The Opportunity
As a dedicated SIU Major Case Manager (Medical Provider), you will be responsible for operational management of Claims fraud investigative teams. Directs staff in the investigation of cases involving questionable, suspect, or fraudulent activity. Ensures compliance with policies and procedures contributing to fraud control objectives, as well as compliance with state insurance fraud-related laws and regulations.
This role is remote eligible in the continental U.S. with occasional business travel.
What you'll do:
Responsible for insurance fraud detection and investigation services to reduce fraud-related claim payments and costs, while avoiding unwarranted risk.
Ensure compliance with laws and regulations relating to claims handling and unfair claims practices and reporting statutes.
Participates in the establishment and implementation of policies and procedures for fraud con...