- EFI Global (Boston, MA)
- …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
- Parsons Corporation (Centreville, VA)
- …looking for. **Job Description:** Parsons is looking for an amazingly talented **SH&E Systems Manager ** to join our team! In this role you will get to provides ... and timely case management. + Initiates and conducts thorough incident investigations and root cause analyses using defensible protocols. Works collaboratively with… 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
- 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
- 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
- CDM Smith (Raleigh, NC)
- …CDM Smith is seeking a Forensic Accounting Specialist with expertise in disaster fraud claims . This role is critical in evaluating and analyzing financial ... data related to disaster-related claims , including property damage, business interruption, and other loss...other loss categories. The specialist will conduct thorough forensic investigations to identify discrepancies, detect potential fraud ,… more
- Elevance Health (Cincinnati, OH)
- …+ Reviews provider medical record documentation to determine if there is potential fraud , waste, or abuse that warrants further investigations . + Conducts ... audits, and participates in developing an investigation team that focuses on potential fraud , waste and abuse in the provider population. **How will you make an… more
- Elevance Health (Mason, OH)
- …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 (Des Moines, IA)
- …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 (Hartford, CT)
- …within the Special Investigations Unit (SIU) plays a key role in supporting fraud , waste, and abuse investigations by managing and responding to Requests for ... best practices. The analyst will also provide **leadership support** to the Manager by assisting with team coordination, reporting, and strategic planning efforts.… more