SIU Major Case Manager – Medical Provider

Job not on LinkedIn

🕒 6 days ago

🐊 Florida, Idaho, +2 more states – Remote

🐊 Florida – Remote 🥔 Idaho – Remote 🌶️ New Mexico – Remote 🤠 Texas – Remote

💵 $119.3k - $228k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

USAA

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1922

🏦 Banking

🛡️ Insurance

💸 Finance

Banking • Insurance • Finance

USAA is a financial services company that provides banking, insurance, and investment products to current and former military members and their families. The company is committed to superior customer service and secure technology for its members, offering a private portal for business access and interaction with their services.

📋 Description

• 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 control and investigative practices. • Performs leadership and management tasks, i.e., providing coaching, evaluating performance, review of time sheets, managing time off, conducting quarterly check-ins/ride-alongs, etc. • Evaluates, authorizes, and implements actions and decisions to carry out proactive claim's projects and investigations. • Review and evaluate investigation recommendations from investigators to ensure results and case documentation support conclusions. • Ensure risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.

🎯 Requirements

• Bachelor's degree; OR 4 years of relevant education and/or experience. • 2 years of demonstrated leadership experience, supervisory or management experience in major case medical provider. • 6 years’ experience in medical provider fraud and P&C industry functional work OR 4 years of medical provider P&C experience plus military service experience. • Experience supporting and developing affirmative litigation referrals and collaborating with counsel on fraud-related legal actions. • Demonstrated ability to manage multiple high-priority investigations and case assignments simultaneously while meeting critical deadlines. • Experience handling large-scale, complex, and high-exposure fraud investigations from initial referral through resolution. • Extensive knowledge and experience in all levels of claims investigation or fraud investigation and regulatory reporting requirements. • Knowledge of anti-fraud analytics programs relates to fraud prevention and identification. • Thorough understanding investigative tools and techniques to guide and coach special investigators. • Demonstrated ability to build and maintain collaborative relationships with internal and external partners and business areas. • Demonstrated management skills and the ability to demonstrate monthly productivity and cycle time outcomes from investigations assigned to the SIU team. • Ability to prepare and present training sessions and case outcomes. • Demonstrated experience facilitating and managing projects and teams

🏖️ Benefits

• comprehensive medical, dental and vision plans • 401(k) • pension • life insurance • parental benefits • adoption assistance • paid time off program with paid holidays plus 16 paid volunteer hours • various wellness programs • career path planning and continuing education