USAA
Atascosa, Texas
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 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 We are looking for a dedicated SIU Investigator Senior - Major Case Unit. Within defined guidelines and framework, you will help protect USAA and our members from potential fraudulent claims by investigating complex fraud investigations with significant financial impact to USAA. This may involve working with Legal Counsel, government agencies and outside consultants in compliance with state laws and regulations for an assigned operational specialty team. This is a Remote eligible position. This is a field-based role that can be based in anywhere in the Continental United States. Relocation assistance is not available for this position. What you'll do: Leads the execution of fraud prevention strategies and investigative operations. Leads high exposure, high profile and critical work assignments, and special investigations involving sophisticated niche fraud referrals, (examples: organized provider rings, staged accidents, large losses of significant exposure and broad scale PIP/Casualty Schemes) across multiple entities or functions. Applies advanced knowledge of P&C insurance industry products, services, and processes in investigating claims. This includes P&C insurance policy contracts and coverages and claims handling process and procedures. Applies advanced knowledge of state laws and regulations pertaining to insurance fraud in investigating claims. Processes large quantities of unstructured detailed information with high levels of accuracy by collecting evidence of potential fraud through field or remote interviews and thorough searches of investigative databases, internal resources, Internet resources, public records, and forensic tools. Makes appropriate and prompt decisions to identify potential complex fraud within defined guidelines. Prepares and presents detailed and comprehensive verbal and written investigative reports summarizing the results and outcome of the investigation. Serves as subject matter authority for team members including providing expert mentorship and training for fraud investigations. Develops and maintains external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection, and prevention. Develops proactive actions and conveys compelling arguments to influence disposition of arbitrated and litigated cases effectively and efficiently. Handles CAT duty responsibilities as business requires. Ensures risks associated with business activities are effectively identified, measured, supervised, and controlled in accordance with risk and compliance policies and procedures. What you have: High School Diploma or General Equivalency Diploma. 4+ years of P&C SIU/Fraud investigation experience; OR 6+ years relevant fraud industry investigation experience. Expert knowledge and understanding of fraud investigations as well as application of case law and state laws and regulations . Must be a skilled investigator with experience taking sophisticated statements from multiple parties to an event. Ability to capture broad range of evidence and draw conclusions based on the objective details related to the applicability of fraud. Demonstrated ability to coordinate and prioritize workload, performing multiple tasks and devising solutions to problems. Experience using computers and various software packages to enter and extract data for analysis from relevant data sources and systems. Knowledge of city, state and local regulations, legal concepts, understanding of contracts, case law, medical treatment, and medical terminology. Experience in concurrent handling of specialty/complex/litigated claims/cases as well as mediation/arbitration/trial preparation and participation. What sets you apart: At least 5 years of SIU/investigative experience in P&C 3+ years of experience conducting multi-claim major case investigations in multiple jurisdictions Experience with Major Case investigations in more than one line of business (for example, auto/property/casualty) Experience handling Major Case Investigation from start to finish with advanced report writing to submit for affirmative litigation. Comprehensive experience applying various causes of action for potential affirmative fraud litigation Experience working on projects within SIU Experience leading or mentoring other SIU investigators Subject Matter Expertise (SME) in at least one personal line of business ( auto/property/casualty) Industry recognized major designations (for example, CPCU, CFI, CFE) Meet all USAA safe driving requirements including verification of driving record through MVR & possession of valid driver's license. US military experience through military service or a military spouse/domestic partner Compensation range: The salary range for this position is: $93,770 - $179,240 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, F-1, 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 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.
