- DXC Technology (Nashville, TN)
- …initiatives in **Life & Annuity Insurance industry** , and manage daily operations ,focusing on achieving efficiency and compliance. * Supervise and mentor a team ... years in a similar role * Proven experience in business process transactions Claims * Proficiencies in business process management and optimization * A continuous… more
- NTT DATA North America (Lincoln, NE)
- …to join our team in Lincoln, Nebraska (US-NE), United States (US). **Posisition: Claims Case Manager ** **This position is eligible for company benefits including ... voluntary or legally required benefits.** **Role Overview:** We are seeking a dedicated Claims Case Manager to provide comprehensive claim servicing to our… more
- Travelers Insurance Company (Salem, OR)
- …+ 5-10 years experience handling serious injury and complex liability claims preferred (casualty claim operations environment determining coverage, liability, ... negotiate and resolve the company's most severe and/or complex claims , in multiple jurisdictions, in accordance with Best Practices....as Subro, Risk Control, nurse consultants and fire or fraud investigators and other experts. + Verify the nature… more
- MyFlorida (Pensacola, FL)
- …in 409.920, Florida Statutes. These matters include but are not limited to: fraud against the Medicaid Program, false claims against the Medicaid program, ... the Office of the Attorney General within the Medicaid Fraud Control Unit in Pensacola, Florida. Pay:$60,000.20 - $62,425.00...subsection is submitted; or (b) Served in the special operations forces for a minimum of 5 years, provided… more
- CDM Smith (Lakewood, CO)
- …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...conduct thorough forensic investigations to identify discrepancies, detect potential fraud , and ensure the integrity and fairness of claim… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …this position is responsible for the accurate and thorough clinical investigation of potential fraud , waste and abuse (FWA) for all lines of business. The scope of ... in a clear and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. + Manages cases as assigned,… more
- Otsuka America Pharmaceutical Inc. (Atlanta, GA)
- …HCP engagement over time. This position reports into the Medical Excellence & Operations Vendor and Contracts Management Lead and directly manages the Manager , ... and Operational Oversight** + Directly manage, coach, and develop the Manager , HCP Engagement Lead, overseeing their performance, workload, and adherence to… more
- Elevance Health (Atlanta, GA)
- …and medical policy guidelines strongly preferred + BA/BS preferred + Medical claims review with prior health care fraud audit/investigation experience preferred ... of utilization and/or fraudulent activities by health care providers through prepayment claims review, post payment auditing, and provider record review. **How you… more
- Otsuka America Pharmaceutical Inc. (Helena, MT)
- …across various departments to support implementation of the S&OP (Sales & Operations Planning) process. You will assist in managing a complex portfolio of ... production takes place to meet market demands. + Lead regular Sales and Operations Planning (S&OP) meetings with all internal key functional areas to share… more
- Ankura (Lexington, NY)
- …Life Sciences sector in matters relating to compliance with the federal False Claims Act; Anti-Kickback Statute; Food Drug and Cosmetic Act; Department of Justice ... guidance; and international compliance standards governing pharmaceutical and medical device operations . You will be joining a team of industry experts with… more