Top 51 Claims lead Jobs in Arizona

Lead SIU Investigator
Centene —Arizona
- $70,100 - $126,200 a year
- Full-time
- Remote
- Master's degree
- High school diploma or GED
- Mentoring
- Paid holidays
- Health insurance
Healthcare Market Finance Lead
Humana —Arizona
- $104,000 - $143,000 a year
- Full-time
- CPA
- Office
- Master's degree
- Paid parental leave
- Paid holidays
Clinical Documentation Improvement Lead
The Center for Orthopedic and Research E —Phoenix, AZ
- 5 years
- Senior level
Quick Apply
Operations Team Lead I
Smart Data Solutions LLC —Tempe, AZ
- Full-time
- Mid-level
- Driver's License
- Leadership
- Paid holidays
- Disability insurance
Quick Apply
Business Intelligence Analyst Lead - Hybrid
Blue Cross Blue Shield of Arizona —Phoenix, AZ
- Full-time
- Mid-level
- Analysis skills
- 1 year
ESIS Claims Team Leader, WC
Chubb —Phoenix, AZ
- $86,000 - $124,000 a year
- Full-time
- 5 years
- Office
- Bachelor's degree
Clinical Risk Consultant Lead
Alliant Insurance Services —Arizona
- $150,000 - $160,000 a year
- Email
- Writing skills
- Research
- Bachelor's degree
- Health insurance
Quick Apply
General Liability Litigation Team Leader - Eastern
The Hartford —Scottsdale, AZ
- $86,400 - $129,600 a year
- Full-time
- Remote
- Team management
- Senior level
- Leadership
Workers' Compensation Claim Team Leader
The Hartford —Scottsdale, AZ
- $86,400 - $129,600 a year
- Full-time
- Hybrid work
- Office
- Analysis skills
- Bachelor's degree
Lead Director - Software Development Engineering (Claims Adjudication)
CVS Health —Scottsdale, AZ
- $144,200 - $288,400 a year
- Full-time
- Computer science
- Computer Science
- SQL
- Health insurance
- Dental insurance
Workers Compensation Lead Claim Examiner I
AmTrust Financial Services, Inc. —Scottsdale, AZ
- $75,000 - $93,000 a year
- Full-time
- Microsoft Outlook
- Customer service
- Research
- Health insurance
- Dental insurance
Lead Director, Healthcare Medicaid Risk Adjustment Analytics
CVS Health —Arizona
- $100,000 - $231,540 a year
- Full-time
- Remote
- 3 years
- SQL
- Bachelor's degree
- Health insurance
- Dental insurance
Lead Director, Risk Adjustment Performance Reporting and Insights
CVS Health —Arizona
- $100,000 - $231,540 a year
- Full-time
- Remote
- Computer Science
- Bachelor's degree
- Mentoring
- Health insurance
- Dental insurance
5d
Lead Director, Medicare Advantage and Group ACA Risk Adjustment Informatics
CVS Health —Arizona
- $100,000 - $231,540 a year
- Full-time
- Remote
- Computer Science
- SQL
- Bachelor's degree
- Health insurance
- Dental insurance
5d
Project Safety Lead
R-2 Contractors —Phoenix, AZ
- $40 - $50 an hour
- Weekends as needed
- CPR Certification
- Construction site
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
12d
Operational Lead
Greentech Renewables —Tucson, AZ
- $22 - $25 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Profit sharing
- Health savings account
6d
Director, Portfolio Management Lead
Markel Service Inc. —Scottsdale, AZ
- $158,720 - $218,240 a year
- Email
- Bachelor's degree
- Continuous improvement
- US work authorization
- AD&D insurance
- Employee stock purchase plan
Quick Apply
14d
Ancillary Team Leader
USI Holdings Corporation —Phoenix, AZ
- Microsoft Excel
- 5 years
- Writing skills
- Health savings account
- Paid holidays
Senior Lead Planner
Ivanhoe Electric —Casa Grande, AZ
- Full-time
- Engineering
- Office
- Presentation skills
Quick Apply
Sr. Manager, AI Lead - Semantic Layer - Remote
CSAA Insurance Services, Inc. —Phoenix, AZ
- $168,300 - $224,300 a year
- Full-time
- Remote
- Computer science
- Computer Science
- Product management
- 401(k) matching
22h

