Senior Fraud Investigator - Supplemental Health Claims
Sustainable World, Inc.
Sun Life U.S. is seeking a Senior Consultant, Claims Investigation Services to lead complex investigations into suspected fraud across Supplemental Health products, supervise quality audits, and collaborate with analytics and legal teams. The role requires a bachelor’s degree, strong analytical skills, experience reviewing medical records, and the ability to present findings to senior leadership. You will develop investigation playbooks, train staff, and drive continuous improvement. #J-18808-Ljbffr Sustainable World, Inc.
- ...personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse... ...exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally. At...SeniorClaimsLocal areaHome officeFlexible hours
- ...general & liability (AGL) Senior Claims Representative ESIS recognizes... ...of the Claims Team Leader investigates and settles claims promptly... ...package including life, health and dental, vision, a generous... ..., personal accident and supplemental health insurance, reinsurance...SeniorClaimsContract workCasual workWork at officeLocal areaFlexible hours
- Luminare Health is seeking a Senior Claims Analyst to support a Claim Unit and vendor staff, and act as a liaison for internal departments. The role covers adjudication and processing of life and disability claims, with emphasis on accurate determinations in accordance...SeniorClaims
- CVS Health is seeking a claims support professional to research, review, and correct pharmacy-related claim issues, ensuring accurate benefit administration and regulatory compliance. The role emphasizes analytic rigor, attention to detail, and the ability to work independently...SeniorClaimsFull time
- CVS Health in Missouri is seeking an experienced claims processor to review and adjudicate self-funded, fully insured, reinsurance, and RX claims. You will handle refunds, adjust complex claim calculations, and respond to customer inquiries while ensuring compliance and...SeniorClaimsFull time
- ...Senior Accountant AbbVie's mission is to discover and deliver innovative... ...solutions that solve serious health issues today and address the... ...learn more: Recruitment Fraud Alert AbbVie will never... ...offer or communication claiming to be from AbbVie, please do not...SeniorClaimsImmediate start
$171.6k - $338.3k
Position Summary Are you an experienced health and welfare benefits consultant ready to lead complex client work? As a Senior Manager, Health Benefits Consulting, you... ...self-insured financial projections, claims, and utilization data to support rate-setting...SeniorClaimsLocal areaVisa sponsorship$18.5 - $38.82 per hour
We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At... ...Responsible for researching, reviewing, and correcting pharmacy-related claim issues to ensure accurate benefit administration, financial...SeniorClaimsHourly payFull timeTemporary workLocal area$124k - $280k
...The OpportunityAs part of the Applied AI Health System Engineering team, you will lead the... ...of health system and health plans. As a Senior Manager, you will drive use case development... ...teams in processing clinical notes, claims data, ADT feeds, and other structured and...SeniorClaimsFull timeH1b$19 - $22 per hour
...the UMKC School of Dentistry is seeking a Senior Dental Assistant to assist in our... ...University of Missouri provides generous leave, health plans, and retirement contributions that... ...Of course, one of Kansas City's biggest claims to fame is its food, especially its world...SeniorClaimsHourly payTemporary workCasual workWork at office- ...delivery leader who combines strong health payer industry knowledge,... ...trusted relationships with senior client executives.As an... ...core payer processes such as claims, enrollment and eligibility,... ...charge, (b) in furtherance of an investigation, proceeding, hearing, or action...SeniorClaimsWork experience placementLive inWork at officeLocal area
$18.5 - $42.35 per hour
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At... ...adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in...SeniorClaimsHourly payFull timeContract workTemporary workLocal area- ...Kansas City Office Full time R5025007 As a Senior Safety Manager, you will ensure the... ...care while enforcing Clark's Safety and Health Policy, as well as, local and federal safety... ...compensation and lead efforts in managing claims. + Utilize experience to proactively mitigate...SeniorClaimsFull timeTemporary workFor subcontractorWork at officeLocal area
$46.99k - $122.4k
We're building a world of health around every individual — shaping a more connected, convenient... ...family and one community at a time. The Senior Analyst, PPO Network Discount... ...objectives. The Senior Analyst leverages claims, reimbursement, and market data to assess...SeniorClaimsHourly payFull timeContract workTemporary workLocal areaRemote work$18.07 - $33.92 per hour
