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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 As a dedicated Property Adjuster Specialist, you will work within defined guidelines and framework, investigate, evaluate, negotiate, and settle complex property insurance claims. You will confirm/analyze coverage, recognize liability exposure and negotiate equitable settlement in compliance with all state regulatory requirements. You will recognize and empathize with members’ life events, as appropriate. Property Adjuster Specialist focus on using technology and desk adjusting for a virtual first approach to inspections and claims handling. USAA also provides a company vehicle to physically inspect losses within your locally assigned territory. Field Adjusters may travel outside of their local territory to respond to claims in other regions when needed. This is an hourly, non-exempt position with paid overtime available. This is a field-based role in the Northern New Jersey area (Newark/Border of New York). Candidates who are willing and able to work in this area are encouraged to apply. What you'll do: * Proactively manages assigned claims caseload comprised of complex damages that require commensurate knowledge and understanding of claims coverage including potential legal liability. * Partners with vendors and internal business partners to facilitate complex claims resolution. May also involve external regulatory coordination to ensure appropriate documentation and compliance. * Investigates claim damages by conducting research from various sources, including the insured, third parties, and external resources. May identify and resolve potential discrepancies and identifies subrogation potential resulting from unusual characteristics. * Identifies coverage concerns, reviews prior loss history, determines and creates Special Investigation Unit (SIU) referrals, when appropriate. Determines coverage through analyzing information involving complex policy terms and contingencies. * Determines and negotiates complex claims settlement within authority limits. Develops recommendations and collaborates with management for determining settlement amounts outside of authority limits and accurately manages claims outcomes. * Maintains accurate, thorough, and current claim file documentation throughout the claims process. * Advance knowledge of estimating technology platforms and virtual inspection tools. Utilizes platforms and tools to prepare claims estimates to manage complex property insurance claims. * Supports workload surges and catastrophe (CAT) response operations as needed, including mandatory on-call dates and potential evening, weekend, and/or holiday work outside normal work hours. * May be assigned CAT deployment travel with minimal notice during designated CATs. * Works various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed. * Works independently solving complex problems with minimal guidance; acts as a resource for colleagues with less experience. * Adjusts complex claims with attorney involvement. * Recognizes and addresses jurisdictional challenges such as applicable legislation and construction considerations. * May require travel to resolve claims, attend training, and conduct in-person inspections. * 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. * 2 years of relevant property claims adjusting experience of moderate complexity losses that includes writing estimates, involving dwelling and structural damages. * Advanced knowledge of estimating losses using Xactimate or similar tools and platforms. * Proficient knowledge of residential construction. * Proficient knowledge of property claims contracts and interpretation of case law and state laws and regulations. * Proficient negotiation, investigation, communication, and conflict resolution skills. * Proven investigatory, analytical, prioritizing, multi-tasking, and problem-solving skills. * Ability to travel 50-75% of the year (local & non-local) and/or work catastrophe duty when needed. * Acquisition and maintenance of insurance adjuster license within 90 days and 3 attempts. * Successful completion of a job-related assessment may be required. What sets you apart: * Hands-on experience in the field handling high-severity and complex property claims such as fire, water damage, vandalism, malicious mischief, foreclosures, earth movement, collapse, and liability. * Residential property field adjusting experience with dwelling, structure and additional living expenses. * Experience working directly for a standard insurance carrier handling claims from start to finish (first notice of loss, reviewing policy, making coverage decisions) * Proficient in using estimating platforms and virtual inspection tools like Xactimate, ClaimXperience and XactAnalysis * Insurance industry designations such as AINS (Associate in General Insurance), CPCU (Chartered Property Casualty Underwriter), AIC (Associate in Claims), or SCLA (Senior Claims Law Associate) or actively pursuing * Active Property & Casualty adjuster license * Currently reside in the Northern New Jersey area, enabling quicker response times for local claims and a better understanding of regional risks * US military experience through military service or a military spouse/domestic partner Physical Demand Requirements: * May require the ability to crouch and stoop to inspect confined spaces, to include attics and go beneath homes into crawl spaces. * May need to meet all USAA safe driving requirements including verification of driving record through MVR & possession of valid driver’s license. * May require the ability to lift a minimum of 35 pounds to include lifting a ladder in and out of the trunk of a car. * May require the ability to climb ladders and traverse roofs, this includes the ability to work at heights while inspecting roofs and attics. Compensation range: The salary range for this position is: $85,050 - $153,090. 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, 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.

