- Citizens (Johnston, RI)
- Description Job Title: Senior Fraud Operations Manager - OLB and Mobile Fraud Detection Description: Citizens Fraud & Claims Organization is ... seeking a dynamic and experienced Senior Fraud Operations Manager to lead...OLB and Mobile Fraud Detection teams. Citizens Fraud & Claims is dedicated to protecting… more
- Academy Sports + Outdoors (Katy, TX)
- …and controlling for other potential avenues for fraudulent activity such as carrier claims fraud , returns fraud , social engineering of Academy's Customer ... experience Work Experiences + 5+ years of eCommerce, Retail, or Online Fraud Experience preferred. Skills: + Strong interpersonal, written, and verbal communication… more
- Humana (Juneau, AK)
- …and monitors investigations of allegations of fraudulent and abusive practices. The Manager , Fraud and Waste works within specific guidelines and procedures; ... goals. **Where you Come In** The Special Investigations Unit Manager assists coordinating investigation with law enforcement authorities. Leads team/investigators… more
- Elevance Health (Atlanta, GA)
- **Clinical Fraud Investigator Senior** **Location:** _Hybrid1:_ This role requires associates be in the office 1-2 days per week, fostering collaboration and ... unless an accommodation is granted as required by law. The **Clinical Fraud Investigator Senior** is responsible for identifying issues and/or entities that may… more
- Deloitte (Philadelphia, PA)
- …and impact strategy, operations , performance and reputation. Work You'll Do The Claims Review Workstream Manager leads teams responsible for the review of ... their path to value creation. The Team Our Enterprise Operations & Risk offering enables clients to achieve profitable...with healthcare policy and approval processes + Experience managing claims review teams + Expertise in identifying Fraud… more
- AIG (Lenexa, KS)
- …Fraud referrals. + Increased responsibility with an expectation of managing higher claims volumes and assist manager with customer escalations and file audits ... help customers to manage risk. Join us as a Claims Examiner II, Accident & Health to play your...an exciting time to join us - across our operations , we are thinking in new and innovative ways… more
- TEKsystems (Columbia, SC)
- …following desk procedures and guidelines and refers these to a lead or manager for resolution. Identifies and reports potential fraud and abuse situations. ... procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals. Determines whether to return, deny or pay … more
- DXC Technology (Richmond, VA)
- …(NYSE: DXC) helps global companies run their mission-critical systems and operations while modernizing IT, optimizing data architectures, and ensuring security and ... mission-critical IT services that enable our customers to modernize operations and drive innovation across their IT ecosystems. Our...**Quality Analyst** with experience in **Life and Annuity Death Claims ** to join our growing team. This role will… more
- Otsuka America Pharmaceutical Inc. (Hartford, CT)
- **Position Summary** The Senior Manager , Fleet & Samples Operations oversees the execution of field fleet logistics and pharmaceutical sample distribution. The ... reliability, and compliance while collaborating closely with the Field Strategy & Operations team to meet field force needs. **Key Responsibilities** **Fleet … more
- AmeriHealth Caritas (Newtown Square, PA)
- …team performance goals. + Proactively identify and analyze patters or anomalies in pharmacy claims and operations indicative of fraud , waste and abuse.; + ... Under direct supervision of the Director, SIU the Pharmacy Manager in the Special Investigations Unit (SIU) will lead...will lead efforts to detect, investigate and prevent healthcare fraud within the pharmacy operations . ; This… more