UNKNOWN

FEED

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. PRIMARY PURPOSE OF THE ROLE: While partnering with the injured worker, employer, and medical providers, create a case management strategy to facilitate medical recovery and a successful return to work through advocacy, communication and coordination of medical services.

<p>Sedgwick Claims Management Services, Inc., is a leading global provider of technology-enabled risk and benefits solutions. At Sedgwick, caring countsSM; the company takes care of people and organizations by delivering cost-effective claims, productivity, managed care, risk consulting and other services through the dedication and expertise of nearly 15,000 colleagues in some 275 offices located in the U.S., Canada, the U.K and Ireland. Sedgwick facilitates financial and personal health and helps customers and consumers navigate complexity by designing and implementing customized programs based on proven practices and advanced technology that exceed expectations. Sedgwick’s majority shareholder is KKR; Stone Point Capital LLC, La Caisse de dépôt et placement du Québec (CDPQ) and other management investors are minority shareholders.</p>

Sedgwick Claims Management Services, Inc.

Field Case Manager

By combining global corporate cards and banking with intuitive spend management, bill pay, and travel software, Brex enables founders and finance teams to accelerate operations, gain real-time visibility, and control spend effortlessly. Data Mining: Use SQL and Python to mine large-scale data, and apply LLM-based tools to detect and automate the identification of fraudulent patterns across credit, deposit, and card payment rails.

YEAR

Brex Inc.

Fraud Strategy Associate

ea_via_bold

Brex Inc

Identify and recommend systems and process modifications necessary to improve the efficiency and effectiveness of the Assignment processes. Cash Claims Processor duties: Process transactions, apply cash, member bills, resubmit invoices, write-offs, etc.

Global Channel Management

Customer Service Rep

You turn customer problems surfaced by FDEs or customers into clear workflows and drive them with engineering from discovery through delivery, owning usability and measuring whether the solution works for users. Claims is the clearest case: high-volume, repetitive workflows handled over the phone, by email, and across 200-page PDFs, most of it sitting in systems built in the early 2000s.

Urban Ridge Supplies

Founding Product Designer

Working under the supervision of Managers, Directors, and Partners, the Associate performs financial analyses, researches financial records, prepares supporting schedules, and assists with the development of reports and litigation-related deliverables. We partner with leading accounting firms across the United States, bringing them together through a shared platform that supports their growth while preserving the local identities and client relationships that make each firm unique.

Current

Forensic Litigation Support Associate

The Fraud Investigator plays a critical role in protecting the financial assets, operational integrity, and reputation of Nymbus clients by leading advanced investigations into complex and high-impact fraud cases across multiple payment channels and products. We expect team members to engage in our global community, proactively build relationships, participate actively in team and company conversations, seek opportunities to collaborate, and take shared ownership of creating a connected and inclusive remote community including showing up on camera.

Nymbus, Inc.

Fraud Investigator

The investigator analyzes claims, encounter, enrollment, medical record, and provider data; conducts interviews, field investigations, and on-site audits, when necessary; prepares detailed investigative reports; and collaborates with compliance, legal, operational stakeholders, regulatory agencies, and law enforcement. Responsibilities: The SIU Fraud Investigator is responsible for identifying, investigating, and resolving allegations and indicators of fraud, waste, and abuse (FWA) involving providers, vendors, members, and other parties participating in Elderplan's product lines.

Metropolitan Jewish Health System

Collaborates with internal business partners, compliance, legal, provider and payment integrity teams, and external agencies to coordinate investigative activities, support corrective actions, recoveries, and case resolution efforts. 2+ years Fraud, waste, and abuse investigations, healthcare investigations, claims audits, payment integrity, healthcare compliance, law enforcement investigations, or a related investigative field required.

Centene Corporation Group

SIU Investigator

Acquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance. High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud.

HOUR

Allied Universal provides unparalleled service, systems and solutions to the people and business of our communities, and is North America's leading security services provider. With over 140,000 employees, Allied Universal delivers high-quality, tailored solutions, which allows clients to focus on their core business. For more information: 866.825.5433 or <a href="http://www.aus.com/" target="_blank">www.AUS.com</a>


Allied Universal

ADAPTED_NOW

Our organization is a URAC accredited leader in IME and Record Review services, currently working with over 170 Work Comp, Disability, Group Health, Auto Liability Carriers, Third Party Administrators, Managed Care Organizations, Employers, Pharmacy Benefit Managers, and Medicare Set-Aside providers to provide customized peer review and IME programs which assist their RN's and adjustors in reaching appropriate medical determinations as part of the claims management process. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers and Pharmacy Benefit Managers.