Summary of Job Conduct complex, in-depth investigations of reported fraud involving the full range of healthcare products. Develop and maintain relationships with law enforcement (HHS-OIG, FBI, DOJ), regulatory agencies (DFS, MEDIC, OMIG, MFCU) and with industry peers. Provide guidance to the Fraud Investigators on SIU investigations and issues. Assist with anti-fraud training sessions and public speaking engagements. Responsibilities • Investigate complex cases of reported fraud involving the Company’s Medicaid healthcare product., • Develop leads from various sources to review for suspect activity., • Review claim files and develop action plans for the investigation., • Conduct highly comprehensive interviews/interrogations with providers., • Conduct medical record assessments, and CPT coding issues., • Provide guidance and mentor to the Fraud Investigators., • Answer and respond to SIU Fraud Hotline cases when assigned based on schedule., • Triage complaints that come to the SIU and follow through on resolution., • Participate in meetings with providers, attorneys, law enforcement on a case-by-case basis as needed., • Attend training, conferences, webinars to keep up to date on current trends and schemes of Fraud, Waste & Abuse., • May assist with fraud awareness training sessions and public speaking engagements., • Establish and maintain relationships with law enforcement (HHS-OIG, FBI), regulatory agencies (i.e DFS, MEDIC, OMIG, MFCU, NYS OAG), and with industry peers., • Refer cases to law enforcement or regulatory agencies as needed., • Periodically meet with representatives from law enforcement and regulatory agencies to keep updated on current trends., • Handle and respond to Requests for Information (RFI) from law enforcement and regulatory agencies., • Perform other duties as directed, assigned, or required. Qualifications • Bachelor’s degree in criminal justice or related field., • AHFI and/or CFE certification (Preferred., • 4 – 6+ years of relevant, professional work experience (Required), • Additional experience/specialized training may be considered in lieu of a bachelor’s degree (Required), • Professional investigation experience in economic or insurance related matters (Required), • Experience in insurance claims investigation or law enforcement (Preferred), • Strong knowledge of CPT and ICD9-CM coding, medical terminology, and treatment options (Required), • Proficiency in MS Office - Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc. (Required), • Strong communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences (Required), • Attention to detail, critical thinking and problem-solving skills (Required), • Ability to monitor and review information from materials, events, or the environment, to detect or assess problems (Required)

Insurance Coverage Associate (5+ Years) | HYBRID | Leading Regional Firm This Jobot Job is hosted by: Kendall Barnett Are you a fit? Easy Apply now by clicking the "Apply" button and sending us your resume. Salary: $160,000 - $200,000 per year A bit about us: We’re a respected Am Law 200 defense firm with over 60 years of experience serving corporate, insurance, and individual clients. Our Coverage practice serves insurance carriers at every stage of coverage disputes- from analytical research and declaratory judgment actions to defending coverage and bad-faith litigation. We value attorneys who are intellectually curious, strong writers, and comfortable engaging directly with clients and opposing counsel. You’ll be part of a collaborative litigation team with deep institutional knowledge and significant runway for professional growth. Why join us? You’ll join a group that: • Emphasizes balanced exposure to research, writing, hands-on litigation, and client interaction, • Values consistent, steady career progression and long-term growth, • Encourages trial advocacy and practical courtroom experience Job Details Practice Focus: • Represent insurance companies in coverage disputes and bad-faith litigation, • Handle declaratory judgment actions and coverage analysis, • Work across first-party property, property SIU, and insurance fraud matters (strong interest/experience a plus), • 5+ years of insurance coverage experience, • Strong analytical writing and legal research skills, • Interest in trial advocacy and litigation strategy 165–185 hours per month In-Office Requirement: Hybrid Compensation & Benefits: • Competitive base salary with multiple bonus opportunities, • Comprehensive benefits package, • Matching 401(k), • Long-term professional support and growth opportunities Interested in hearing more? Easy Apply now by clicking the "Apply" button. Jobot is an Equal Opportunity Employer. We provide an inclusive work environment that celebrates diversity and all qualified candidates receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, age (40 and over), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. Jobot also prohibits harassment of applicants or employees based on any of these protected categories. It is Jobot’s policy to comply with all applicable federal, state and local laws respecting consideration of unemployment status in making hiring decisions. Sometimes Jobot is required to perform background checks with your authorization. Jobot will consider qualified candidates with criminal histories in a manner consistent with any applicable federal, state, or local law regarding criminal backgrounds, including but not limited to the Los Angeles Fair Chance Initiative for Hiring and the San Francisco Fair Chance Ordinance. Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from Jobot, and/or its agents and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here: jobot.com/privacy-policy

