examiner (CFE) designations are + preferred. + This position… more
    Kemper (07/02/25)
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  • SIU Specialist - Pharmacy Tech - Remote in…

    Prime Therapeutics (Des Moines, IA)
    …Education Level Bachelors + Experience Level 2+ years + Required Fraud Investigations and Claims experience Must be eligible to work in the United States without the ... or residency sponsorship. **Additional Qualifications** + 3+ years' fraud investigations/ claims experience. + Ability to manage workload while simultaneously working… more
    Prime Therapeutics (06/24/25)
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  • Risk Control Consultant, Boiler & Machinery

    Travelers Insurance Company (Burlington, VT)
    …on all accounts. Under close supervision, performs risk evaluations and claims investigations on less complex accounts as assigned. Participates in individual ... equipment breakdown, and overall insurability. Investigate less complex Equipment Breakdown claims as requested by the claim department. Evaluate elements of the… more
    Travelers Insurance Company (07/31/25)
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  • Assistant Insurance Fund Services Representative…

    New York State Civil Service (Endicott, NY)
    …existing, or past payments being provided to check the coordination of claims , if applicable.* Provide any additional information required to assist various internal ... including telephone, email, letter, and web inquiry.* Assist with other claims functions including answering provider calls, processing bill corrections, and… more
    New York State Civil Service (07/22/25)
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  • PCE Coordinator

    Baylor Scott & White Health (Temple, TX)
    …position type and/or level **Job Summary** Manages detailed assessments of high-risk claims with a medical/legal plan to prevent claim elevation. Reviews and ... timely reviews, feedback, recommendations, and resolution of professional liability claims . Coordinates follow-up and collaborates with multiple reviewers to ensure… more
    Baylor Scott & White Health (07/09/25)
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  • Medicolegal Analyst (Law Dept) Lv2

    City of New York (New York, NY)
    …for all medically related issues for medical management of workers' compensation claims . Responsibilities include: Consult managerial and legal staff in regards to ... not related to the claimant's job related injury. Assist examiner and legal staff to determine compensability of treatment...work injury and assist with medical case management of claims . Review and process high value and complicated in-patient… more
    City of New York (05/14/25)
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  • Operational Risk Manager - Fraud | Where Strategy…

    Citizens (Johnston, RI)
    …Risk Oversight will support the independent Risk Oversight of the Fraud and Claims divisions and all aspects of Fraud risk across the organization. Independent risk ... + Understanding of how Fraud works in consumer and commercial + Certified Fraud Examiner Hours & Work Schedule Hours per Week: 40 Work Schedule: 8AM-5PM EST Pay… more
    Citizens (08/03/25)
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  • Flight Engineer (Instructor) (Title 32)

    Army National Guard Units (Salisbury, NC)
    …a FLIGHT ENGINEER (INSTRUCTOR), GS-2185-10, you will serve as instructor/flight examiner providing instruction, evaluation and examination on ground and operational ... You must provide transcripts or other documentation to support your Educational claims . To receive credit for Education, you must provide documentation of proof… more
    Army National Guard Units (08/03/25)
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  • Flight Engineer (Instructor)

    Air National Guard Units (Reno, NV)
    …fuel consumption, range, and in flight performance data. Serves as a flight examiner as required and performs staff duties. Administers no notice and annual ... must provide transcripts or other documentation to support your Training/Educational claims . To receive credit for Training/Education, you must provide documentation… more
    Air National Guard Units (08/01/25)
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