Supervisor – Field Audit/Investigation

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $49.7k - $95k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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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 on potential government program fraud, waste, and abuse cases • Review incoming audits/investigations and leads; assign work to auditors/investigators • Vet providers and/or retailers with agencies and law enforcement; supervise the vetting process • Review audit/investigation plans, operations plans, priorities, files, requests, data, reports, and correspondence for quality and appropriateness • Supervise and conduct interviews, onsite audits/investigations, site verification, and law-enforcement liaison activities • Lead audit/investigation projects, develop strategies, conduct stakeholder meetings, review project actions, and document findings • Coordinate with senior leadership, Data and Medical Review departments, program integrity contractors, regulators, and law enforcement • Prepare, present, and summarize audits/investigations, overpayments, and questions for stakeholder meetings • Document case information and file reviews in case-tracking systems • Determine whether fraud, waste, and abuse issues meet established criteria • Review findings with auditors/investigators and approve courses of action and closing summaries • Prepare team audits/investigations for customer presentations and perform quality assurance reviews • Initiate and maintain communications with law enforcement and regulatory agencies regarding further investigation, prosecution, or administrative remedies • Supervise administrative remedies such as payment suspensions, revocations, and provider education • Collect and submit information requested by internal and external stakeholders, including CMS, USDA, law enforcement, and FOIA requests • Testify at legal or administrative proceedings as necessary • Manage team performance through regular feedback and formal performance reviews

🎯 Requirements

• Bachelor's degree required; education can be substituted for experience • 5–7 years of experience required; 8–11 years preferred; experience can be substituted for education • Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator Certification preferred • Ability to oversee audits/investigations involving government program fraud, waste, and abuse • Knowledge of Medicare, Medicaid, and/or Supplemental Nutrition Assistance Program compliance cases • Ability to conduct interviews, onsite audits/investigations, site verification, and liaison with law enforcement • Ability to prepare and present findings to customers, stakeholders, regulatory agencies, and law enforcement • 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 • Pre-employment background and drug screens required as part of contingent offer process