Specialist, Claims

5 days ago

East Providence, United States Santander Full time

Specialist, Claims & Fraud Operations

Country: United States of America

USA Job Family Description: Responsible for the day-to-day operations of the company's business units. Aims to deliver superior service to clients by driving and optimizing the effectiveness and efficiency of people, processes and technology thereby enhancing financial performance, increasing investment capacity, and managing risk. Builds the sustainable repeatable capabilities that support delivery of the highest standards of service and execution. Analyzes and reviews data tools, business processes and operational standards to execute service delivery. Evaluates and ensures that operations meet company objectives, business needs, service agreements and relevant requirements. Researches and monitors external landscape to identify developments and translate them into operational implications for the company.

USA Job Function Description: Responsible for the day-to-day operations of the company's business units. Aims to deliver superior service to clients by driving and optimizing the effectiveness and efficiency of people, processes and technology thereby enhancing financial performance, increasing investment capacity, and managing risk. Builds the sustainable repeatable capabilities that support delivery of the highest standards of service and execution. Analyzes and reviews data tools, business processes and operational standards to execute service delivery. Evaluates and ensures that operations meet company objectives, business needs, service agreements and relevant requirements. Researches and monitors external landscape to identify developments and translate them into operational implications for the company.

Essential Functions/Responsibilty Statements:
Analyzes current fraud trends and provide input into rules and parameters.

Develops and maintains Policy and Procedure Manuals.
Develops registration & licensing documents, policy and procedure manuals, and other documentation as needed.
Completes governmental reports such as SAR.
Investigates fraud claims involving ACH, Pre-authorized drafts, altered check, forged endorsements, unauthorized third party transfers, elder fraud, identity theft or other operations fraud issues.
Researches discrepancies, accumulate all necessary information and take appropriate action to stop, and where possible, prevent fraud and identity theft losses.
Reviews daily reports for unauthorized share activity.
Maintains case files and work with law enforcement agencies and internal departments.
Enters fraud cases in the case management system.
Reports suspicious activity as required by the Bank Secrecy Act.
Assists in the preparation of filing bonded claims and un-bonded charge off recommendations.
Conducts daily new business and member account and/or changed account review and due diligence actions in compliance with the USA Patriot Act Member Identification Program (MIP).
0

Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education:
Bachelor's Degree or equivalent work experience in (Req)
in

Work Experience:
Experience in loss prevention, fraud, regulatory compliance, fraud prevention or security area preferably in financial services., 0-3 years (Req)

Skills and Abilities:
Working knowledge of loss and fraud detection/prevention principals, multiple fraud areas, compliance and regulatory issues related to the department and/or company.
Working knowledge of fraud systems such as Lexus Nexus, Targus, Tran Union TLO
Knowledge and experience with root cause analysis
Solid analytical, interpretive and problem solving skills
Ability to analyze diverse information and develop strategy recommendations
Excellent customer service and communication skills, both verbal and written
Excellent organization skills
Solid ability to multi-task
Solid knowledge of department computer applications and systems
Proficient in MS Office Applications

Diversity & EEO Statements: At Santander, we value and respect differences in our workforce and strive to increase the diversity of our teams. We actively encourage everyone to apply.

Santander 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, genetics, disability, age, veteran status or any other characteristic protected by law.

Working Conditions: Frequent Minimal physical effort such as sitting, standing and walking. Occassional moving and lifting equipment and furniture is required to support onsite and offsite meeting setup and teardown. Physically capable of lifting up to fifty pounds, able to bend, kneel, climb ladders.

Employer Rights: Employer Rights:This job description does not list all of the job duties of the job. You may be asked by your supervisors or managers to perform other duties. You may be evaluated in part based upon your performance of the tasks listed in this job description. The employer has the right to revise this job description at any time. This job description is not a contract for employment and either you or the employer may terminate at any time for any reason.

The base pay range for this position is posted below and represents the annualized salary range. For hourly positions (non-exempt), the annual range is based on a 40-hour work week. The exact compensation may vary based on skills, experience, training, licensure and certifications and location.