Summary of Position Responsible for upholding the standard for code review functions in the setting of business/industry/legislative issues relating to, and impacting, quality coding audit and compliance issues. Identify inconsistencies and coding compliance risks between EH reimbursement policies and claims which directly impact claim payment (i.e. authorizations) and responsible for working with leadership to bring to resolution. Audit inpatient and outpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed. Principal Accountabilities • Audit internal and external business partners (processes and results) for accurate claim coding reviews for various programs, pre- and post-payment., • Review reporting for outlier provider claims; request patient medical records to assign diagnoses, treatments, and surgical and non-surgical procedures for facility and medical services for coding and payment integrity., • Analyze and audit claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities., • Identify potential documentation and coding errors by recognizing aberrant coding and documentation patterns such as inappropriate billing for readmissions, inpatient admission status, and Hospital-Acquired Conditions (HACs)., • Provide audit reporting, results, and recommendations to management and SIU as appropriate., • Analyze results to assess compliance with regulations, identify procedural weaknesses and education needs that contribute to instances for non-compliance both to business, external business partners, and providers., • Prepare formal written reports summarizing current state (findings), desired future state, and critical success factors., • Perform audits of changes to coding introduced by new medical policies, reimbursement policies, regulatory changes, and business requirements on a quarterly basis., • Participate in RPC, RPCW, Medical Policy Committee (MPC) and Medical Policy Committee Workgroup (MPCW) as added Coding Integrity representation at meetings; ensure that decisions are appropriate and will result in accurate., • Claim reimbursement., • Identify reimbursement and coding variances from industry standards and brings to leader's attention., • Continuously gains knowledge of CPT, ICD, HCPCS and business/industry/legislative issues relating to and impacting Quality Coding Audit and Compliance issues., • Bachelor's degree, preferably in a healthcare, quantitative/analytical, or business-related field of study, • AAPC CPC (AAPC Certified Professional Coder) & AAPC CIC (Certified Inpatient Coder)/or CCS (AHIMA Certified Coding Specialist), • AAPC CPMA (AAPC Certified Professional Medical Auditor), • 4 - 6+ years of coding experience, • 1+ year auditing experience, • Extensive knowledge of inpatient DRG clinical documentation review, • Additional related work experience/specialized training may be considered in lieu of educational requirements, • Proficiency with MS Office (Word, Excel, Access, PowerPoint, Outlook, Teams, etc.), • Attention to detail; and ability to communicate or escalate issues in a timely manner, • Ability to independently prioritize and complete multiple tasks with competing priority levels and deadlines, • Ability to perform effectively in a fast-paced work environment, • Excellent communication skills (verbal, written, presentation, interpersonal) with all types and levels of audiences Additional Information • Requisition ID: 26037, • Hiring Range: $68,040-$118,800

At Allstate, great things happen when our people work together to protect families and their belongings from life's uncertainties. And for more than 90 years, our innovative drive has kept us a step ahead of our customers' evolving needs. From advocating for seat belts, air bags and graduated driving laws, to being an industry leader in pricing sophistication, telematics, and, more recently, device and identity protection. Job Description Join our legal team and play a key role in defending both the insured and the Company. As a Personal Injury Protection (PIP)/No-Fault / Special Investigations (SIU) Attorney, you'll manage a diverse caseload involving no-fault claims, arbitrations, and mediations. You'll stay current on evolving laws and regulations to ensure our defense strategies remain effective and compliant. This is a dynamic opportunity to sharpen your litigation skills and make a meaningful impact in a fast-paced, team-oriented environment. This position is 100% remote and candidates should be comfortable managing their caseload and collaborating with colleagues in a virtual environment with minimal court appearances required. Key Responsibilities • Manage all aspects of PIP/no-fault litigation from case inception through resolution including case evaluation, discovery, motion practice, arbitrations, mediations, and settlement negotiations., • Conduct Special Investigation Unit (SIU) Examinations Under Oath (EUOs) and prepare comprehensive reports with a focus on SIU and Personal Injury Protection (PIP) matters., • Review new file assignments, analyze evidence, develop case strategies, and prepare and draft pleadings, motions, and other legal documents., • Conduct AAA no-fault arbitrations, and try cases as needed, including preparing witnesses and clients for testimony., • Keep claim business partners consistently updated on case status through regular communications, strategy conferences, and pre-trial reports., • Monitor changes in laws and regulations to ensure compliance and optimize legal strategies for the company and clients. Education • Juris Doctorate and active membership in good standing with the New York State Bar. Minimum Requirements • Successful completion of courses focused on legal research, writing, and analysis, demonstrating the ability to conduct thorough legal research and draft clear, well-structured legal documents., • Demonstrates strong time management skills, effectively balancing multiple tasks and deadlines., • Capable of organizing case files, managing legal documents, and understanding the discovery process., • Skilled in communicating with clients, preparing summaries, and maintaining records of interactions., • Well-versed in legal ethics and the standards of professional conduct., • Equipped with fundamental negotiation techniques and strategies for client interactions and settlement discussions., • Must be commutable distance to courthouses throughout New York. Explore the Benefits of Joining Allstate's Client Legal Services: • Exceptional Work-Life Balance:At Allstate, we understand the importance of achieving harmony between work and personal life. Our in-house litigation roles provide more predictable schedules and flexibility, allowing you to excel professionally while enjoying a fulfilling personal life., • Holistic Understanding of the Business:As part of the Allstate legal team, you'll gain invaluable insight into our diverse business operations, objectives, and culture. This comprehensive understanding enables you to align legal strategies closely with the company's goals, fostering impactful contributions and strategic partnerships across departments., • Direct Client Collaboration:Working in-house at Allstate means collaborating directly with internal stakeholders and business units. This close partnership cultivates deeper client relationships, facilitating a nuanced understanding of their needs and priorities. By providing proactive legal guidance and support, you'll play a pivotal role in driving the company's success., • Strategic Influence and Impact:As an integral member of our legal team, you'll have the opportunity to shape strategic decisions and risk management initiatives. Your insights and expertise will inform key business decisions, empowering you to mitigate risks effectively and drive positive outcomes that directly impact Allstate's bottom line., • Diverse Legal Challenges:In-house litigation roles at Allstate encompass a broad spectrum of legal work beyond traditional litigation, including regulatory compliance, risk assessment, and dispute resolution. This diversity of challenges ensures continuous professional growth and development, expanding your skill set and enhancing your career trajectory., • Professional Growth Opportunities:With ample opportunities for advancement and professional development, you'll have the support and resources you need to reach new heights in your legal career. #LI-JA2 Skills Case Management, Client Documentation, Documentation, Evidence Gathering, Legal Document Preparation, Legal Writing, Litigation, Time Management, Torts Compensation Compensation offered for this role is 70,100.00 - 121,475.00 annually and is based on experience and qualifications. The candidate(s) offered this position will be required to submit to a background investigation. Joining our team isn't just a job - it's an opportunity. One that takes your skills and pushes them to the next level. One that encourages you to challenge the status quo. One where you can shape the future of protection while supporting causes that mean the most to you. Joining our team means being part of something bigger - a winning team making a meaningful impact. Allstate generally does not sponsor individuals for employment-based visas for this position. Effective July 1, 2014, under Indiana House Enrolled Act (HEA) 1242, it is against public policy of the State of Indiana and a discriminatory practice for an employer to discriminate against a prospective employee on the basis of status as a veteran by refusing to employ an applicant on the basis that they are a veteran of the armed forces of the United States, a member of the Indiana National Guard or a member of a reserve component. For jobs in San Francisco, please click "___" for information regarding the San Francisco Fair Chance Ordinance. For jobs in Los Angeles, please click "___" for information regarding the Los Angeles Fair Chance Initiative for Hiring Ordinance. To view the "EEO Know Your Rights" poster click "___". This poster provides information concerning the laws and procedures for filing complaints of violations of the laws with the Office of Federal Contract Compliance Programs. To view the FMLA poster, click "___". This poster summarizing the major provisions of the Family and Medical Leave Act (FMLA) and telling employees how to file a complaint. It is the Company's policy to employ the best qualified individuals available for all jobs. Therefore, any discriminatory action taken on account of an employee's ancestry, age, color, disability, genetic information, gender, gender identity, gender expression, sexual and reproductive health decision, marital status, medical condition, military or veteran status, national origin, race (include traits historically associated with race, including, but not limited to, hair texture and protective hairstyles), religion (including religious dress), sex, or sexual orientation that adversely affects an employee's terms or conditions of employment is prohibited. This policy applies to all aspects of the employment relationship, including, but not limited to, hiring, training, salary administration, promotion, job assignment, benefits, discipline, and separation of employment.