At Luminare Health, our people are what set us apart... ...includes a variety of claim administrative and... ...addition to these tasks, the Senior Claims Analyst is... ...administration experience: solid investigation, analytical and... ...disability insurance, supplemental life insurance,...SeniorClaimsFlexible hoursShift work$65k
...dynamic, student-centered team dedicated to promoting the mental health, well-being, and success of the UMKC community. Through... ...making yourself at home. Of course, one of Kansas City’s biggest claims to fame is its food, especially its world-famous barbecue. Foodies...SeniorClaimsTemporary workTraineeshipCasual workWork at officeShift workWeekend workAfternoon shift$24 per hour
Role Snapshot The Senior Overpayment Recovery Specialist will assist... ...procedures, HIGLAS system, claims processing guidelines, edit... ...Competitive paid time off Health insurance, dental insurance,... ...to screening and background investigation including fingerprinting prior...SeniorClaimsContract workFor contractorsLocal areaImmediate startRemote workShift work- ...preserving food and food production, health, and our planet. Corbion is seeking a Senior 3PL Warehouse Manager based at... ...periodic joint cycle counts; investigate deviations and ensure corrective... ...agreed requirements, including claims and compensation when applicable...SeniorClaimsContract workFor subcontractorWork at office
- Allied Universal is hiring a Surveillance Investigator to perform discreet mobile and stationary surveillance of claimants to support insurance claim administration. The role requires analyzing activities and reporting observations clearly. Responsibilities include conducting...Claims
- ...English/Spanish) a plus Experience in knowing how to evaluate claims, etc. Excellent verbal and written communication skills Have a... ...401K Retirement Savings Plan with Firm match Employer-Covered Supplemental Benefits Voluntary Supplemental Benefits Annual Performance Reviews...SeniorClaimsFull timeWork at officeVisa sponsorship
$100k - $115k
...great healthcare affordable, improve the health of patients, and restore the fulfillment... ...better path!! Job Description The Senior Technical Integration Specialist plays a... ...new practices’ clinical data, new payers' claims data, and managing technical...SeniorClaimsBi-weekly payFull timeTemporary workFor contractorsLocal areaRemote workWork from homeFlexible hours- ...Position Summary The Senior Project Manager is... ...Regulation (FAR), and agency-specific supplements. The SPM serves as the primary... ...Equitable Adjustment (REAs) and claims when necessary Project... ...based on experience Health/dental/vision insurance, 401(...SeniorClaimsDaily paidContract workFor contractorsFor subcontractorNight shift
- BCA Financial Services, Inc. is seeking a detail-oriented Insurance Claim Collector for a REMOTE position. Ideal candidates have a minimum of 2 years in medical insurance billing and claims follow-up and can work effectively with creditor clients and insurance carriers...ClaimsRemote job
- The University of Kansas Health System is seeking a Director of Claims & Senior Counsel to lead risk management, claims handling, and legal strategy across... ...regulatory matters, with a track record of guiding complex investigations and defense strategies in a #J-18808-Ljbffr...Claims
- Lockton Insurance and Claims Counsel seeks an experienced attorney to manage high-volume financial lines claims, including D&O, E&O, and... ...strong leadership and executive presence to interface with senior stakeholders. Qualified candidates will have a Law degree and 5+...SeniorClaims
$70k - $90k
...Insurance, Home Insurance, Life Insurance, Business Insurance, Health Insurance, and Renters Insurance. Account Associate As an... ...customers with policy changes and inquiries. Process insurance claims and follow up with customers on claim status. Coordinate with...ClaimsWork at officeImmediate start- ...with orthopedic issues Respond to clinical queries to support claims management Deliver detailed IME reports within an expected... ...abilities are a plus Benefits Robust opportunity for supplemental income Schedule flexibility and predictable work hours-...ClaimsExtra incomeContract workFlexible hours
- Revecore is seeking a Health Claims Specialist to bill and investigate health insurance claims for hospitals and medical providers. You will maximize payments from commercial insurers, Medicare, and Medicaid while supporting the team with denial reports and audits. The...ClaimsRemote job
- W. R. Berkley Corporation seeks an SIU Senior Investigator in Overland Park, KS to lead complex investigations into suspected commercial lines insurance fraud. You will manage major case files and develop investigative strategies. You will interview sources, gather evidence...Senior
- ...Senior Health Actuarial Pricing RolePricing partner to underwriting. Closer to a pricing-underwriting partner than a modelling-heavy... ...development, filings, reserve analysis, and underwriting support for Supplemental Health and Accident products. The role is aimed at...Senior
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