Note: The job is a remote job and is open to candidates in USA. Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. The Auditor/Investigator I serves as an entry-level professional responsible for ensuring the integrity and accuracy of claims processes, conducting audits and investigations, and providing recommendations for claim resolution.

Responsibilities

• Conducts routine and impartial audits/investigations into customer claims, ensuring accurate and fair assessments of claims validity
• Provides customer service by addressing inquiries and concerns, and escalates audit/investigation, as needed
• Compiles detailed and organized records of audit/investigation findings, ensuring accuracy and compliance with legal and regulatory requirements
• Applies functional knowledge to create and implement strategies to identify and prevent fraudulent activities, safeguarding the integrity of the claims process
• Conducts interviews with relevant witnesses, claimants, and other stakeholders to gather additional information and perspectives on claims
• Communicates with appropriate internal teams to ensure the proper processing of audits/investigations, while adhering to legal and regulatory standards
• Ensures that all audit and investigative documents and records are processed into the database in a timely and accurate manner
• Communicates audit/investigation findings clearly and professionally to customers, claimants, and other stakeholders, managing expectations and providing updates
• Supports management in regular audit and investigation proceedings, ensuring full compliance with all applicable regional and federal standards, regulations, and protocols

Skills

• 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

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