recover corporate and client funds paid on fraudulent claims. 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 indepen...
recover corporate and client funds paid on fraudulent claims. 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 indepen...
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to recover corporate and client funds paid on fraudulent claims, utilizing Health and... Human Services-Office of Inspector General (HHS-OIG), FBI and other law enforcement resources, and state of the art investigation techniques. Responsible for enterprise-wide specific investigations that may impac...
in order to detect fraudulent, abusive or wasteful activities/practices.... 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...
in order to detect fraudulent, abusive or wasteful activities/practices.... include: Using appropriate system tools, analyzes data to detect fraudulent, abusive or wasteful payments... to providers and subscribers. Prepares statistical/financial analyses and reports to document findings and maintains up-to-date case files...
Investigator - Full Time - Hybrid Work Model - Healthcare Fraud Investigation Schedule: 1-2 days per week in the office (Hybrid 1) Location: Hybrid model (remote and office) with ideal candidate living within 50 miles of one of...
Secretary The candidate will be responsible for: proper processing of court filings and legal documents primarily in multiple courts or jurisdictions according to jurisdictional requirements; the coordination of court-related services in legal programs with Attorneys; serving as a lead person...
Compensation Defense Attorney The candidate will work under the direction and supervision of a Supervising Attorney or Assistant Chief Counsel. Will represent Agency in handling/litigating workers' compensation cases to defend the Agency and its insureds. May advise any of Agency's...
Compensation Defense Attorney The candidate will work under the direction and supervision of an Assistant Chief Counsel. Will represent Agency in handling/litigating the most sensitive, difficult and complex appellate matters or legal assignments necessary to defend the Agency and its...
IV - Subrogation The candidate, under the direction and supervision of a Supervising Attorney or Assistant Chief Counsel, will represent the State Fund in handling/litigating the more sensitive, difficult and complex workers' compensation subrogation cases and assignments before the DWC...
the Legal leadership team, Claims leadership team and other... business partners. Will be responsible for handling, and appearing, on complex cases in various venues and jurisdictions in California, and occasionally out of state, for matters involving workers' compensation issues, and...
Subrogation Attorney The candidate, under the direction and supervision of a Supervising Attorney or Assistant Chief Counsel, will represent the Agency in handling/litigating the more sensitive, difficult and complex workers' compensation subrogation cases and assignments before the DWC (Workers' Compensation...