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 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 We are looking for a dedicated SIU Investigator Senior - Major Case Unit. Within defined guidelines and framework, you will help protect USAA and our members from potential fraudulent claims by investigating complex fraud investigations with significant financial impact to USAA. This may involve working with Legal Counsel, government agencies and outside consultants in compliance with state laws and regulations for an assigned operational specialty team. This is a Remote eligible position. This is a field-based role that can be based in anywhere in the Continental United States. Relocation assistance is not available for this position. What you'll do: Leads the execution of fraud prevention strategies and investigative operations. Leads high exposure, high profile and critical work assignments, and special investigations involving sophisticated niche fraud referrals, (examples: organized provider rings, staged accidents, large losses of significant exposure and broad scale PIP/Casualty Schemes) across multiple entities or functions. Applies advanced knowledge of P&C insurance industry products, services, and processes in investigating claims. This includes P&C insurance policy contracts and coverages and claims handling process and procedures. Applies advanced knowledge of state laws and regulations pertaining to insurance fraud in investigating claims. Processes large quantities of unstructured detailed information with high levels of accuracy by collecting evidence of potential fraud through field or remote interviews and thorough searches of investigative databases, internal resources, Internet resources, public records, and forensic tools. Makes appropriate and prompt decisions to identify potential complex fraud within defined guidelines. Prepares and presents detailed and comprehensive verbal and written investigative reports summarizing the results and outcome of the investigation. Serves as subject matter authority for team members including providing expert mentorship and training for fraud investigations. Develops and maintains external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection, and prevention. Develops proactive actions and conveys compelling arguments to influence disposition of arbitrated and litigated cases effectively and efficiently. Handles CAT duty responsibilities as business requires. Ensures risks associated with business activities are effectively identified, measured, supervised, and controlled in accordance with risk and compliance policies and procedures. What you have: High School Diploma or General Equivalency Diploma. 4+ years of P&C SIU/Fraud investigation experience; OR 6+ years relevant fraud industry investigation experience. Expert knowledge and understanding of fraud investigations as well as application of case law and state laws and regulations . Must be a skilled investigator with experience taking sophisticated statements from multiple parties to an event. Ability to capture broad range of evidence and draw conclusions based on the objective details related to the applicability of fraud. Demonstrated ability to coordinate and prioritize workload, performing multiple tasks and devising solutions to problems. Experience using computers and various software packages to enter and extract data for analysis from relevant data sources and systems. Knowledge of city, state and local regulations, legal concepts, understanding of contracts, case law, medical treatment, and medical terminology. Experience in concurrent handling of specialty/complex/litigated claims/cases as well as mediation/arbitration/trial preparation and participation. What sets you apart: At least 5 years of SIU/investigative experience in P&C 3+ years of experience conducting multi-claim major case investigations in multiple jurisdictions Experience with Major Case investigations in more than one line of business (for example, auto/property/casualty) Experience handling Major Case Investigation from start to finish with advanced report writing to submit for affirmative litigation. Comprehensive experience applying various causes of action for potential affirmative fraud litigation Experience working on projects within SIU Experience leading or mentoring other SIU investigators Subject Matter Expertise (SME) in at least one personal line of business ( auto/property/casualty) Industry recognized major designations (for example, CPCU, CFI, CFE) Meet all USAA safe driving requirements including verification of driving record through MVR & possession of valid driver's license. US military experience through military service or a military spouse/domestic partner Compensation range: The salary range for this position is: $93,770 - $179,240 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, F-1, 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 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.