At Allstate, great things happen when our people work together to protect families and their belongings from life's uncertainties. And for more than 90 years, our innovative drive has kept us a step ahead of our customers' evolving needs. From advocating for seat belts, air bags and graduated driving laws, to being an industry leader in pricing sophistication, telematics, and, more recently, device and identity protection. Job Description Join our legal team and play a key role in defending both the insured and the Company. As a Personal Injury Protection (PIP)/No-Fault Attorney, you'll manage a diverse caseload involving no-fault claims, arbitrations, and mediations. You'll stay current on evolving laws and regulations to ensure our defense strategies remain effective and compliant. This is a dynamic opportunity to sharpen your litigation skills and make a meaningful impact in a fast-paced, team-oriented environment. This position is 100% remote, and candidates should be comfortable managing their caseload and collaborating with colleagues in a virtual environment, with minimal court appearances required. Key Responsibilities * Manage all aspects of PIP/no-fault litigation from caseinceptionthrough resolution, including case evaluation, discovery, motion practice, arbitrations, mediations, and settlement negotiations. * Conduct Special Investigation Unit (SIU) Examinations Under Oath (EUOs) and prepare comprehensive reports with a focus on SIU and Personal Injury Protection (PIP) matters. * Review new file assignments, analyze evidence, develop case strategies, and prepare and draft pleadings, motions, and other legal documents. * ConductAAAno-fault arbitrations, and try cases as needed, including preparing witnesses and clients for testimony. * Keepclaimbusiness partners consistently updated on case status through regular communications, strategy conferences, and pre-trial reports. * Monitor changes in laws and regulations to ensure compliance andoptimizelegal strategies for the company and clients. Education * Juris Doctorate and active membership in good standing with the New York State Bar. MinimumRequirements * Successful completion of courses focused on legal research, writing, and analysis,demonstratingthe ability to conduct thorough legal research and draft clear, well-structured legal documents. * Demonstrates strong time management skills, effectively balancing multiple tasks and deadlines. * Capable of organizing case files, managing legal documents, and understanding the discovery process. * Skilled in communicating with clients, preparing summaries, andmaintainingrecords of interactions. * Well-versed in legal ethics and the standards of professional conduct. * Equipped with fundamental negotiation techniques and strategies for client interactions and settlement discussions. * Must becommutabledistance to courthouses throughoutNew York. Explore the Benefits of Joining Allstate's Client Legal Services: * Exceptional Work-Life Balance:At Allstate, we understand the importance of achieving harmony between work and personal life. Our in-house litigation roles provide more predictable schedules and flexibility, allowing you to excel professionally while enjoying a fulfilling personal life. * Holistic Understanding of the Business:Aspart of the Allstate legal team,you'llgain invaluable insight into our diverse business operations,objectives, and culture. This comprehensive understanding enables you to align legal strategies closely with the company's goals, fostering impactful contributions and strategic partnerships across departments. * Direct Client Collaboration:Working in-house at Allstate means collaborating directly with internal stakeholders and business units. This close partnership cultivates deeper client relationships,facilitatinga nuanced understanding of their needs and priorities. By providing proactive legal guidance and support,you'llplay a pivotal role in driving the company's success. * Strategic Influence and Impact:As an integral member of our legal team,you'llhave the opportunity to shape strategic decisions and risk management initiatives. Your insights andexpertisewill inform key business decisions, empowering you to mitigate risks effectively and drive positive outcomes that directlyimpactAllstate's bottom line. * Diverse Legal Challenges:In-house litigation roles at Allstate encompass a broad spectrum of legal work beyond traditional litigation, including regulatory compliance, risk assessment, and dispute resolution. This diversity of challenges ensures continuous professional growth and development, expanding your skill set and enhancing your career trajectory. * Professional Growth Opportunities:Withample opportunitiesfor advancement and professional development,you'llhave the support and resources you need to reach new heights in your legal career. #LI-JA2 Skills Case Management, Client Documentation, Evidence Gathering, Legal Document Preparation, Litigation, Negotiation, Report Writing, Time Management, Torts Compensation Compensation offered for this role is 70,100.00 - 121,475.00 annually and is based on experience and qualifications. The candidate(s) offered this position will be required to submit to a background investigation. Joining our team isn't just a job - it's an opportunity. One that takes your skills and pushes them to the next level. One that encourages you to challenge the status quo. One where you can shape the future of protection while supporting causes that mean the most to you. Joining our team means being part of something bigger - a winning team making a meaningful impact. Allstate generally does not sponsor individuals for employment-based visas for this position. Effective July 1, 2014, under Indiana House Enrolled Act (HEA) 1242, it is against public policy of the State of Indiana and a discriminatory practice for an employer to discriminate against a prospective employee on the basis of status as a veteran by refusing to employ an applicant on the basis that they are a veteran of the armed forces of the United States, a member of the Indiana National Guard or a member of a reserve component. For jobs in San Francisco, please click "___" for information regarding the San Francisco Fair Chance Ordinance. For jobs in Los Angeles, please click "___" for information regarding the Los Angeles Fair Chance Initiative for Hiring Ordinance. To view the "EEO Know Your Rights" poster click "___". This poster provides information concerning the laws and procedures for filing complaints of violations of the laws with the Office of Federal Contract Compliance Programs. To view the FMLA poster, click "___". This poster summarizing the major provisions of the Family and Medical Leave Act (FMLA) and telling employees how to file a complaint. It is the Company's policy to employ the best qualified individuals available for all jobs. Therefore, any discriminatory action taken on account of an employee's ancestry, age, color, disability, genetic information, gender, gender identity, gender expression, sexual and reproductive health decision, marital status, medical condition, military or veteran status, national origin, race (include traits historically associated with race, including, but not limited to, hair texture and protective hairstyles), religion (including religious dress), sex, or sexual orientation that adversely affects an employee's terms or conditions of employment is prohibited. This policy applies to all aspects of the employment relationship, including, but not limited to, hiring, training, salary administration, promotion, job assignment, benefits, discipline, and separation of employment.

