2 counsel jobs found in Edmeston, NY

EFW Examiners review claims for red flag indicators that will determine if further investigation and referral to special investigation unit (SIU) is needed. They also collaborate with examiners, supervisors and EFW examiners to reach mutual decisions on the disposition of claims that have been investigated. Duties & Responsibilities: Collaborate with the examiner teams to identify claims in need of further investigation. Work with examiners, customers, vendors, and other resources to gather information to establish facts of loss and if potential fraud indicators exist. Conduct objective, fair, thorough, and timely investigations, and reviews. Ensure processing of the claims are handled in accordance with regulation time frame. Submit claims to SIU through the database for assist or referral when fraud indicators are present. Return to examiner for normal claim processing when all red flag indicators have been ruled out. Generate detailed denials based on...

The Internal Audit Plan Manager (Hybrid) manages the execution of the annual internal audit plan, including assigning audit resources. This position will provide guidance to the internal audit staff in planning and conducting concurrent operational, financial, regulatory, and other relevant audit and advisory engagements outlined in the plan. The Internal Audit Plan Manager will assist in developing the internal audit staff by reviewing completed engagements for quality, providing feedback and coaching to ensure compliance with the Internal Audit and Compliance (IA&C) Division's policies and procedures, as well as The Institute of Internal Auditors (IIA) Standards. Duties & Responsibilities: Manage the completion of the internal audit plan and assign internal audit resources, resolving or escalating competing priorities. Develop the annual internal audit plan using a risk-based approach in collaboration with the division manager. Provide guidance to internal...