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Made For People Like You - Financial Services - San Antonio, Texas - 361,650 followers

SIU Major Case Manager – Medical Provider

ManagerManagerFull TimeRemoteSeniorTeam 10,001+Since 1922H1B SponsorCompany SiteLinkedIn

Location

Florida + 3 moreAll locations: Florida | Idaho | New Mexico | Texas

Posted

3 days ago

Salary

$119K - $228.0K / year

Seniority

Senior

Bachelor Degree6 yrs expExperience acceptedEnglish

Job Description

SIU Major Case Manager – Medical Provider

USAA

• 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.

Job 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

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