Enters SIU claim data information into multiple SIU systems. SIU Sr Cons I: $68,500-104,100. This job is responsible for investigating and analyzing complex, multi-discipline coverage and claims that have been referred to the special investigation unit (SIU) for potential fraud.

A minimum of 5 years' SIU experience is required. The SIU Investigator should demonstrate proficiency in the following areas:.

Insight Service Group (ISG) is a national investigative services firm specializing in cost containment and anti-fraud related services. Canvassing: Engage in neighborhood and witness canvassing to gather additional information.

Special Investigations Unit (SIU) - Field Investigator. Our dynamic Ethos team is seeking a Special Unit Investigations (SIU) Field Investigator to conduct field investigations, gather and analyze evidence, and produce detailed reports that support claims decisions. Active Private Investigator licen

Liaise with the Blue Cross Blue Shield Association SIU Executives, and OPM-OIG's Section Chief and Criminal investigators on Horizon Blue Cross Blue Shield of New Jersey's SIU current cases. Horizon Blue Cross Blue Shield Of New Jersey. Horizon Blue Cross Blue Shield of New Jersey empowers our membe

A health insurance company in New York is seeking a Fraud Investigator to conduct in-depth investigations of Medicaid fraud. The role involves developing relationships with law enforcement and regulatory agencies, providing guidance to investigators, and participating in fraud awareness training.

