Auditor/Investigator II

Qlarant; Addison (TX); On-site; USD 58,000 - 86,000; Full time

Job summary

Qlarant in Dallas, Texas seeks a Full Time Special/Analyst II to ensure integrity and accuracy in claims processes, collecting data for audits and investigations, interviewing stakeholders, and delivering findings for resolution.

The role emphasizes applying regulatory knowledge to identify fraud, waste, and abuse, with opportunities to train others and collaborate across teams. A Bachelor's degree and healthcare fraud experience are preferred.

Qualifications

• Bachelor's degree required
• 2–4 years of experience required; 5–7 years preferred
• Healthcare fraud experience desired
• Knowledge of Medicare preferred

Responsibilities

• Conduct routine audits/investigations from start to closure into customer claims, ensuring accurate assessments of claims validity.
• Provide customer service by addressing inquiries and concerns, escalating as needed.
• Compile detailed records of audit/investigation findings, ensuring accuracy and regulatory compliance.
• Identify and implement strategies to detect and prevent fraudulent activities within claims processes.
• Conduct interviews with witnesses, claimants, and stakeholders to gather information.
• Communicate findings clearly to internal teams and stakeholders; manage expectations.

Skills

Audit investigations

Data analysis

Fraud prevention

Regulatory compliance

Witness interviews

Education

Bachelor's degree

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Full Time Salary Special/Analyst II Dallas, TX, US

Salary Range: $57,512.00 To $85,839.00 Annually

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. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for underserved communities.

Best People, Best Solutions, Best Results

Job Summary

Ensures 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 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.

Essential Functions

• Conducts routine and impartial audits/investigations from start to closure 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.
• Communicates audit/investigation findings clearly and professionally to customers, claimants, and other stakeholders, managing expectations and providing updates.
• Assists in providing training and support to other auditors/investigators, contributing to the continuous improvement of investigative processes.

Level of Supervision Received

Plans and arranges own work; works with manager to prioritize projects.

Education (can be substituted for experience)

Minimum Bachelor's Degree required

Work Experience (can be substituted for education)

2 - 4 years of experience required; 5 - 7 years preferred

Healthcare fraud experience desired

Knowledge of Medicare preferred

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.

Qlarant is a drug-free workplace. All offers of employment are contingent upon successful completion of pre-employment background and drug screens.