UNKNOWN

FEED

Oversees investigations involving account takeover, check fraud, ACH fraud, wire fraud, elder financial exploitation, money mule activity, identity theft, cyber-enabled fraud, new account fraud, loan fraud, employee misconduct, and other financial crimes. Collects, analyzes, and disseminates intelligence related to organized fraud groups, money mule activity, account takeover schemes, elder financial exploitation, check fraud, wire fraud, cyber-enabled fraud, and emerging fraud threats.

BankUnited Inc

Fraud Investigations Manager

FULL_TIME

Review and verify evidence supporting administrative action as it relates to payment suspensions, revocations, overpayments as well as other administrative actions that can be pursued (payment suspension, revocation, prepayment edits, auto-denial edits). Responsibilities: SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.

YEAR

Peraton drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world’s leading mission capability integrator and transformative enterprise IT provider, we deliver trusted and highly differentiated national security solutions and technologies that keep people safe and secure. Peraton serves as a valued partner to essential government agencies across the intelligence, space, cyber, defense, civilian, health, and state and local markets. Every day, our employees do the can’t be done, solving the most daunting challenges facing our customers.

Peraton

Admin Action Specialist

[AW]-iCims

Provides support for claims examination activities including evaluation of adjudication of claims to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors. At least 1 year of experience in a clerical role in a claims, and/or customer service setting - preferably in managed care, or equivalent combination of relevant education and experience.

Molina Healthcare Inc

Examiner, Claims (must reside in Florida)

The Dental Fraud, Waste, and Abuse (FWA) Investigator/Auditor is responsible for conducting retrospective and prospective reviews, investigations, and audits of dental providers to identify potential fraud, waste, abuse, overpayments, and non-compliant billing practices. This position analyzes provider claims and clinical documentation, conducts audits, develops investigative findings, supports recovery efforts, and collaborates with internal and external stakeholders to ensure compliance with applicable regulatory, contractual, and organizational requirements.

Hawaii Dental Service

Fraud, Waste, and Abuse (FWA) Auditor/Investigator

As part of our internship program you will receive: Targeted business training designed to help you refine your professional skills and acumen critical to the success of Westfield professionals; Technical training to deepen your skill level within your chosen discipline; and an understanding of the broader insurance industry; Access to additional training to compliment your professional development. An Claims Intern at Westfield Specialty works on a variety of projects to gain hands-on experience in the insurance industry and develop technical skills.

HOUR

Westfield Insurance Co

2027 Summer Intern Program- Claims Intern, Berkeley Heights, NJ

Both positions play a critical role in managing workers compensation claim files and ensuring compliance with state regulations while delivering exceptional service. Reviewing and analyzing medical bills to confirm charges and treatment are workers’ comp injury-related and in accordance with the treatment plan.

AmTrust Financial Services, Inc.

Senior Claim Examiner I, OK

We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. Collaborate with a variety of external sources to identify current and emerging patterns and schemes related to FWA to ensure additional TIP submission.

UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions worldwide. We are comprised of two distinct and complementary businesses, UnitedHealthcare and Optum, working to build a better health system for all. Here, your contributions matter as they will help transform health care for years to come. Make an impact with a diverse team that shares your passion for helping others.

What we do

Gain insights on how we work to help people live healthier lives and help make the health system work better for everyone by watching this video.

<a href="https://www.youtube.com/watch?v=5PbNyi2IDkY">https://www.youtube.com/watch?v=5PbNyi2IDkY</a> 

Caring. Connecting. Growing together. 

Being a part of UnitedHealth Group means working to improve health outcomes for everyone, including yourself. Here is how:

• Caring. Your total health and well-being are important to us. Whatever matters most to you — we have resources to help you be your best at work and at home. The benefits range from free Peloton courses to financial counseling. <a href="https://careers.unitedhealthgroup.com/culture/what-we-offer/">Learn more about what we offer.</a> 

• Connecting. We recognize our collective power to make an impact across our communities because we believe the health of any society is measured by the overall health of its people. <a href="https://careers.unitedhealthgroup.com/culture/">Learn more about our culture.</a> 

• Growing together. UnitedHealth Group is full of inspiring career stories, and we offer a lifetime of opportunities. <a href="https://careers.unitedhealthgroup.com/career-areas/">Discover all the ways you can learn, grow and develop.</a>

UnitedHealth Group Inc.

Senior Investigator

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The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally. The Senior Claim Examiner, under an appropriate level of direction from the manager, investigates, evaluates, and resolves Professional Liability claims while ensuring the highest level of customer service.