A healthcare services provider is seeking a Business Change Director for their office in New York.This hybrid role involves collaborating with stakeholders to manage significant change initiatives and ensure alignment with strategic business goals.Ideal candidates will possess a related BA/BS, at le

A leading insurance provider is seeking a skilled Personal Injury Protection Attorney for a fully remote position in New York.The role includes managing a diverse caseload involving no-fault claims, conducting SIU examinations, and preparing legal documents.Candidates must have a Juris Doctorate and

Job Description As Litigation Counsel, you will defend cases in New York City and the surrounding areas, and may also defend cases in New Jersey. To be successful in this position, you need to be a self-starter, highly organized, focused, detail-oriented, and willing to travel for single-day trips and occasionally overnight. This role requires you to have technical proficiency and experience defending bodily injury, personal injury, first-party property damage, NY labor law, wrongful death, insurance coverage, employment practices, extra-contractual or bad faith litigation and subrogation. Accountabilities: • This position will defend litigation throughout New York and some travel, with occasional overnight stays, as needed for case appearances and for the annual team meeting., • The position may also defend litigation in New Jersey or other jurisdictions (where admitted or on a pro hac vice basis)., • The primary function of GuideOne Litigation Counsel is to handle all assigned litigation and other legal matters for GuideOne and its policyholders., • Litigation work includes but is not limited to case analysis, preparation of motions, pleadings, discovery, conducting depositions, hearings, trials, appeals and communicating with the claims department., • The candidate must be able to competently present a controversy from inception through trial or appeal while maintaining the independent professional judgment required of a lawyer., • The position involves a busy, fast-paced, full practice with a mix of commercial property, coverage, and personal injury (including catastrophic injury and wrongful death) cases representing individuals as well as corporate and nonprofit entities., • Other duties as assigned, including but not limited to meetings, training, legislative updates, writing articles and publications, EUOs, SIU investigation, and other corporate legal functions. Requirements: • Licensed to practice law in New York., • Licensed or eligible to obtain a license to practice law in New Jersey., • A J.D. from an accredited law school., • Five or more years of insurance defense litigation experience required., • Trial experience preferred., • Admitted to or eligible for admission to federal court., • Able to timely handle full-time, high volume case load with little to no direct supervision., • Frequent travel required, with some overnight stays, including a weeklong team meeting., • Prior in-house experience a plus., • CPCU or insurance-related designation. Compensation: At GuideOne, we believe that our people are our greatest asset, and we foster a sense of collaboration among our team members so they can learn from and inspire one another to deliver excellence in risk solutions and services to our customers. For more than 75 years, we've established a reputation as a trusted partner in the communities where we live and work, and with our steadfast commitment to help make positive change possible, we're excited to see what we can accomplish during the next 75. Explore our values and culture, and learn why GuideOne might be a great fit for you! GuideOne is proud to offer a robust benefits suite that includes: • Competitive base salary plus incentive plans for eligible team members., • 401(K) retirement plan that includes a company match of up to 6% of your eligible salary., • Free Basic Life and AD&D, long-term disability and short-term disability insurance., • Medical, dental and vision plans to meet your unique healthcare needs., • Wellness incentives, • Generous time off program including; personal, holiday, and volunteer paid time off., • Flexible work schedules and hybrid/remote options for eligible positions., • Educational assistance program. #GuideOne

Job Description Hi, we're Oscar. We're hiring a Senior Analyst, Data Analytics, SIU to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role: The Senior Analyst, Data Analytics, SIU partners across the organization to manage inefficiencies in the business. You will support teams in scoping, analyzing and monitoring performance of important financial and utilization metrics in service of our goals. The Senior Analyst, Data Analytics collaborates independently with stakeholders to define key questions and scope analyses. They may at times be called upon to speak to prepared analysis both internally and externally. This work aims to reduce medical waste and deliver more affordable and higher-quality health care for Oscar's members. You will report into the Manager, SIU Data Analytics & Reporting. Work Location: This is a remote position, open to candidates who reside in: Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas and Virginia. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. If you live within commutable distance to our New York City office (in Hudson Square) or our Tempe office (off the 101 at University Ave), you will be expected to come into the office at least three days each week. Otherwise, this is a remote / work-from-home role. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. The base pay for this role in the states of New Jersey and New York is: $72,036 - $94,575 per year. The base pay for this role in all other locations is: $64,832 - $85,092 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities: • Analyze data to support business teams in making better informed, data-driven decisions, • Use data to tell a story that non-technical colleagues can understand, including packaging and presenting findings in a clear, concise and compelling manner, • Oversee the creation and maintenance of essential operational and analytical dashboards, and update and enhance them as our user's needs evolve, • Create models and tools that produce relevant insights to identify inefficiencies and generate insights to remove inefficiencies, • Collaborate across the organization to identify actions to achieve improvements and monitor initiative impact, • Support other strategic projects as assigned to meet business needs, • Compliance with all applicable laws and regulations, • 1+ years of technical work experience using analytical tools and writing analytical reports, • 1+ years demonstrated ability to work with large datasets and distill analyses into relevant insights with a structured and systematic thought process, • Strong communication skills, verbal and written, around business reporting impact and requirements, as demonstrated by experience on at least 2 reporting projects requiring communication between technical and non-technical users, • Experience in SQL, with the ability to filter, aggregate, and build CTEs, or proficiency in R or Python, including experience with Pandas, for loops, and statistical tests, • Proficiency in Google Sheets or Excel skills, with ability to use VLookup, nested if statements and connected Sheets, • 1+ years experience in preparing healthcare analytics and reporting, • 1+ years experience managing value-based contracts at a payer or a provider organization (ACO, CIN, MSO), • 1+ years experience developing dashboards and working with Looker, or other business intelligence/data visualization tools At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

