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The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse.
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Accredited Health Care Fraud Investigator (AHFI). Detects potential health care fraud, waste, and abuse through the identification of aberrant coding and/or billing patterns through utilization review.
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Health Care Anti-Fraud Associate (HCAFA). The SIU Investigator is responsible for reviewing and analyzing information to draw conclusions on allegations of FWA and/or may determine appropriateness of care.
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Strong business and industry regulatory acumen complemented by claims adjusting knowledge, premium and medical billing familiarity, and industry best practices in risk management and fraud detection/prevention.
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The Director will be instrumental in achieving key performance indicators, such as reducing delinquency rates, improving collection recoveries, and implementing cutting-edge technologies for fraud detection.
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Minimum of 2 years of experience in a call center environment preferably focused on fraud detection, risk management, or a related field. The Bilingual Wireless Fraud Care Specialist plays a crucial role in identifying, mitigating and preventing fraudulent activities related to new activations and existing customer upgrades and adding additional lines.
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LANGUAGE ABILITY : Able to read, analyze, interpret and advise regarding complex governmental regulations, legal opinions, claims laws and regulations, technical claims processes and procedures relating to fraud detection/prevention, and medical billing and reports.
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In addition the Fraud Detection Agent Iwill be accountable for meeting performance targets and necessary requirements for agent advancement via career path. We are seeking a talented Fraud Detection Agent I to assist cardholders by verifying activity on their debit or credit card while identifying and reporting potential fraud trends and patterns to minimize potential losses.
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In-depth knowledge of the anti-money laundering, countering financing of terrorism regulations and fraud prevention and detection techniques; strong analytical and decision-making skills; organizational skills; AML and anti-fraud software; Microsoft Word; Microsoft Excel.
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Applies knowledge of nuclear medicine and PET/CT principles and practices, including anatomy and physiology, radiation protection and physics, quality assurance, positioning and patient care skills.
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Creates and facilitates required fraud detection/prevention training to company staff. The Director of Special Investigations is responsible for oversight of the Special Investigations Unit, ensuring strategic direction and implementation of effective prevention, detection, investigation, reporting, and recovery techniques to mitigate company exposure related to fraud.
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We are seeking an experienced and motivated Manager to lead our Boost Mobile Retailer Fraud Team. As the Manager of this crucial role, you will be responsible for overseeing all aspects of retailer fraud prevention, detection, and mitigation.
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Collaborate with cross-functional teams, including IT, Sales, Product, and Customer Care and Support, to implement fraud prevention measures and solutions. Experience with fraud detection and prevention tools, systems, and technologies.
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The Nuclear Medicine/PET Technologist is responsible for producing high quality diagnostic images with special attention to radiation safety/regulations, including proper documentation and technique when working with patients and radioactive materials.
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Certified Fraud Examiner (CFE) or ACAMS. 6+ years of experience in Fraud Risk Management, Fraud Investigation, Audit, Finance, Payment Security, Compliance, Information Security, Law Enforcement, Business, or related experience.
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pet care fraud detection jobs Company: Rover
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