Dane Street

REMOTE OPPORTUNITY! Physician Advisor, Utilization Review (Orthopedic Surgeon)

Responsibilities: of the Data Analyst (Healthcare Fraud) include: Develop, test, and document analytical business rules and algorithm logic designed to identify healthcare fraud, waste, and abuse schemes. Familiarity with VA Community Care data, the CMS Integrated Data Repository (IDR), the HHS Office of Inspector General's List of Excluded Individuals/Entities (LEIE), or SAM exclusion lists.

Zp Group Llc

Data Analyst - 176046

Administrative Support Specialist - 176042

Our clients are enterprises as diverse as sophisticated financial institutions and start-ups, global public firms, and middle-market companies, as well as high net worth individuals, family offices, not-for-profit organizations, and entrepreneurial ventures across a variety of industries. In this role, you will partner closely with FAS leadership and engagement teams to identify and address professional, regulatory, and operational risks early, while developing practical controls, workflows, and training that support engagements from intake through case closure.

EisnerAmper

Risk Management Manager, Financial Advisory Services

Risk Management Senior Manager, Financial Advisory Services

TAG EisnerAmper, LLC (Inactive)

Convene leaders from key operational areas (such as SIU, claims, program integrity, provider network, pharmacy, member services, and IT) to ensure that PHW has compliant end to end workflows and process for providers and members with regard to identifying, investigating and corrective actions for fraud. You'll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective.

Senior Compliance Analyst

Creating benefits statement to provide lien information to attorney OR referring to Optum for response and taking us out of the loop (which has never been the route I have chosen) This includes reviewing all paid claims in member history that appear to be related to the accident that occurred. This includes all attorney communications, interaction with our Subrogation vendor, creating and mailing lien packages, and working with internal Claims Department to ensure claims are processed.

Amalgamated Life

Manager, Fund Administration

Assists Partners with client proposals, which includes but is not limited to providing and negotiating equitable adjustment and termination claims as well as providing strategic pricing assistance, analyzes Requests for Proposals (RFPs), and prepares cost volumes. Aids in firm development activities and other marketing initiatives including but not limited to attending trade shows, networking, developing internal and external practice development opportunities and identifying cross servicing opportunities.

BDO USA PC

Senior, Industry Specialty Services

Analyze and calculate ability to pay settlements and judgments, including analyzing debt covenants, borrowing capacity, adjusted earnings and earnings per share, financial ratios, accounts receivable and accounts payable, aging schedules, tax considerations, assessing collectability, and developing payment terms and schedules. CGS is seeking a Senior Auditor who will assist the district legal staff by conducting medical claims data analysis, forensic investigations, financial damages, statistical sampling, and ability-to-pay analyses, which serve a significant role in determinations regarding investigations, prosecutions, settlements, and recovery in these matters, which can be voluminous and complex.

Claims Examiner Jobs in New York, NY

Field Case Manager Sedgwick Claims Management Services, Inc.

Fraud Strategy Associate Brex Inc.

Fraud Strategy Associate Brex Inc

Customer Service Rep Global Channel Management

Founding Product Designer Urban Ridge Supplies

Forensic Litigation Support Associate Current

Fraud Investigator Nymbus, Inc.

Fraud Investigator Metropolitan Jewish Health System

SIU Investigator Centene Corporation Group

SIU Investigator Allied Universal

REMOTE OPPORTUNITY! Physician Advisor, Utilization Review (Orthopedic Surgeon) Dane Street

Data Analyst - 176046 Zp Group Llc

Administrative Support Specialist - 176042 Zp Group Llc

Risk Management Manager, Financial Advisory Services EisnerAmper

Risk Management Senior Manager, Financial Advisory Services EisnerAmper

Risk Management Manager, Financial Advisory Services TAG EisnerAmper, LLC (Inactive)

Senior Compliance Analyst Centene Corporation Group

Manager, Fund Administration Amalgamated Life

Senior, Industry Specialty Services BDO USA PC

Senior Auditor CONTACT GOVERNMENT SERVICES

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