Job DescriptionOverview Company Overview: Advance Your Career in Insurance Claims with Allied Universal® Compliance and Investigation Services. Allied Universal® Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you're ready to grow with the best, explore a career with us and make a difference. Job Description Allied Universal® is hiring a Special Investigations Unit (SIU) Investigator. Special Investigations Unit (SIU) Specialists investigate claims with red flags that suggest fraudulent behavior In relation to an Insurance claim. The SIU Specialist must use their extensive knowledge of Insurance policies and the components of fraud to determine If claims warrant reporting to the appropriate state agency for prosecution. • Must possess a valid driver's license with at least one year of driving experience, • Candidate must reside in state listed in job posting, • Pay Rate: $32 - $38 / hr RESPONSIBILITIES: • Independently investigate suspected fraudulent insurance claims for a variety of coverage to include workers' compensation, general liability, property and casualty and disability, • Acquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance, • Create and maintain detailed documentation for investigations, file reviews, audits, training tasks, consulting projects, and other assignments as directed, • Produce professional and expert reports, memos, and letters that are clear, concise, and grammatically correct, • Run appropriate database indices if necessary and verify the accuracy of results found, • Must possess one or more of the following:, • Bachelor's degree in Criminal Justice, • High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud, • Ability to be properly licensed as a Private Investigator as required by the state where work Is completed, • Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course, • Minimum of five (5) years of demonstrated experience conducting complex insurance investigations or adjusting complex insurance claims, • Proficient understanding and application of anti-fraud laws, insurance regulations, and compliance standards within their home state and designated regional area., • Proficient in utilizing laptop computers and cell phones., • Special Investigative Unit (SIU) Compliance knowledge, • Ability to type 40+ words per minute with minimum error, • Military experience, • Law enforcement, • Insurance administration experience, • Familiarity with California SIU regulations, • One or more of the following professional industry certifications:, • Certified Fraud Investigator (CFE), • Certified Insurance Fraud Investigator (CIFI), • Fraud Claim Law Associate (FCLA), • Fraud Claim Law Specialist (FCLS), • Certified Protection Professional (CPP), • Associate in Claims (AIC), • Medical, dental, vision, basic life, AD&D, retirement plan and disability insurance, • Seven paid holidays annually, sick days available where required by law If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: . Requisition ID 2026-1556202

Job Description Hi, we're Oscar. We're hiring a SIU Coding Auditor to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role The Senior Specialist works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations. You will report to the Manager, SIU Coding Audit. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. Pay Transparency: The base pay for this role in the states of New Jersey and New York is: $65,412 - $85,853 per year. The base pay for this role is: $58,870 - $77,267 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities • Develop a depth of expertise on CPT, HCPCS, and ICD-10 Coding guidelines and other insurance billing submission requirements., • Perform complex audits of assigned medical records and claims on both a prepayment and post payment basis to determine accuracy of claims submitted to Oscar., • Document findings including reference to sources used to support decision making and in a way that can be easily understood by non clinicians or coders., • Create audit report findings, tools, and reference guide that can be used by other team members to communicate findings or more effectively perform similar reviews., • Help draft written communications to providers to convey audit findings., • Participate in educational calls with providers., • Help train new team members., • Develop and document processes to improve the effectiveness of the team., • Compliance with all applicable laws and regulations, • Other duties as assignedQualifications, • 2+ years of coding or auditing experience across multiple specialties is required, • Bachelor's degree or 4+ years of work experience, • Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC) designation or similar certification, • Experience working in production-based environment, • Experience of both outpatient and inpatient auditingBonus Points, • Certified Professional Medical Auditor (CPMA), • Additional certification applicable to this work such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), other coding certifications or similar, • Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity, • Demonstrated experience translating technical jargon to non-technical end users., • Experience working in health insurance specifically with claims processing, billing, reimbursement, or provider contracting., • Experience with HIPAA, data privacy, and/or data security processes At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

