- Zurich NA (Pasadena, CA)
- Medical Provider Claims Fraud Investigator 121315 Zurich North America is hiring an Medical Provider Claims Fraud Investigator to join ... Case Medical Provider Investigator** + Conduct thorough investigations into medical provider cases involving potential fraud or abuse. + Collect,… more
- Regions Bank (Charlotte, NC)
- …+ Independent self-starter + Strong data and analytics capabilities + Experience with fraud claims from intake to final decision + Understanding of Compelling ... into the careers section of the system. **Job Description:** At Regions, the Fraud Strategy Analyst performs analysis and interpretation of fraud -based threats… more
- Citizens (Pittsburgh, PA)
- …the identification, management, and mitigation of the risk and controls environment supporting Fraud and Claims . You will serve as a liaison, interfacing with ... business partners to drive meaningful reductions in risk. You will provide and direct complex analysis on product and customer strategies to establish risk… more
- Sedgwick (Moline, IL)
- … claims , staged accidents, or unnecessary medical treatments. + Analyzes claims for fraud indicators through case review and other analytical methods. + ... the development of the investigation action plan. + Identifies claims that meet state fraud reporting criteria,...benefits package is offered including but not limited to, medical , dental, vision, 401k and matching, PTO, disability and… more
- Fallon Health (Worcester, MA)
- …relevant federal and/or state regulations Interface with other clinicians including internal Medical Directors Provide training to SIU staff related to clinical ... as Medical Directors, as needed. + Make recommendations for member/ provider /employee education. + Ability to communicate effectively both verbally and in writing… more
- UMB Bank (Kansas City, MO)
- …& P2P. Responsible for mastering the associated systems and tools used for tracking fraud prevention and fraud claims work. Responsible for communicating ... of business partners to identify adverse impacts to customers, provide solutions, and implement change to ensure the best...or defects. Adheres to the applicable regulatory requirements governing fraud claims for cards, checks, ACH, and… more
- State of Georgia (Fulton County, GA)
- …meeting the minimum qualifications, meet one or more of the following: . Audit experience in medical claims and/or claims data. . Certification as a CPA or a ... Investigative Auditor - Medicaid Fraud Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/64128/other-jobs-matching/location-only) Hot...with an accounting degree as well as auditing experience, medical claims and/or claims data.… more
- Galileo Financial Technologies, LLC (Salt Lake County, UT)
- …identify potentially fraudulent activity + Review disputed transactions to investigate fraud claims , identify charge-back opportunities, and ensure compliance ... most inspired goals. Galileo leads its industry with superior fraud detection, security, decision-making analytics and regulatory compliance functionality combined… more
- Elevance Health (Des Moines, IA)
- …fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. + Researches new healthcare-related ... **Nurse/CPC - Clinical Fraud Investigator Senior - SIU Fraud ...in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines… more
- Bank of America (Kennesaw, GA)
- …educate staff on fraud detection techniques and policies. + Partner with claims , policy, strategy, and product teams to deliver data insights and analysis that ... Fraud Analytics and Innovation Leader - Digital Strategy...Maintain thorough documentation of project plans, progress, and outcomes. Provide regular updates and reports to senior management on… more