- Blue KC (Kansas City, MO)
- …discount program** **Job Description Summary:** As part of Blue KC's Special Investigations Unit (SIU), the Fraud Investigator conducts reviews to identify ... and other resources for potential FWA schemes. + Conduct investigations of fraud , waste and abuse in...Manager and/or Senior Investigator on larger, more complex, investigations . + Create and maintain detailed case files in… more
- Elevance Health (Atlanta, GA)
- …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 - Registered Nurse and CPC...prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Cross and Blue Shield of Minnesota Position Title: Supervisor - Special Investigations Unit Clinical Location: Hybrid | Eagan, Minnesota Career Area: Legal About ... In this position, you will be responsible for the daily supervision of fraud investigation activities including ensuring that key steps are being documented to meet… more
- Bank of America (Jacksonville, FL)
- …enhance fraud prevention methodologies. + Analyze data and conduct investigations to identify patterns, trends, and anomalies indicative of potential fraud ... Fraud Analytics and Innovation Lead Analyst - ...improvements and efficiencies via data analysis. + Partner with claims , policy, strategy, and product teams to deliver data… more
- Zurich NA (Rocky Hill, CT)
- …and internal controls throughout the claims process. + Identify and refer claims with subrogation or fraud potential to the appropriate internal teams for ... organizations. **This role will be filled at either the** **Senior or AVP Claims Professional** **Level.** **The hiring manager will determine the appropriate… more
- BMO Financial Group (Brookfield, WI)
- …E Dispute Analyst is responsible for investigating, analyzing, and resolving consumer and non- fraud dispute claims in accordance with Regulation E, NACHA, and ... internal bank policies. Conducts investigations to identify, assess, decision and report on activity...customers reach theirs. From in-depth training and coaching, to manager support and network-building opportunities, we'll help you gain… more
- Banco Popular Puerto Rico (San Juan, PR)
- … Investigations Manager is responsible for overseeing the Special Investigations unit, which handles inquiries into customer claims , allegations, and ... improvement. Special Investigations & Audit Collaboration + Oversee investigations of customer claims , internal irregularities, and whistle-blower cases,… more
- Lundbeck (Deerfield, IL)
- Manager , Field Compliance Requisition ID: 7092 Location: Deerfield, IL, US Do you want to join a team where the mission is meaningful, the challenges are complex, ... and transform lives. Join us on our journey of growth! **Summary:** The Manager , Field Compliance will support the Director, Field Compliance and Investigations … more
- MyFlorida (Tallahassee, FL)
- …Investigator II performs work that may include performing all aspects of Medicaid fraud investigations . This work includes but is not limited to entering ... Statutes. These matters include but are not limited to fraud against the Medicaid Program, false claims ...or five (5) years of work experience conducting healthcare fraud investigations . Note: All newly hired employees… more
- American Family Insurance - Corporate (Los Angeles, CA)
- …internal and external partners, agents and customers. You will report to a Special Investigations Manager . In this primarily home-based role, you will spend 80% ... You will Investigate low to moderately complex insurance fraud activity involving property claims , develop..., develop meaningful industry social network and assist special investigations leadership in promoting fraud awareness and… more
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