OptumCare
San Antonio, Texas
Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your lifes best work.(sm) The Cardiology RN is responsible for carrying out day-to-day support duties and facilitating teaching related to the Chronic Care, Heart Failure, and Ischemic Heart Disease. The Cardiology RN works in conjunction with the Cardiology team, providers, clinic staff and primary care physicians. This position assists in providing patient empowerment through the use of motivational interviewing skills, problem solving and self-management goal setting. Primary Responsibilities: Works with the providers and clinic staff to identify patients with Heart failure, IHD and ensures clinical guidelines are being followed Triage patients, administer IV therapy under the direction of the providers, and relay test results after provider interpretation Conducts Chronic Care Model visits and reviews the patients informal and formal support systems, focusing on what patients want to improve and educating them about their chronic disease Utilizes appropriate motivational interviewing techniques necessary for coaching and assisting the patient to complete self-management goal / action plans Enters timely and accurate data into the EMR system and other applications necessary to communicate patient needs and to ensure complete documentation of patient visits and phone calls Responsible for remote monitoring of patients, setting parameters with provider direction, identify changes in patient vitals, conduct on - going discussions in regards to disease management with the providers Maintains current knowledge regarding HF, IHD as well as treatments and medications related to each Establishes a trusting relationship with identified patients, caregivers, clinic staff members and physicians Conducts clinic one-on-one visits with patients, triaging, educated on disease, diet, assess patient needs. Communicates these needs to the appropriate person (i.e. Social Worker, clinic staff, etc.) or addresses them per process Solves problems by gathering and / or reviewing facts and selecting the best solution from identified alternatives. Decision making is usually based on prior practice or policy, with some interpretation. Applies individual reasoning to the solution of a problem devising or modifying processes and writing procedures Serves as a resource or consultant for LVN / MA team members Attends educational offerings to keep abreast of change and complies with licensing requirements, ensures all patient educational materials are up-to-date, and maintains knowledge of specialty and ancillary provider contract contents, to include exclusions and contract terms Collaborates with the cardiology team to recommend policies, procedures and standards which affect the care of the patient with high-risk chronic disease diagnoses such as HF, IHD, and all Cardiology related diseases Exhibits professionalism and is courteous with all patients, physicians and co-workers Performs all other related duties as assigned This position is located at WellMed, Specialist for Health Crockett Park / Downtown San Antonio, minutes for Metropolitan Methodist . This position may require assisting other locations as needed - Mileage reimbursement available Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your lifes best work.(sm) The Cardiology RN is responsible for carrying out day-to-day support duties and facilitating teaching related to the Chronic Care, Heart Failure, and Ischemic Heart Disease. The Cardiology RN works in conjunction with the Cardiology team, providers, clinic staff and primary care physicians. This position assists in providing patient empowerment through the use of motivational interviewing skills, problem solving and self-management goal setting. Primary Responsibilities: Works with the providers and clinic staff to identify patients with Heart failure, IHD and ensures clinical guidelines are being followed Triage patients, administer IV therapy under the direction of the providers, and relay test results after provider interpretation Conducts Chronic Care Model visits and reviews the patients informal and formal support systems, focusing on what patients want to improve and educating them about their chronic disease Utilizes appropriate motivational interviewing techniques necessary for coaching and assisting the patient to complete self-management goal / action plans Enters timely and accurate data into the EMR system and other applications necessary to communicate patient needs and to ensure complete documentation of patient visits and phone calls Responsible for remote monitoring of patients, setting parameters with provider direction, identify changes in patient vitals, conduct on - going discussions in regards to disease management with the providers Maintains current knowledge regarding HF, IHD as well as treatments and medications related to each Establishes a trusting relationship with identified patients, caregivers, clinic staff members and physicians Conducts clinic one-on-one visits with patients, triaging, educated on disease, diet, assess patient needs. Communicates these needs to the appropriate person (i.e. Social Worker, clinic staff, etc.) or addresses them per process Solves problems by gathering and / or reviewing facts and selecting the best solution from identified alternatives. Decision making is usually based on prior practice or policy, with some interpretation. Applies individual reasoning to the solution of a problem devising or modifying processes and writing procedures Serves as a resource or consultant for LVN / MA team members Attends educational offerings to keep abreast of change and complies with licensing requirements, ensures all patient educational materials are up-to-date, and maintains knowledge of specialty and ancillary provider contract contents, to include exclusions and contract terms Collaborates with the cardiology team to recommend policies, procedures and standards which affect the care of the patient with high-risk chronic disease diagnoses such as HF, IHD, and all Cardiology related diseases Exhibits professionalism and is courteous with all patients, physicians and co-workers Performs all other related duties as assigned This position is located at WellMed, Specialist for Health Crockett Park / Downtown San Antonio, minutes for Metropolitan Methodist . This position may require assisting other locations as needed - Mileage reimbursement available Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
