Claims Case Investigator Jobs in Boston, Massachusetts

57 jobs

Job Summary: The Investigator, Special Investigations Unit (SIU) is a key contributor to the Plan’s member and provider fraud, waste, and abuse (FWA) detection, investigation, remediation, and prevention efforts. The Investigator utilizes preliminary recommendations provided by the SIU Data Analyst to develop, conduct, resolve, document, and report on investigations of tips, allegations, or data ...

At Gallagher Bassett (GB) we are constantly seeking skilled professionals who are up for a challenge and take exceptional performance to heart. The professionals we hire help us maintain our reputation as one of the most progressive property/casualty third party claims service organizations in our industry and throughout the world. Gallagher Bassett provides services to Fortune 1000 companies thro...

The Property Claims Examiner processes claims involving property coverage under personal and commercial lines insurance policies. They ensure claim assignments are completed in accordance with company best practices and state insurance regulations. They will investigate, evaluate, negotiate and make settlements on property damage claims. Work requires the assignment and direction of field adjuster...

Responsible for the investigation, evaluation, negotiation and settlement of automobile first party physical damage and first party property damage insurance losses. Initiates contact with injured parties to obtain claim information and establish potential exposure. · Evaluates coverage, investigates and determines liability · Negotiates and settles property damage claims and applies comparative...

At Gallagher Bassett Services, Inc. (GB) we are constantly seeking skilled professionals who are up for a challenge and take exceptional performance to heart. The professionals we hire help us maintain our reputation as one of the most progressive property/casualty third party claims service organizations in our industry and throughout the world. Gallagher Bassett provides services to Fortune 1000...

MAJOR RESPONSIBILITIES: Consistently apply in-depth knowledge of federal and state regulations and healthcare industry standards. Conduct independent data mining and data analysis techniques utilizing claims data to detect aberrancies and outliers in claims and develop trends and patterns for potential cases. Develop algorithms, queries, and reports to detect potential FWA activity. Analyze member...

MAJOR RESPONSIBILITIES: Conduct with assistance data mining and data analysis utilizing claims data to detect aberrancies and outliers in claims and develop trends and patterns for potential cases Develop with assistance audit rules, queries and reports to detect potential FWA activity. Analyze member records and claims data to ensure compliance with applicable regulations, contracts and policy ma...

The Nurse Investigator will conduct complex investigations into allegations of fraud, waste and abuse through clinical review of medical records and comprehensive coding analysis ESSENTIAL FUNCTIONS: Utilizes medical knowledge and/or professional coder expertise to detect and investigate instances of fraud, waste and abuse in order to safeguard or recover financial assets Clinical review and an...

Donan, established in 1947 andan industry leader in Forensic Engineering, Fire Investigation and additional Claims Services, has an immediate opening for an experiencedCertified Fire Investigatorin a Part-Time statusat ourBoston, MA areaoffice. This is an excellent opportunity for a seasoned professional to join a first class, rapidly growing organization. Are you a problem solver? Do you enjoy g...

Position Summary Under general supervision of the Director of Claims Management, the Claims Representative investigates and resolves professional and general liability incidents, claims and lawsuits involving Steward’s insureds to determine liability and exposure. Travels to Steward facilities to conduct on-site interviews and evaluation of facilities in order to satisfy the position function. Ma...

Plymouth Rock, founded in 1982 by Jim Stone, former Massachusetts Insurance Commissioner, is a privately held insurance company that writes personal and commercial lines of business in the Northeastern United States. Today, Plymouth Rock, with more than $1billion in premiums underwritten and serviced, is comprised of a group of companies that were started or acquired to expand product offerings, c...

Description: Advance your career at Liberty Mutual Insurance- A Fortune 100 Company! Are you looking for an opportunity to join a Bodily Injury Claims Team with a responsible company that has consistently outpaced the industry in year over year growth? Liberty Mutual Insurance has an excellent claims opportunity available. As a Bodily Injury Claims Adjuster, you will get the opportunity to use y...

Description: Advance your career at Liberty Mutual Insurance- A Fortune 100 Company! Are you looking for an opportunity to join a Bodily Injury Claims Team with a responsible company that has consistently outpaced the industry in year over year growth? Liberty Mutual Insurance has an excellent claims opportunity available. As a Bodily Injury Claims Adjuster, you will get the opportunity to use y...

Bodily Injury Claims Adjuster-Hingham, MA-64074 Description Advance your career at Liberty Mutual Insurance- A Fortune 100 Company! Are you looking for an opportunity to join a Bodily Injury Claims Team with a responsible company that has consistently outpaced the industry in year over year growth? Liberty Mutual Insurance has an excellent claims opportunity available. As a Bodily Injury Claims...

Description: Advance your career at Liberty Mutual Insurance- A Fortune 100 Company! Are you looking for an opportunity to join a Bodily Injury Claims Team with a responsible company that has consistently outpaced the industry in year over year growth? Liberty Mutual Insurance has an excellent claims opportunity available. As a Bodily Injury Claims Specialist, you will get the opportunity to use...

Responsible for the investigation, evaluation, negotiation and settlement of a caseload of automobile adverse subrogation claims. In the course of their duties the Adverse Subrogation Specialist works towards mitigating adverse damages for the company while maintaining high standards of integrity and thoroughness in the handling of their cases. · Evaluates coverage, investigates and determines li...

Description: Position Description: Energize your career with one of Healthcare's fastest growing companies. You dream of a great career with a great company where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it's a dream that definitely can come true. Already one of the world's leading Healt...

Be a part of a team of case managers that respond to reports of abuse of seniors. Conduct investigations and create a care plan that helps alleviate abuse. Intensive training and support provided. Company Profile At Springwell, we are serious about our mission. For more than 37 years, our staff has worked to help ensure that seniors and individuals with disabilities have the village they need an...

Fraud, Waste and Abuse Program AuditorFraud, Waste and Abuse Program Auditor Agency Name: University of Massachusetts Medical School Official Title: Fraud, Waste and Abuse Program Auditor Functional Title: Fraud, Waste and Abuse Program Auditor Occupational Group: Accountants and Auditors Position Type: Not Given Full-Time or Part-Time: Full-Time Salary Range: $0.00 to $0.00 Annually...

Overview: Located in Charlestown, MA, the Commonwealth Medicine Center for Health Care Financing (CHCF) helps state agencies, our primary clients, identify opportunities to increase savings and reimbursements through federal and other third party sources, establish effective savings and reimbursement programs and capitalize on all possible revenue streams. At the same time, we identify opportunit...