Auditor/Investigator I

🕒 6 days ago

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Qlarant

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1973

🏛️ Government

⚕️ Healthcare Insurance

Government • Healthcare Insurance • Insurance & Financial Services

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

• Serves as an entry level professional who develops baseline plans for ensuring the integrity and accuracy of claims processes and protocols. • Collects data for audits/investigations into claims, utilizing a combination of analytical skills and attention to detail, reviewing documentation, interviewing involved parties, and communicating with various stakeholders to gather relevant information for successful resolution and closure. • Identifies opportunities to target fraud, waste, and abuse or discrepancies in claims submissions. • Adheres to industry regulations and company policies for managerial follow-up. • Analyzes data in order to effectively assess the validity of claims. • Provides accurate recommendations to management for claim resolution and closure. • Documents and inputs all findings, while preparing comprehensive reports that may be used for legal or audit/investigative purposes.

🎯 Requirements

• Minimum Bachelor's Degree required • 0 - 2 years of experience required; 2 - 4 years preferred • Medicaid experience preferred • Certified Fraud Examiner or Accredited Healthcare Anti-Fraud Investigator preferred