Auditor/Investigator II
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Job Description
Auditor/Investigator ensuring the integrity of claims processes at Qlarant. Conducting investigations and audits to identify fraud and improve processes.
Responsibilities:
- 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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