Supervisor – Audit/Investigation

🔥 3 minutes ago

⛰️ Colorado, Louisiana, +4 more states – Remote

⛰️ Colorado – Remote ⚜️ Louisiana – Remote 🌶️ New Mexico – Remote 🌪️ Oklahoma – Remote 🎸 Mississippi – Remote 🤠 Texas – Remote

💵 $66.3k - $92k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.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

• Oversee audits/investigations and audit/investigation workload • Perform in-depth evaluations and make field-level judgments concerning potential Medicare fraud, waste, and abuse cases • Review incoming audits/investigations and leads, determine appropriateness, and assign cases to auditors/investigators • Vet providers with appropriate agencies and law enforcement and supervise the vetting process • Review audit/investigation plans, priorities, files, requests, reports, and correspondence for quality and appropriateness • Supervise and conduct interviews, onsite audits/investigations, and site verification • Lead audit/investigation projects, develop strategies, conduct stakeholder meetings, review project actions, and document findings • Communicate with Data and Medical Review departments • Prepare and present audits/investigations, overpayments, and questions for stakeholder meetings • Document case information and file reviews in case tracking systems • Review findings and approve courses of action and closing summaries • Prepare the team’s audits/investigations for Major Case Coordination meetings and perform quality assurance reviews • Maintain communications with law enforcement and regulatory agencies and present findings for further action • Supervise administrative remedies such as payment suspensions, revocations, and provider education • Collect and submit information requested by internal and external stakeholders, including CMS and law enforcement • Collaborate with other program integrity contractors • Testify at legal or administrative proceedings • Manage team performance through feedback and formal performance reviews to support service delivery, engagement, motivation, and development

🎯 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 • Experience overseeing Medicare and/or Medicaid fraud, waste, and abuse audits/investigations • Ability to conduct interviews, onsite audits/investigations, and site verification as needed • Ability to testify at legal or administrative proceedings as necessary • 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 • Offers contingent upon successful completion of pre-employment background and drug screens

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