Base Pay Range

Minimum:

$45,000.00 USD

Maximum:

$61,000.00 USD

  • Claims Specialist Sr

    2 weeks ago

    East Meadow, New York, United States Sedgwick Claims Management Services Full time

    To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client se Claims Specialist, Claims, Professional, Liability, Specialist, Client Relations, Insurance, Business...

  • Specialist, Claims

    1 month ago

    East Syracuse, United States RXO Inc. Full time

    Accelerate your career at RXO. RXO is a leading provider of transportation solutions. With cutting-edge technology at the center, we're revolutionizing the industry with our massive network and commitment to finding solutions for every challenge. We create more efficient ways for shippers and carriers to transport goods across North America. Compensation...

  • Specialist, Claims

    4 weeks ago

    East Syracuse, United States RXO Inc. Full time

    Accelerate your career at RXO. RXO is a leading provider of transportation solutions. With cutting-edge technology at the center, we're revolutionizing the industry with our massive network and commitment to finding solutions for every challenge. We create more efficient ways for shippers and carriers to transport goods across North America. Compensation...

  • Specialist, Default FHA MI Claims, II

    1 week ago

    Providence, United States Carrington Full time

    Carrington Specialist, Default FHA MI Claims, II Providence , Rhode Island Apply Now Come join our amazing team and work remote from home! The Default FHA Claims Specialist II will work under moderate supervision, be responsible for preparing, filing, and following up on FHA claims timely and accurately according to insurer/investor guidelines. Performs all...

  • Specialist, Default FHA MI Claims, II

    2 weeks ago

    Providence, Rhode Island, United States Carrington Full time

    Carrington Specialist, Default FHA MI Claims, II Providence , Rhode Island Apply Now Come join our amazing team and work remote from homeThe Default FHA Claims Specialist II will work under moderate supervision, be responsible for preparing, filing, and following up on FHA claims timely and accurately according to insurer/investor guidelines. Performs all...

  • Billing Specialist

    4 weeks ago

    East Providence, United States University Orthopedics Full time

    Job DescriptionJob DescriptionJob Title: Surgical Facility Billing Specialist Reports to: Finance Manager GENERAL SUMMARY OF DUTIES: The Surgical Facility Biller is responsible for billing all diagnosis and procedures with proper codes. The Biller is responsible for record maintenance, daily charges and preparing and submitting claims to the payers. The...

  • Billing Specialist

    4 weeks ago

    East Providence, United States University Orthopedics Full time

    Job DescriptionJob DescriptionJob Title: Surgical Facility Billing Specialist Reports to: Finance Manager GENERAL SUMMARY OF DUTIES: The Surgical Facility Biller is responsible for billing all diagnosis and procedures with proper codes. The Biller is responsible for record maintenance, daily charges and preparing and submitting claims to the payers. The...

  • Billing Specialist

    1 month ago

    East Providence, United States University Orthopedics Full time

    Job DescriptionJob DescriptionJob Title: Surgical Facility Billing Specialist Reports to: Finance Manager GENERAL SUMMARY OF DUTIES: The Surgical Facility Biller is responsible for billing all diagnosis and procedures with proper codes. The Biller is responsible for record maintenance, daily charges and preparing and submitting claims to the payers. The...

  • Claims Compliance Analyst

    2 days ago

    East Longmeadow, United States The MH Group LLC Full time

    Job DescriptionJob DescriptionDescription:The Claims Compliance Analyst occupies an essential role, necessitating a thorough knowledge of policies and procedures, a profound expertise in the claims process, and the ability to process claims effectively. The ideal candidate will lead the establishment, oversight, and enactment of compliance-centered...

  • Revenue Specialist I

    3 weeks ago

    Providence, United States Acadia Healthcare - Providence CBO Full time

    Overview: **Now Hiring: Revenue Specialist I** Hybrid in Providence, RI We are improving the lives we touch. We need passionate, talented people working together who share our desire to create a world-class organization that sets the standard of excellence in the treatment of speciality behavioral health and addiction disorders.** **Acadia Healthcare is...

  • Revenue Specialist I

    3 weeks ago

    Providence, United States Acadia Healthcare Full time

    Overview: Now Hiring: Revenue Specialist I Hybrid in Providence, RI We are improving the lives we touch. We need passionate, talented people working together who share our desire to create a world-class organization that sets the standard of excellence in the treatment of speciality behavioral health and addiction disorders.Acadia Healthcare is...