Chubb is the world&rsquo;s largest publicly traded property and casualty insurance company and the largest commercial insurer in the U.S.
With operations in 54 countries and territories, we are a major personal lines writer, as well as a leading middle market, small commercial and large industrial commercial insurer, providing a wide range of traditional and specialty coverages.
As an underwriting company, we assess, assume and manage risk with insight and discipline. We service and pay our claims fairly and promptly. And we combine the precision of craftsmanship with deep experience to conceive, craft and deliver the very best insurance coverage and service to individuals and families and to businesses of all sizes.
Our products and services are distributed through brokers, independent agents, exclusive agents and various forms of direct marketing.
What we deliver:
<ul>
<li>Extensive product and service offerings</li>
<li>Broad distribution capabilities</li>
<li>Service excellence</li>
<li>Risk expertise</li>
<li>Underwriting discipline</li>
<li>Exceptional financial strength</li>
<li>Local operations globally</li>
</ul>

Chubb Ltd

Senior Claims Examiner

Pay Range : There are a host of factors that can influence final salary including, but not limited to, geographic location, Federal Government contract labor categories and contract wage rates, relevant prior work experience, specific skills and competencies, education, and certifications. As a valued team member, you’ll be part of a high-performing group dedicated to our customer’s missions and driven by a higher purpose – to ensure the safety of our nation.

CACI provides information solutions and services in support of national security missions and government transformation for Intelligence, Defense, and Federal Civilian customers. A member of the Fortune 1000 Largest Companies, the Russell 2000 Index, and the S&amp;P SmallCap 600 Index, CACI provides dynamic careers for over 15,800 employees working in over 120 offices worldwide. Visit <a href="http://www.caci.com" target="_blank" itemprop="url" mns_rt="Company">www.caci.com</a>. 
 
 We strive to sustain a corporate culture based on integrity - one that's focused on treating customers ethically and making their priorities our priorities. We pride ourselves in finding and hiring people with the highest intellectual capital, and providing them with challenging opportunities and encouraging their innovation and initiative.

CACI

Claims Examiner

Consistently calculates, communicates and manages a caseload of claims with varying levels of complexity, demonstrating a strong technical ability necessary to administer overpayment claims across multiple products and system applications. Once a file is complete and an overpayment has been determined by the associate, the associate works directly with the claimant or advocate, primarily on the phone, to ensure that overpayments are recovered timely and in accordance with the specific policy language.

Preparing for the Future

LTD Claims Examiner

Must have one of the following: Current valid Emergency Medical Technician (EMT) or Paramedic (NRP) Certification from the Department of Health or the National Registry of Emergency Medical Technicians (NREMT); OR Current active Athletic Trainer Certification, by either the Board of Certification (BOC) or equivalent State Certification. In terms of professional development, Everforth Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA.

StratAcuity Staffing Partners Inc

Medical Rep - Medical Representative

This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. This includes evaluation of coverage, assessment of legal liability (where relevant) and exposure analysis, to bring the matters to a timely and accurate resolution; ensuring mitigation of indemnity and expense exposure while communicating developments and outcomes as necessary to all internal and external stakeholders.

Markel Corporation

Sr. Claims Examiner, Program Claims

Some of the Claim Examiner responsibilities include but are not limited to: Makes timely and appropriate contacts, determines, and completes appropriate level of investigation to make determination of coverage, assess liability and determine damages for complex and specialized claims. For candidates located in San Francisco, CA; Washington DC; our Massachusetts based offices and the New York City metro area, the base salary range is $111,000 -$130,000.

Onebeacon Professional Insurance Inc

Claims Examiner - Transactional Surety (Hybrid)

Intact Insurance

ADAPTED_NOW

Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work.

ICW Group

SIU - Senior Investigator

Sutter Health

Leads or directs the preparation of cases for presentation to outside agencies, leads or directs pursuit of criminal or civil actions through gathering and documenting relevant data, organizing and summarizing facts and testifying on behalf of the company in civil or criminal matters. Performs a combination of duties in accordance with departmental guidelines: Leads the detailed analysis and completion of thorough and timely investigations of suspected claim fraud by following Best Practice Guidelines and collaborating with insureds, claimants, witnesses and experts.

CNA's approach to research is a modern iteration of the Newtonian principle that complex, dynamic processes are best understood through direct observation of events and people.

That was the methodology CNA analysts first applied in the 1940s when they pioneered the field of operations research by helping the Navy address the German U-boat threat. Not content to study the problem from afar, this small group of MIT scientists insisted on deploying with Navy forces in order to observe operations and collect the data needed for meaningful analyses. Their groundbreaking work, and the anti-submarine warfare equations it produced, set a standard for operations research methods that CNA has maintained for 75 years.

