• Fraud Operations Sr Manager

    Citizens (Johnston, RI)
    …regulations and standards. Qualifications: + Experience: Extensive experience in either fraud detection management, fraud investigations , strategy or ... Description Job Title: Senior Fraud Operations Manager - OLB and...OLB and Mobile Fraud Detection Description: Citizens Fraud & Claims Organization is seeking a… more
    Citizens (08/01/25)
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  • Operational Risk Manager - Fraud

    Citizens (Johnston, RI)
    Description The Manager of Fraud Risk Oversight will support the independent Risk Oversight of the Fraud and Claims divisions and all aspects of Fraud ... including the effectiveness of Fraud Strategy/Analytics, the efficiency of Fraud Alert Review and Investigations and effectiveness of Front-Line Controls… more
    Citizens (08/03/25)
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  • Manager Special Investigations

    AmeriHealth Caritas (Newtown Square, PA)
    **ROLE OVERVIEW** Under direct supervision of the Director, SIU the Pharmacy Manager in the Special Investigations Unit (SIU) will lead efforts to detect, ... team performance goals. + Proactively identify and analyze patters or anomalies in pharmacy claims and operations indicative of fraud , waste and abuse.; + Lead… more
    AmeriHealth Caritas (08/02/25)
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  • Manager , Fraud and Waste

    Humana (Juneau, AK)
    …a part of our caring community and help us put health first** The Special Investigations Unit Manager leads and monitors investigations of allegations of ... fraudulent and abusive practices. The Manager , Fraud and Waste works within specific...schedules and goals. **Where you Come In** The Special Investigations Unit Manager assists coordinating investigation with… more
    Humana (08/09/25)
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  • Clinical Fraud Investigator II

    Elevance Health (Norfolk, VA)
    …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
    Elevance Health (07/30/25)
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  • Life Sciences - Compliance, Risk Management…

    Ankura (Chicago, IL)
    …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
    Ankura (07/25/25)
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  • Client Services Manager - Large Complex…

    EFI Global (Montgomery, AL)
    …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 ... leader in engineering failure analysis, origin-and-cause investigations , environmental consulting, laboratory testing and specialty consulting. Our forensic… more
    EFI Global (08/08/25)
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  • Client Services Manager

    EFI Global (Providence, RI)
    …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 ... leader in engineering failure analysis, origin-and-cause investigations , environmental consulting, laboratory testing and specialty consulting. Our forensic… more
    EFI Global (08/08/25)
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  • Compliance Auditor - Physician - Enterprise Risk

    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
    Bon Secours Mercy Health (08/08/25)
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  • Sr. Workers' Compensation Claim Representative

    Travelers Insurance Company (Diamond Bar, 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
    Travelers Insurance Company (08/02/25)
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