• Senior Fraud and Claims…

    Citizens (Johnston, RI)
    … Risk Managers and/or Senior Risk Managers primarily supporting the Fraud and Claims line of business Qualifications: + 8-12+ years experience in ... adherence to policies and procedures. + Advise and help senior management understand and manage risk and...understanding of regulatory and legislative guidelines, as well as Fraud and Disputes processes + Extensive experience managing projects… more
    Citizens (05/18/25)
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  • Senior Manager, Clinical Management

    Otsuka America Pharmaceutical Inc. (Providence, RI)
    …Under the direction of the Director/Associate Director of Clinical Management, the Senior Clinical Study Manager is responsible for the oversight and management of ... of protocols within and across portfolios, as assigned.** **Participate in program-level risk mitigation strategies and collaborate with ESPs on study-level risk … more
    Otsuka America Pharmaceutical Inc. (05/13/25)
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  • Senior Project Manager

    Otsuka America Pharmaceutical Inc. (Providence, RI)
    **Position Summary** The Senior Project Manager is responsible for leading key marketing initiatives, ensuring the timely and efficient execution of strategic ... between cross-functional teams, ensuring communication flow, alignment on deliverables, and risk mitigation. + Proactively identify issues, risks, and resource gaps,… more
    Otsuka America Pharmaceutical Inc. (05/16/25)
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  • Senior Medical Stop Loss Underwriter

    Highmark Health (Providence, RI)
    …quotes and analyzes the structure of a contract for a group based on claims experience, characteristics of the employee groups, etc. The incumbent uses discretion of ... do not fit into the overall HMIG strategy and risk structure. Analyzes risk factors for new...claim patterns of renewal clients and issues with competitor's claims experience for prospect clients and develops recommendations to… more
    Highmark Health (04/30/25)
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  • Senior Forensic Engineer

    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 ... Collaborates with sales and operations managers, architects, developers, insurance adjusters, claims managers and attorneys to develop demand for your professional… more
    EFI Global (05/08/25)
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  • Consultant, Organization Strategy (Hybrid…

    Lincoln Financial (Providence, RI)
    …data driven GP Claims & Ops managed supplier profiles using spend, risk , key contract terms, service level agreements, and performance metrics for GP Claims ... thinking, innovative, and highly motivated Consultant of Organizational Strategy to our GP Claims & Ops Vendor Strategy and Management team. Over the past few years,… more
    Lincoln Financial (04/30/25)
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  • SIU Clinical Consultant

    Prime Therapeutics (Providence, RI)
    …current on industry trend and best practices to understand potential clinical fraud indicators and risk mitigation; contribute clinical expertise to department ... confrontational situations + Knowledge and understanding of pharmacy or medical claims processing environment **Preferred Qualifications** + Certified Fraud … more
    Prime Therapeutics (05/16/25)
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  • Associate Medical Stop Loss Underwriter

    Highmark Health (Providence, RI)
    …quotes and analyzes the structure of a contract for a group based on claims experience, characteristics of the employee groups, etc. The incumbent develops and uses ... do not fit into the overall HMIG strategy and risk structure. Analyzes risk factors for new...This is an entry level position, with oversight by Senior Underwriters and/or Management until the individual is acclimated… more
    Highmark Health (04/04/25)
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  • Executive Director of R&D Global Quality

    Otsuka America Pharmaceutical Inc. (Providence, RI)
    …of the Quality Systems and Risks will be reported periodically to Senior Management through the Management Review process to ensure alignment with Company ... policy and strategy and gain a consensus of risk mitigation approaches. **Key Responsibilities:** + **Inspection Readiness:** Ensure continuous inspection readiness… more
    Otsuka America Pharmaceutical Inc. (04/30/25)
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  • Manager, Internal Audit - IT

    FM (Johnston, RI)
    …objectivity - Ethical behavior - Due professional care - Organizational governance - Fraud - Risk management - Internal control - Engagement planning, fieldwork ... providing more than one-third of FORTUNE 1000-size companies with engineering-based risk management and property insurance solutions. FM helps clients maintain… more
    FM (04/06/25)
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