  • Claims Specialist

    1 week ago

    East Hanover, United States Randstad Life Sciences US Full time

    Title: Reimbursement Specialist 1 Duration: 6 months Pay Rate : $27.50/hr on W2 Location - East Hanover, NJ 07936Shift: Actual hours will be 8am-5pm EST shiftTraining is a mix of on-site in East Hanover, NJ and virtual for from 8am – 5pm and will be 8-10 weeks.Overview:The Reimbursement Specialist will be responsible for providing support and information...

  • Claims Specialist

    1 week ago

    East Hanover, United States Randstad Life Sciences US Full time

    Title: Reimbursement Specialist 1 Duration: 6 months Pay Rate : $27.50/hr on W2 Location - East Hanover, NJ 07936 Shift: Actual hours will be 8am-5pm EST shift Training is a mix of on-site in East Hanover, NJ and virtual for from 8am – 5pm and will be 8-10 weeks. Overview: The Reimbursement Specialist will be responsible for providing support and...

  • Claims Specialist

    2 weeks ago

    East Hanover, United States Randstad Life Sciences US Full time

    Title: Reimbursement Specialist 1 Duration: 6 months Pay Rate : $27.50/hr on W2 Location - East Hanover, NJ 07936Shift: Actual hours will be 8am-5pm EST shiftTraining is a mix of on-site in East Hanover, NJ and virtual for from 8am – 5pm and will be 8-10 weeks.Overview:The Reimbursement Specialist will be responsible for providing support and information...

  • Claims Specialist

    1 week ago

    East Hanover, United States Randstad Life Sciences US Full time

    Title: Reimbursement Specialist 1 Duration: 6 months Pay Rate : $27.50/hr on W2 Location - East Hanover, NJ 07936 Shift: Actual hours will be 8am-5pm EST shift Training is a mix of on-site in East Hanover, NJ and virtual for from 8am 5pm and will be 8-10 weeks. Overview: The Reimbursement Specialist will be responsible for providing support and...

  • Claims Support Specialist Ii

    2 weeks ago

    East Peoria, United States Erie Insurance Full time

    At Erie Insurance, you’re not just part of a Fortune 500 company; you’re also a valued member of a diverse and inclusive team that includes more than 6,000 employees and over 13,000 independent agencies. Our Employees work in the Home Office complex located in Erie, PA, and in our Field Offices that span 12 states and the District of...

  • Medical Billing Specialist

    3 weeks ago

    East Providence, United States Kathleen K Kroessler, MD Full time

    Job Summary: I am seeking a part time Medical Biller w/ experience in Athena medical record billing. Athena submits the claims but follow up is needed, as well as posting charges, payments and adjustments and f/u claims that are unpaid.. Obtaining insurance info on some inpatient billing.F/U claims that are unpaid. Doctor works 2-3 d/wk. Sometime in office...

  • Health Information Specialist

    3 weeks ago

    East Providence, United States Community Care Alliance Full time

    The BH Link is searching for an enthusiastic professional who is looking to make a positive impact in the Rhode Island community! The BH Link is a 24/7 triage facility providing assessment and referral services for adults experiencing mental health and/or substance use crises. The purpose of the Health Information Specialist is to streamline program-level...

  • Third Party Specialist

    1 month ago

    Providence, United States Care New England Full time

    Job DescriptionJob DescriptionJob Summary: Under the direction of the A/R Supervisor, the Third Party Specialist facilitates all phases of the billing process.Duties and Responsibilities:Responsible for submitting paper and electronic claims to all payers.Following up on current, past due accounts and secondary balances with third party payers, on claims...

  • Third Party Specialist

    1 week ago

    Providence, United States Care New England Full time

    Job DescriptionJob DescriptionJob Summary: Under the direction of the Accounts Receivable (A/R) Supervisor, the Third Party Specialist facilitates all phases of the billing process.Duties and Responsibilities:Responsible for submitting paper and electronic claims to all payers.Following up on current, past due accounts and secondary balances with third party...