Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. The Opportunity We are looking for a SIU Investigator (mid-level). This is a desk position. Within defined guidelines and framework, protects USAA and our members from potential fraudulent claims by investigating questionable, suspect claims activity in compliance with state insurance fraud-related laws and regulations and policies and procedures. The candidate selected will have strong multi-line SIU Investigation experience. This role is remote eligible. However, you must live in the assigned territory which is ME, VT, NH, MA, CT, RI, DE, MD or Washington DC. There may be occasional business travel. What you'll do: - Applies knowledge and understanding of fraud schemes and investigation strategies on any questionable or suspect first or third part claims. - Participates in the development of fraud prevention strategies. - Applies knowledge of P&C insurance industry products, services, and processes in investigating claims to include P&C insurance policy contracts, coverages and internal claims handling process and procedures. - Applies knowledge of state laws and regulations pertaining to insurance fraud in investigating claims. - Collects evidence of potential fraud through field or remote interviews and thorough searches of investigative databases, internal resources, Internet resources, public records, and forensic tools. - Makes recommendations within defined authority guidelines. - Prepares and presents detailed and comprehensive verbal and written investigative reports summarizing the results of the investigation and recommended outcome. - Develops and maintains external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection, and prevention. - May serve as a resource team member on specific matters through demonstrated skill or training. - Assists with the delivery of fraud awareness training initiatives in a defined environment. - Handles CAT duty responsibilities as business requires. - Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures. What you have: - High School Diploma or General Equivalency Diploma (GED). - 2+ years claims adjusting experience, or P&C SIU/Fraud Investigation experience OR 4+ years prior investigative law enforcement (to include military) or relevant fraud industry investigation experience. - Proven investigatory skills. - Experience obtaining statements from various parties to incidents, witnesses, and suspects. - Ability to gather broad range of evidence and draw conclusions based on the objective details related to the applicability of fraud. - Demonstrated ability to organize and prioritize workload, performing multiple tasks and devising solutions to problems. - Familiarity with using computers and various software packages to enter and extract data for analysis from relevant data sources and systems. - Knowledge of city, state and local regulations, legal concepts, understanding of contracts, case law, medical treatment, and medical terminology. What sets you apart: - SIU experience conducting low to complex P&C fraud investigations OR a combination of Insurance Claims and (Law Enforcement Investigations OR Military Investigations) experience. - Strong background with multi-line SIU investigations - Designations such as CFE, CIFI, SCLA, ACLS, FCLS, LPCS, AIC, CPCU, CCLS, or other. - US military experience through military service or a military spouse/domestic partner Compensation range: The annualized range for this position is: $77,120 - $147,390. This is an hourly position. USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, F-1, STEM OPT Training Plans, etc.). Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors. The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job. Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include 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, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals. For more details on our outstanding benefits, visit our benefits page on USAAjobs.com Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting. USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Claim Examiner - Liability (REMOTE - Heavy GL, Lit & BI exp) 10 years complex litigation & BI experience. General Liability Experience required with Premises, Products and Completed operations, and Public Entity would be preferred but not required. NY Adjusters license needed or will be required within 90 days of employment. Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands? - Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. - Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations. - Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. - Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights. - Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. - Enjoy flexibility and autonomy in your daily work, your location, and your career path. - Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. PRIMARY PURPOSE: To analyze mid- and higher-level general liability claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.. ESSENTIAL FUNCTIONS and RESPONSIBILITIES - Manages mid-level general liability claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level. - Assesses liability and resolves claims within evaluation. - Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract. - Manages subrogation of claims and negotiates settlements. - Communicates claim action with claimant and client. - Ensures claim files are properly documented and claims coding is correct. - May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review. - Maintains professional client relationships. ADDITIONAL FUNCTIONS and RESPONSIBILITIES - Performs other duties as assigned. - Supports the organization's quality program(s). - Travels as required. QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university preferred. Experience: 4 years of Liability claims management experience or equivalent combination of education and experience required. TAKING CARE OF YOU - Flexible work schedule. - Referral incentive program. - Career development and promotional growth opportunities. - A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

"NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our end client and their team. In this Role the candidate will be responsible for: • Processing of Professional claim forms files by provider • Reviewing the policies and benefits • Comply with company regulations regarding HIPAA, confidentiality, and PHI • Abide with the timelines to complete compliance training of NTT Data/Client • Work independently to research, review and act on the claims • Prioritize work and adjudicate claims as per turnaround time/SLAs • Ensure claims are adjudicated as per clients defined workflows, guidelines • Sustaining and meeting the client productivity/quality targets to avoid penalties • Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA. • Timely response and resolution of claims received via emails as priority work • Correctly calculate claims payable amount using applicable methodology/ fee schedule Requirements: • 3 year(s) hands-on experience in Healthcare Claims Processing • 2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools • High school diploma or GED. • Previously performing – in P&Q work environment; work from queue; remotely • Key board skills and computer familiarity – o Toggling back and forth between screens/can you navigate multiple systems. o Working knowledge of MS office products – Outlook, MS Word and MS-Excel. Preferred Skills & Experiences: • Amisys • Ability to communicate (oral/written) effectively in a professional office setting • Effective troubleshooting where you can leverage your research, analysis and problem-solving abilities • Time management with the ability to cope in a complex, changing environment"

Extraordinary Careers. Endless Possibilities. With the nation’s largest home infusion provider, there is no limit to the growth of your career. Option Care Health, Inc. is the largest independent home and alternate site infusion services provider in the United States. With over 8,000 team members including 5,000 clinicians, we work compassionately to elevate standards of care for patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the infusion care experience for patients, customers and team members. Join a company that is taking action to develop an inclusive, respectful, engaging and rewarding culture for all team members. At Option Care Health your voice is heard, your work is valued, and you’re empowered to grow. Cultivating a team with a variety of talents, backgrounds and perspectives makes us stronger, innovative, and more impactful. Our organization requires extraordinary people to provide extraordinary care, so we are investing in a culture that attracts, hires and retains the best and brightest talent in healthcare. Job Description Summary: This position is responsible for overseeing and executing the reauthorization process for therapies, ensuring that all necessary reauthorization steps are completed in a timely manner. The individual in this position must consistently meet performance targets related to speed and accuracy while maintaining a high level of professionalism and attention to detail in all reauthorization tasks.Job Description: ​ Job Responsibilities - Processes reauthorization with speed and accuracy. - Manages the documentation, communication, and follow-up with relevant plans, referral sources, Pharmacies, and patients. - Assist Reauthorization Supervisor and Manager with special assignments as needed. Supervisory Responsibilities Does this position have supervisory responsibilities? NO (i.e. hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, etc.) Basic Education and/or Experience Requirements - High school diploma or equivalent is required. - Minimum of two years of experience in related experience. Basic Qualifications - Ability to multi-task and support numerous referrals/priorities at one time. - Ability to work in a fast past environment. - High degree of self-discipline in maintaining productivity expectations. - Must be detail-oriented and have a high degree of quality focus. Travel Requirements Not Applicable Preferred Qualifications & Interests Healthcare/medical billing experience preferred. May perform other duties as assigned Due to state pay transparency laws, the full range for the position is below: Salary to be determined by the applicant's education, experience, knowledge, skills, and abilities, as well as internal equity and alignment with market data. Pay Range is $17.02-$28.38 Benefits: -Medical, Dental, & Vision Insurance -Paid Time off -Bonding Time Off -401K Retirement Savings Plan with Company Match -HSA Company Match -Flexible Spending Accounts -Tuition Reimbursement -myFlexPay -Family Support -Mental Health Services -Company Paid Life Insurance -Award/Recognition Programs Option Care Health subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information. ​