• 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.

• Assesses member's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to member's needs and aligned with the benefit structure. • Facilitates response to gaps in care and identified high risk members to appropriate settings of care for annual wellness visits including collaboration with treating provider. • Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided for both acute and chronic health care needs. • Develops, coordinates and assists in implementation of individualized plan of care for members and identification of barriers towards Self-Management and optimal wellness. • Coordinates with members, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome. • Monitors member's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness. • Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided. • Encourages member participation and compliance in the case/disease management program efforts.

Role Description Du möchtest mehr als nur Zahlen verwalten? Bei Pathé spielst du eine wichtige Rolle in unserem Finance Team. Du lernst von erfahrenen Kolleginnen und Kollegen, arbeitest mit modernen Tools und gestaltest Prozesse mit. Wir bieten dir ein dynamisches Umfeld mit kurzen Entscheidungswegen, flexiblen Arbeitsbedingungen und klarer Einarbeitung. Qualifications - Abgeschlossene KV-Ausbildung mit Weiterbildung im Bereich Finanz- und Rechnungswesen (Eidg. FA) - Min. 4 Jahre Erfahrung im Bereich Finanzbuchhaltung inkl. Führungserfahrung - Gute MS-Office-Kenntnisse - Erfahrung mit Abacus und/oder Microsoft Dynamics von Vorteil - Deutsch als Muttersprache, Englisch B2/C1 erforderlich Requirements - Debitorenmanagement inkl. Mahnwesen - Kreditorenmanagement inkl. Zahlungswesen - Kontrolle der täglichen Einnahmen und deren Verbuchung - Cash-Management - Buchführung der allgemeinen Buchhaltung - Führen und Überwachen der Anlagebuchhaltung - Periodische Abschlüsse (Monat, Semester, Jahr), allgemeines Reporting - Intercompany-Abstimmungen und Verrechnungen - Administrative Arbeiten und gesetzlich vorgeschriebene Abrechnungen (MWSt/Steuern) Benefits - Praxisnahes Onboarding mit klarer Begleitung und regelmässigem Feedback. - Moderne Arbeitsmittel und flexible Arbeitsbedingungen. - Ein kollegiales Team und kurze Entscheidungswege. - Entwicklungsmöglichkeiten im Finance-Bereich. Skills - Buchhaltung - Belastbarkeit - Organisation - Management - Teamwork - Zahlenaffinität

Role Description Functions as a Government Lending Resolutions Manager for the Special Assets Department. As a manager, guides and motivates Commercial Resolutions Officers and the Claims Management Team to exceed expectations for case management and resolution along with adherence to policies and procedures governing the department. Conducts business development initiatives and contributes to the generation of new business. In addition to the management role, also has responsibility for a portfolio of loans. Assists the Director of Special Assets in such areas as portfolio review and analysis, quality assurance, internal and external audits, business unit risk identification and management, department procedure changes, and other tasks as assigned by the Director of Special Assets. Success in the role is defined by team and individual efficacy in the department's goals relating to case management and resolution while minimizing expense and loss to the bank, compliance with bank policy and procedures, as well as applicable banking regulations. Qualifications - High School Diploma required. - Bachelor’s degree in business, finance, banking, or related field is preferred. - Graduation from a recognized school of banking is an asset. - Minimum of 10+ years commercial lending or commercial credit experience. - 3-5 years management experience. - Experience should include significant loan structuring, credit analysis and portfolio management. - At least 5 years of commercial workout and litigation experience. - Extensive knowledge of Bank lending facilities, services, procedures, and practices. - In-depth knowledge of loan workout strategies and litigation strategies. - Knowledge of Federal and State lending regulations and Bank policies relating to lending and Special Assets procedures. - Well-developed interpersonal, negotiating, and problem-solving skills. - Excellent written and verbal communication skills. - Detail oriented with the ability to prioritize complex work assignments. - Excellent time management skills. - Proven analytical skills and the ability to evaluate credit worthiness. - Proficient in the use of basic office equipment, Microsoft Word, Excel, and Outlook. Requirements - Works with the Director of Special Assets to develop and implement effective strategies for case resolution. - Assists in managing the performance of Commercial Resolutions Officers. - Reviews and approves all quarterly CLARs for the SAM government loan portfolio. - Manages the overall transfer, resolutions and claim submission process for the SBA and USDA loan portfolio. - Participates in establishing goals for the department. - Conducts regular one-on-one meetings with team members. - Creates a positive and collaborative work environment. - Assists the Director of Special Assets with portfolio reviews and quality assurance measures. - Performs day-to-day management of a portfolio of classified assets. - Communicates with borrowers via phone, face-to-face meetings, and written correspondence. - Issues past due and demand letters to delinquent borrowers as necessary. - Documents collection activities in the designated system. - Maintains an orderly e-file system to retain necessary documentation. - Effectively manages maturing loans in the assigned portfolio. - Negotiates renewal/modification terms with borrowers and secures necessary approvals. - Reviews all assigned loans and develops a resolution strategy for each. - Negotiates settlements with borrowers and guarantors. - Ensures accurate coding on all loans in portfolio based on current status. - Engages attorneys, appraisers, and other outside vendors as needed. - Identifies loans in portfolio that require an impairment analysis. Benefits - Salary Ranges: $133,533.00 - $213,307.00 - Equal Opportunity Employer, including disabled/veterans.