Title: Sr Investigator Job Responsibilities: The Sr Investigator is tasked with the independent identification, investigation, and development of complex cases against individuals or entities perpetrating healthcare fraud. The primary aim is to recover corporate and client funds that have been paid on...
Job Title: Nurse Appeals (Grievance & Appeals) Job... Responsibilities: The Nurse Appeals role involves several... critical responsibilities aimed at ensuring that medical necessity appeals are investigated and processed effectively. The key duties include: - Supporting legal, management, and executive leadership by managing State...
Job Title: Nurse Appeals (Grievance & Appeals) Job... Responsibilities: The Nurse Appeals role involves a... range of responsibilities focused on managing and processing medical necessity appeals from members and providers. Key duties include: - Supporting legal, management, and executive leadership by managing State...
Job Title: Nurse Appeals (Grievance & Appeals) Job... Responsibilities: The Nurse Appeals role involves investigating... and processing medical necessity appeal requests from members and providers. Key responsibilities include: - Supporting legal, management, and executive leadership by managing State Fair Hearing and External Medical...
Job Title: Nurse Appeals (Grievance & Appeals) Job... Responsibilities: The Nurse Appeals is tasked with... investigating and processing medical necessity appeals requests from both members and providers. This role supports legal, management, and executive leadership by managing State Fair Hearing and External...
Job Title: Nurse Appeals (Grievance & Appeals) Job... Responsibilities: - Investigate and process medical necessity appeal requests from members and providers. - Support legal, management, and executive leadership by managing State Fair Hearing and External Medical Review requests. - Act as a resource for...
Title: Senior Risk Management Professional Job Responsibilities: The Senior Risk Management Professional is responsible for identifying and analyzing potential sources of loss to minimize risk within the organization. The role involves developing and implementing controls and cost-effective approaches to minimize risk specifically...
Title: Investigator Senior - Pharmacy Job Responsibilities: The Investigator Senior - Pharmacy is responsible for independently identifying, investigating, and developing complex healthcare cases against perpetrators of healthcare fraud to recover corporate and client funds paid on fraudulent claims. Key responsibilities include: - Conducting...