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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manner. Reviews and makes recommendations on outcomes of investigations in a prompt and expeditious manner. Provides guidance and recommendations to claims leadership and associates on... claims resolution. Promotes and provides... “On Your Side†customer service. Continuously monitors suspicious claims an...
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...
III or Attorney Duties: The candidate will, under the direction and supervision of an Assistant Chief Counsel, represent the Agency in handling/litigating the more complex workers' compensation subrogation cases and assignments before the DWC (Workers' Compensation Appeals Board), California Civil...
III The candidate will work 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 candidate will work under the direction and supervision of a Supervising Attorney or Assistant Chief Counsel. Represent the State Fund in handling/litigating the more sensitive, difficult and complex workers' compensation subrogation cases and assignments before the DWC (Workers' Compensation...
manner. Reviews and makes recommendations on outcomes of investigations in a prompt and expeditious manner. Provides guidance and recommendations to claims leadership and associates on... claims resolution. Promotes and provides... “On Your Side†customer service. Continuously monitors suspicious claims...
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 - Virginia Medicaid Schedule: 1-2 days per week in the office (Hybrid 1) Location: Hybrid (remote and office) Salary Range: $77,028 to $132,048 Company Overview: - **MEMBERS ONLY**SIGN UP NOW***. is a Fortune 25 company dedicated...