Job DescriptionDescription: Command Investigations, LLC is seeking an Insurance Field Investigator with a minimum of three years experience to become part of a dynamic team. This is a great opportunity for individuals with prior SIU experience who demonstrate integrity, independence, and a drive to succeed in a fast-paced investigative environment. Why You Will Love Working with Command Investigations, LLC? At Command Investigations, we are invested in YOU! We know, together, we can Lead with Excellence to provide top tier Service with Integrity that drives Results! Pay: $28.00 – $32.00 per hour Schedule: Part-time, on-call. Due to the nature of this role, there is no guarantee of hours or case assignments; however, we pride ourselves on distributing available cases fairly. Our employees have opportunities to grow within a nationally recognized organization in an exciting and evolving industry. How We Take Care of You (for Full Time positions): • Accrued Paid Time Off, • Medical, Dental, Vision, and Life Insurance, • 401(k) Plan What You will Do: In this role, you will conduct claims investigations by gathering evidence, interviewing involved parties, documenting findings, and preparing comprehensive, detailed reports for client review. • Conduct investigations related to insurance claims, including workers’ compensation, general liability, auto, and property cases, • Obtain in-person recorded statements from claimants, witnesses, and involved parties, • Capture detailed scene photographs to support investigative findings, • Prepare comprehensive, factual, and well-organized investigative reports within required deadlines, • Review case materials and identify inconsistencies or areas requiring further inquiry, • Communicate effectively with clients and internal teams to provide case updates and ensure investigative objectives are met, • Utilize sound judgment and discretion while maintaining confidentiality and compliance with company standards, • Manage multiple case assignments simultaneously while prioritizing tasks to meet strict due dates, • Exceptional attention to detail and accuracy, • Strong work ethic with a willingness to learn and adapt, • Team-oriented mindset and open-minded attitude, • Ability to thrive in a focused, detail-driven, and repetitive environment, • Strong computer skills and working knowledge of Microsoft Suite, specifically in Word and Outlook, • 3-5 years of experience working as a field investigator required, • Prior experience with multi-lines investigations strongly preferred, • Reside within a 60-mile radius of the posted location required, • Multi-lingual is a plus, • High school diploma or equivalent required, • College degree strongly preferred, • Proficient reading skills and ability to follow directions required, • Must be able to work independently, provide excellent customer service, and demonstrate strong interpersonal, organizational, and multi-tasking skills. Flexibility and effective time management are required, • Flexible to work overtime preferred, • Regular, predictable, and full attendance, as assigned, is an essential function of the job, • Willingness to work the required schedule The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. • The employee will be required to remember and understand certain instructions, guidelines, or other information., • The employee should have the ability to lift up to and including 25lbs/11.34kg on occasion., • The employee will be required to sit, stand, and/or walk for long periods at a time., • The employee will be required to enter text or data into a computer or other machine by means of a traditional keyboard. Traditional Keyboard refers to a panel of keys used as the primary input device on a computer, typographic machine, or 10-Key numeric keypad. Command Investigations, founded in 2012, is a nationally recognized investigations firm offering surveillance, remote investigations, desktop intelligence, and specialty services to the insurance defense industry. Grounded in core values of integrity, service, and results, we deliver fast, reliable outcomes and treat every client like they are our only client. Our team leverages cutting-edge technology to stay at the forefront of the industry. With headquarters in Lake Mary, Florida, our experts provide services across the U.S. on a national scale. Command Investigations, LLC is an Equal Opportunity Employer.

Job Description Hi, we're Oscar. We're hiring a SIU Investigator to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role: The SIU Investigator identifies and investigates aberrant behavior observed in medical claims data and member enrollment data. You will manage an investigative caseload from case identification through to resolution, including data mining, investigation planning, data analysis, sampling, medical records requests, audit interpretation, overpayment recovery, reporting to regulatory agencies and monitoring ongoing provider behavior. The Senior Analyst will meet metrics set forth related to caseload, turn around times, and other unit-wide goals. You will report into the Investigations Manager, SIU. Work Location: This is a remote position, open to candidates who reside in: Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas and Virginia. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. If you live within commutable distance to our New York City office (in Hudson Square) or our Tempe office (off the 101 at University Ave), you will be expected to come into the office at least three days each week. Otherwise, this is a remote / work-from-home role. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. The base pay for this role in the states of New Jersey and New York is: $72,036 - $94,546 per year. The base pay for this role in all other locations is: $64,832 - $85,092 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities: • Identify and conduct investigations into suspected FWA with high autonomy, • Document findings to include formal investigative reports, tables, graphs, audit logs, and other supporting documentation, • Met metrics to align with caseload, turn around times, and other unit-wide goals, • Continue to monitor providers with substantiated findings to track behavior change, • Participate in the development and presentation of FWA-related education for Oscar teams, • Build evidentiary files for potential recovery, legal action, and/or referrals to appropriate outside agencies, • Compliance with all applicable laws and regulations, • 3+ years of healthcare fraud investigation experience or professional investigation experience with law enforcement agencies, • Bachelor's degree in Criminal Justice or a related field, • Experience with HIPAA, data privacy, and/or data security processes, • Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), or similar At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

Our Special Investigations Unit (SIU) plays a vital role in identifying and mitigating risks associated with fraud and misconduct. We are seeking a meticulous and experienced SIU Investigator to join our team. Insurance Experience: Background in insurance, including workers' compensation, auto, liab

SIU Investigator Job Description: We are seeking a meticulous and experienced SIU Investigator to join our team. Our Special Investigations Unit (SIU) plays a vital role in identifying and mitigating risks associated with fraud and misconduct. Key Responsibilities as an SIU Investigator:.

Investigator For Special Investigations Unit (Siu). This is a remote opportunity for part-time employment in our Special Investigations Unit (SIU). As an SIU Investigator, you will be joining an incredible team of investigators and industry leaders.

Special Investigative Unit (SIU) Compliance knowledge Ability to type 40+ words per minute with minimum error Flexibility to work varied and irregular hours and days including weekends and holidays PREFERRED QUALIFICATIONS (NICE TO HAVE): Military experience Law enforcement Insurance administration

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