Qlarant
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.
Auditor/Investigator II
🔥 0 minutes ago
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Qlarant
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
• Ensures the integrity and accuracy of claims processes and protocols. • Collects data for audits/investigations into claims, utilizing analytical skills and attention to detail. • Identifies opportunities to target fraud, waste, and abuse or discrepancies in claims submissions. • Adheres to industry regulations and policies for managerial follow-up. • Analyzes data to 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 • 2 - 4 years of experience required; 5 - 7 years preferred • Prior experience with Medicaid required • Certified Fraud Examiner preferred
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