Supervisor – Audit/Investigation

🔥 12 minutes ago

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Qlarant

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1973

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Qlarant is a US-based services and technology firm specializing in healthcare program integrity, offering quality improvement, fraud, waste & abuse (FWA) detection and investigative services, and advanced data analytics and predictive modeling tools (the RIViR® Risk Solution Suite) for government agencies, health plans, and related sectors. The company also operates initiatives like the Qlarant Foundation and Qlarant Capital to fund grants and early-stage startups, and provides pharmacy, drug pricing, and transportation-focused solutions.

📋 Description

• Oversees audits/investigations and audit/investigation workload • Performs in-depth evaluation and makes field level judgments related to audits/investigations of potential Medicare fraud waste and abuse audits/investigations • Reviews new audits/investigations and/or incoming leads to determine appropriateness and assigns to auditors/investigators • Reviews audit/investigation plans and priorities to ensure appropriateness and quality for the specific functions/workload assigned to team • Conducts file reviews regularly of audits/investigations • Reviews auditor/investigator requests for information, data, reports, and correspondence • Supervises and conducts audit/investigation actions such as interviewing, onsite audit/investigation, and/or site verification as needed • Leads audit/investigation projects including developing an audit/investigation strategy • Communicates with the Data and Medical Review departments to ensure efficient audits/investigations • Prepares and presents audits/investigations, overpayments, and questions for stakeholder meetings • Documents audit/investigation information and file reviews into the case tracking systems • Determines audit/investigation appropriateness of fraud, waste, and abuse issues in accordance with pre-established criteria • Reviews audit/investigative findings with auditors/investigators and approves course of action • Supervises and prepares team’s audits/investigations for the Major Case Coordination meetings • Initiates and maintains communications with law enforcement and appropriate regulatory agencies • Supervises administrative remedies in accordance with major case coordination direction • Reviews and approves closing summary of audit/investigation • Collects information and documentation as requested by internal and external stakeholders • Collaborates with other program integrity contractors • Testifies at various legal or administrative proceedings • Manages team performance through regular, timely feedback as well as the formal performance review process

🎯 Requirements

• Minimum Bachelor's Degree required • 5 - 7 years of experience required; 8 - 11 years preferred • Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator Certification preferred