Claims Consultant - NFP (Community Association D&O Liability) The candidate manages and resolves D&O Community Association claims by evaluating coverage, assessing liability and damages, setting timely reserves, negotiating and settling claims, and directing litigation. Works under general direction, and within...
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, specifically within the Medicaid operations of the company's Payment Integrity Unit. The role involves developing and implementing...
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 company. This role involves developing and implementing controls and cost-effective approaches to mitigate risk in...
Claims Consultant - NFP (Community Association D&O Liability) The candidate plays a critical role in managing and resolving D&O Community Association claims by evaluating coverage, assessing liability and damages, setting timely reserves, negotiating and settling claims, and directing litigation. Works...
The following jobs are no longer active but were real openings previously posted by employers. These listings provide valuable insight into employer hiring trends and frequently lead to job offers. In many cases, employers are still hiring or open to strong candidates even if no new job is posted. Applying to these listings often makes you the only applicant, increasing your chances of being hired.
II - Telecommute The candidate will investigate, collect, research and analyze billing data in order to detect fraudulent, abusive or wasteful activities/practices. Will use appropriate system tools, analyzes data to detect fraudulent, abusive or wasteful payments to providers and subscribers. Prepare statistical/financial analyses and reports to document findings and maintain up-to-date case files for management review. Prepare final report and notification of... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
SIU Pharmacy Investigator The candidate will manage a load of cases and provide expertise as it relates to pharmacy fraud, waste and abuse. Will... manage a caseload of pharmacy fraud investigations. Identify fraud schemes... and trends within the Pharmacy line of business, geographic region, or across specialties. Develop and maintain strong working relationships with the business and market offices in their assigned regions. Collaborate with investigative researchers and other i... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
Investigator I, II, or Senior The candidate will be responsible for the independent identification, investigation and development of complex cases against perpetrators of healthcare fraud in order to recover... corporate and client funds paid on fraudulent claims. Will claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims. Responsible for... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
Fraud and Waste Investigator, Special... Investigations Unit The candidate coordinates investigation with law enforcement authorities. Assembles evidence and documentation to support successful adjudication, where appropriate. May conduct on-site audits of provider records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Understands department, segment, and organizational strategy and operating objectives, including their linkages... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
Program Integrity Lead The candidate will carry out the provisions of the compliance plan, including FWA policies and procedures. Investigate unusual incidents and implement corrective action plans. Assess records and independently refer suspected member fraud, provider fraud, and member... abuse cases to the Louisiana Department of Health (LDH) and other duly authorized enforcement agencies. Coordinate across all departments to encourage sensible and culturally-competent busin... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
Fraud and Waste Investigator, Commercial... The candidate conducts healthcare fraud investigations of moderate complexity.... Traditional investigative methodologies will apply to include evidence collection, site surveys, data analysis, and interviews of individuals related to the case. Assembles evidence and documentation to support successful adjudication, where appropriate. May conduct on-site audits of provider records ensuring appropriateness of billing practices. Prepares c... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
VP, Special Investigation Unit - Claims The candidate will be responsible for driving the identification and detection of fraud through the use of... technology and analysis as well as facilitate an effective exchange of information/intelligence that will support anti-fraud initiatives at the company. Will lead all aspects of the special investigation unit including setting strategic vision, strategy, establishing best practices, and execution and follows through for commercial... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
Staff VP Program Integrity/Investigations The candidate will be responsible for providing leadership to the Commercial Special Investigations Unit, Provider Audit and Data Mining teams. Primary duties include development and implementation of program strategies, goals, deliverables, and overall program execution. Develops and administers a strategy that continually reduces the inappropriate provider payments and optimizes opportunities to drive fraud, waste and abuse savings...... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
Staff VP, Program Integrity / Investigations The candidate will provide leadership to the Commercial Special Investigations Unit, Provider Audit and Data Mining teams. Primary duties include: development and implementation of program strategies, goals, deliverables, and overall program execution. Develop and administer a strategy that continually reduces the inappropriate provider payments and optimizes opportunities to drive fraud, waste and abuse savings... including identify... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
The candidate will work in primary areas of practice such as domestic, divorce, custody and adoption, with a smattering of personal injury and criminal defense. Should be an experienced paralegal. The candidate with experience in other areas of litigation will be considered. Must have strong experience and proficiency in researching with LexisNexis and Westlaw, along with experience in drafting petitions, motions and other pleadings, propounding and responding to d... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here