Auditor/Investigator I

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $60k - $72k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Develop baseline plans to ensure the integrity and accuracy of claims processes and protocols • Conduct routine and impartial audits and investigations into customer claims • Collect and analyze data to assess claim validity • Review documentation and interview involved parties • Identify fraud, waste, abuse, and discrepancies in claims submissions • Provide recommendations to management for claim resolution and closure • Address customer inquiries and concerns and escalate matters as needed • Compile detailed records of audit and investigation findings • Create and implement strategies to identify and prevent fraudulent activities • Communicate with internal teams to ensure proper processing of audits and investigations • Process audit and investigative documents and records into the database accurately and timely • Communicate findings and updates to customers, claimants, and stakeholders • Support management in audit and investigation proceedings while ensuring regulatory compliance

🎯 Requirements

• Minimum Bachelor's Degree required • 0–2 years of experience required; 2–4 years preferred • Certified Fraud Examiner or Accredited Healthcare Anti-Fraud Investigator preferred • Ability to conduct audits and investigations into customer claims • Ability to collect and analyze claims data • Ability to review documentation and interview witnesses, claimants, and stakeholders • Knowledge of legal, regulatory, regional, and federal standards, regulations, and protocols • Ability to prepare comprehensive reports for legal or audit/investigative purposes • Ability to communicate findings clearly and professionally • Successful completion of pre-employment background and drug screens

🏖️ Benefits

• Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities • Drug-free workplace • Employment offers contingent upon successful completion of pre-employment background and drug screens