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claims lead jobs near arizona

Lead SIU Investigator

Centene -
Arizona

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Job Details

Full-time
$70,100 - $126,200 a year

Benefits

Paid holidays
Health insurance
401(k)
Tuition reimbursement
Paid time off

Qualifications

Healthcare financial misconduct investigations
Investigations regulatory compliance
Medicare
Medical law
Managed care
Managed care organization experience
Health insurance policy knowledge
Regulatory legal research
Medicare regulations
Insurance investigations
Centers for Medicare & Medicaid Services (CMS) billing regulations
Medicaid regulations
Medicaid

Full Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

*This is a remote role anywhere within the continental US.*

Position Purpose: Position acts as a subject matter expert in the field of Special Investigations Unit (SIU) investigations. Provides direction and guidance to staff who investigate and remediate compliance and fraud, waste, and abuse related matters; while maintaining an investigative workload of moderate to high complexity. Assists manager on monitoring team caseload and report on metrics.

Provides guidance to team members who investigate and remediate compliance and fraud, waste, and abuse related matters.
Assists manager on monitoring team caseload and report on metrics.
Identifies training needs and develop training aids and step actions.
Provides training and mentoring to team on casework and other SIU activities.
Evaluates and assesses allegations to determine those criteria, including federal and state regulations, Centers for Medicare & Medicaid Services (“CMS”) guidelines, and internal policies, procedures, and standards that are alleged to have been violated.
Conducts and documents interviews investigatory purposes.
Reviews investigative interviews prepared by junior investigators.
Manages caseloads of moderate to high complexity, develops investigative plans for multiple investigations, prioritizing and managing through execution.
Thoroughly documents actions, organizes, and reviews case files.
Consults with management, in-house counsel, and/or senior leadership to resolve difficult or complex issues.
Identifies risks and recommends and communicates remedial actions to mitigate future potential risks.
Performs follow up to ensure remedial and disciplinary measures are implemented appropriately and timely.
Prepares clear and concise investigative plans and reports.
Provides support and guidance to junior investigative staff.
Identifies trends and aberrant activity to generate proactive leads for investigations and analyzes data to detect potentially fraudulent activity.
Attends, actively participates in, and/or leads meetings with various business area managers.
Communicates directly with Federal or State regulators.
Prepares cases for referral to management, government agencies, and law enforcement.
Develops and maintains strong working relationships with associates and regulators.
Testifies in criminal and civil matters.
Participates in and lead special projects as needed.
Performs other duties as assigned.
Complies with all policies and standards.

Education/Experience:

Bachelor's Degree in related field; or Associate's degree with 6 years related experience; or High School Diploma/GED with 7 years related experience. required.
Master's Degree preferred.
5+ years Healthcare fraud-related investigations with audit and risk analysis required.
1+ years Managed care or working with health insurance company required.
In-depth knowledge of government programs, the managed care industry, Medicare, Medicate laws and requirements, federal, state, civil and criminal statutes required.
Reading, analyzing and interpreting State and Federal laws, rules and regulations. Knowledge of community, state and federal laws and resources required.
Knowledge and understanding of managed care claims processing systems and medical claims coding preferred preferred.

Licenses/Certifications:

Accredited Health Care Fraud Investigator (AHFI), Certified Fraud Examiner (CFE) or other industry related certification preferred.

Pay Range: $70,100.00 - $126,200.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Apply Now

Refine Your Search

claims lead jobs in arizona

Lead SIU Investigator

Healthcare Market Finance Lead

Clinical Documentation Improvement Lead

Operations Team Lead I

Business Intelligence Analyst Lead - Hybrid

ESIS Claims Team Leader, WC

Clinical Risk Consultant Lead

General Liability Litigation Team Leader - Eastern

Workers' Compensation Claim Team Leader

Lead Director - Software Development Engineering (Claims Adjudication)

Workers Compensation Lead Claim Examiner I

Lead Director, Healthcare Medicaid Risk Adjustment Analytics

Lead Director, Risk Adjustment Performance Reporting and Insights

Lead Director, Medicare Advantage and Group ACA Risk Adjustment Informatics

Project Safety Lead

Operational Lead

Director, Portfolio Management Lead

Ancillary Team Leader

Senior Lead Planner

Sr. Manager, AI Lead - Semantic Layer - Remote

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