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About the role
Key responsibilities & impact- 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
What you’ll need- Minimum Bachelor's Degree required
- 2 - 4 years of experience required; 5 - 7 years preferred
- Prior experience with Medicaid required
- Certified Fraud Examiner 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 II 🔥 1 hour ago 🇺🇸 United States – Remote 💵 $56.1k - $83.7k / year ⏰ Full Time 🟢 Junior 🟡 Mid-level 🔎 Auditor Apply Now Find Hiring Managers Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
- 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 Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Auditor II 🔥 6 hours ago Palmetto GBA 1001 - 5000 ⚕️ Healthcare Insurance 🏛️ Government 🤝 B2B Website LinkedIn All Job Openings Auditor II providing financial, compliance, and operational audits in a remote position. Working for a healthcare service administrator with multiple locations across the US. 🇺🇸 United States – Remote 💵 $49.4k - $94.7k / year ⏰ Full Time 🟢 Junior 🟡 Mid-level 🔎 Auditor 🦅 H1B Visa Sponsor Auditor II 🔥 7 hours ago BlueCross BlueShield of South Carolina 10,000+ employees ⚕️ Healthcare Insurance 💸 Finance Website LinkedIn All Job Openings Auditor II conducting a full range of financial, compliance, and operational audits with the responsibility to report findings. This full-time remote role offers a comprehensive benefits package. 🇺🇸 United States – Remote 💵 $49.4k - $94.7k / year ⏰ Full Time 🟢 Junior 🟡 Mid-level 🔎 Auditor Medical Review Nurse – SNF/MDS Auditor 🔥 14 hours ago Machinify 1001 - 5000 ⚕️ Healthcare Insurance 🤖 Artificial Intelligence ☁️ SaaS Website LinkedIn All Job Openings Medical Review Nurse auditing SNF medical claims at Machinify. Joining experienced medical auditors in a dynamic remote environment. 🇺🇸 United States – Remote 💰 $10M Series A - Machinify on 2018-10 ⏰ Full Time 🟡 Mid-level 🟠 Senior 🔎 Auditor 🦅 H1B Visa Sponsor Inpatient Medical Coding Auditor 🔥 18 hours ago Humana 10,000+ employees ⚕️ Healthcare Insurance Website LinkedIn All Job Openings Medical Coding Auditor reviewing inpatient hospital claims for proper reimbursement. Contributing to cost reduction through accurate coding and resolution of provider disputes. 🇺🇸 United States – Remote 💵 $71.1k - $97.8k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior 🔎 Auditor 🦅 H1B Visa Sponsor Hospital Coding Auditor 🕒 Yesterday Baptist Health 10,000+ employees 🤝 Non-profit 💊 Pharmaceuticals Website LinkedIn All Job Openings Coding Auditor reviewing hospital patient records for proper coding guidelines and educating coders at Baptist Health Care. 🇺🇸 United States – Remote ⏰ Full Time 🟡 Mid-level 🟠 Senior 🔎 Auditor 🦅 H1B Visa Sponsor View More Auditor Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Privacy policy Terms of service Job board SEO course AI Apply Copilot OpenClaw job finder Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs
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Hard Skills & Tools
data analysisclaims processingauditingreport writingrecommendation formulation
Soft Skills
analytical skillsattention to detailcommunicationproblem-solving
Certifications
Certified Fraud Examiner