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SIU Major Case Manager (Medical Provider)
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at USAA in Spokane, Washington, United States
Remote
Full-Time
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Job Description
at USAA in Spokane, Washington, United States Job Description 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. We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs. The Opportunity As a dedicated SIU Major Case Manager (Medical Provider) , you will be responsible for operational management of Claims fraud investigative teams. Directs staff in the investigation of cases involving questionable, suspect, or fraudulent activity. Ensures compliance with policies and procedures contributing to fraud control objectives, as well as compliance with state insurance fraud-related laws and regulations. This role is remote eligible in the continental U.S. with occasional business travel. What you'll do: + 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.