Today, with more than 500 professionals at our headquarters and 50 researchers in the field, CNA still takes a multi-disciplinary, real-world approach to our work. On-site analysts carefully observe all aspects of a process—people, decisions, actions, consequences—and then collaborate with a headquarters-based research team to assess data and arrive at findings.

CNA's objective, empirical research and analysis helps decision makers develop sound policies, make better-informed decisions, and manage programs more effectively. Our work, which in its early decades focused solely on defense-related matters, has grown to include investigation and analysis of a broad range of national security, defense, and public interest issues including education, homeland security and air traffic management. Through our Center for Naval Analyses and Institute for Public Research, we provide public-sector organizations with the tools they need to tackle the complex challenges of making government more efficient and keeping our country safe and strong.

SIU Senior Consultant

Collaborate with senior leaders of the Legal, Data, Finance, and Service Delivery teams to create and update fraud prevention and detection strategies based on observed patterns and trends as well as industry best practices. With over 1,300 municipal and utility partners, that means providing their customers with access to affordable home repair plans, making it easier, faster and less expensive to have their home repair needs met.

HomeServe USA

Assistant Manager Data Analysis

As a dedicated Injury Claims Examiner (East region), you will be responsible to adjust complex auto and homeowner bodily injury claims, UM/UIM , and small business claims to include confirming coverage, determining liability, investigating, evaluating, negotiating, and adjudicating claims in compliance with state laws and regulations. Investigates loss details, determines legal liability, evaluates, negotiates, and adjudicates claims appropriately and timely; within appropriate authority guidelines with clear documentation to support accurate outcomes.

Industry leading service that puts our memberships' needs first. We're dedicated to the financial well-being of members of the military and their families for generations to come. That's why we provide a variety of financial products and best-in-class service to help our members achieve their financial goals and plan for the future. Our history continues to drive our purpose. USAA began in 1922 with 25 Army officers who offered to insure each other's vehicles when no one else would. Today, their tiny organization has grown into a respected institution offering a full range of financial products to millions of members. We believe they'd be pleased to know that USAA remains true to their founding values of service, loyalty, honesty and integrity. In 1922, when 25 Army officers met in San Antonio, Texas, and decided to insure each other's vehicles, they could not have imagined that their tiny organization would one day serve over 8 million members and become one of the only fully integrated financial services companies in America. We believe they would be pleased to know that USAA has remained true to their founding values of service, loyalty, honesty and integrity.

USAA

Injury Claims Examiner (East region)

TMP PX

NTT DATA recruiters will never ask for payment or banking information and will only use @nttdata.com, @nttdatafed.com and @talent.nttdataservices.com email addresses. 2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools.

NTT DATA Group Corp

Claims Examiner Remote

OTHER

Responsibilities: The Senior Claims Examiner is responsible for managing and analyzing a diverse portfolio of reinsurance claims across multiple lines of business, delivering timely and accurate claim handling, and maintaining strong relationships with cedents, brokers, and internal business partners. The role collaborates closely with underwriting, actuarial, and finance teams to evaluate complex coverage issues, analyze claim developments, and provide insights that support sound business decisions.

Claims Examiner Jobs in the United States

Fraud Investigations Manager BankUnited Inc

Admin Action Specialist Peraton

Examiner, Claims (must reside in Florida) Molina Healthcare Inc

Fraud, Waste, and Abuse (FWA) Auditor/Investigator Hawaii Dental Service

2027 Summer Intern Program- Claims Intern, Berkeley Heights, NJ Westfield Insurance Co

Senior Claim Examiner I, OK AmTrust Financial Services, Inc.

Senior Investigator UnitedHealth Group Inc.

Senior Claims Examiner Chubb Ltd

Claims Examiner CACI

LTD Claims Examiner Preparing for the Future

Medical Rep - Medical Representative StratAcuity Staffing Partners Inc

Sr. Claims Examiner, Program Claims Markel Corporation

Claims Examiner - Transactional Surety (Hybrid) Onebeacon Professional Insurance Inc

Claims Examiner - Transactional Surety (Hybrid) Intact Insurance

SIU - Senior Investigator ICW Group

SIU Senior Consultant CNA

Assistant Manager Data Analysis HomeServe USA

Injury Claims Examiner (East region) USAA

Claims Examiner Remote NTT DATA Group Corp

Senior Claims Examiner Berkley

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