Auditor/Investigator I

Qlarant

Auditor/Investigator I responsible for investigating claims processes and addressing inquiries. Collecting data, analyzing claims, and supporting management in compliance with audits and investigations.

Posted 4/23/2026full-timeRemote • 🇺🇸 United StatesJunior💰 $65,000 - $72,500 per yearWebsite

About the role

Key responsibilities & impact

Serves as an entry level professional who develops baseline plans for ensuring the integrity and accuracy of claims processes and protocols.
Collects data for audits/investigations into claims, utilizing a combination of analytical skills and attention to detail, reviewing documentation, interviewing involved parties, and communicating with various stakeholders to gather relevant information for successful resolution and closure.
Identifies opportunities to target fraud, waste, and abuse or discrepancies in claims submissions.
Adheres to industry regulations and company policies for managerial follow-up.
Analyzes data in order to effectively 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.
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.

Requirements

What you’ll need

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

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Qlarant Website LinkedIn All Job Openings 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 I 🔥 36 minutes ago 🇺🇸 United States – Remote 💵 $65k - $72.5k / year ⏰ Full Time 🟢 Junior 🔎 Auditor Apply Now Find Hiring Managers Customize resume for this job Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
Serves as an entry level professional who develops baseline plans for ensuring the integrity and accuracy of claims processes and protocols.
Collects data for audits/investigations into claims, utilizing a combination of analytical skills and attention to detail, reviewing documentation, interviewing involved parties, and communicating with various stakeholders to gather relevant information for successful resolution and closure.
Identifies opportunities to target fraud, waste, and abuse or discrepancies in claims submissions.
Adheres to industry regulations and company policies for managerial follow-up.
Analyzes data in order to effectively 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.
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. 🎯 Requirements
Minimum Bachelor's Degree required
0 - 2 years of experience required; 2 - 4 years preferred
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Hard Skills & Tools

data analysisauditinginvestigative techniquesdocumentationreport writingclaims processingfraud detectioncompliance assessmentrecord keepingstrategic implementation

Soft Skills

attention to detailcommunicationcustomer serviceinterpersonal skillsorganizational skillsproblem-solvinganalytical thinkingstakeholder managementprofessionalismadaptability

Certifications

Certified Fraud ExaminerAccredited Healthcare Anti-Fraud Investigator