Auditor/Investigator II

Jobtailor; Colorado; On-site; USD 70,000 - 110,000; Full time

Job summary

Jobtailor in the United States seeks an experienced auditor/investigator to conduct routine and impartial audits of healthcare claims, from start to closure.

You will assess claim validity, interview witnesses, and compile thorough reports while ensuring compliance with Medicare regulations and legal standards. Experience with fraud prevention and training others, plus coordination with internal teams, is essential.

Qualifications

• Bachelor's degree required; education can be substituted for experience.
• 2–4 years of experience required; 5–7 years preferred.
• Healthcare fraud experience desired.
• Knowledge of Medicare preferred.
• Certified Fraud Examiner certification preferred.
• Successful completion of pre-employment background and drug screens.
• Ability to conduct audits/investigations, review claims documentation, and prepare reports.
• Ability to communicate with customers, claimants, stakeholders, and internal teams while adhering to legal standards.

Responsibilities

• Conduct routine and impartial audits/investigations from start to closure.
• Ensure accurate and fair assessments of claims validity.
• Address inquiries and escalated audits as needed.
• Compile detailed records of findings in compliance with regulations.
• Create and implement strategies to identify prevent fraud.
• Conduct interviews with witnesses, claimants, and stakeholders.
• Communicate findings clearly and provide updates to internal teams.
• Assist with training and support for other auditors/investigators.
• Plan and arrange own work with manager to prioritize projects.

Skills

Audits/Investigations

Data analysis

Communication

Problem solving

Team collaboration

Education

Bachelor's degree

Certified Fraud Examiner

Job description

Conduct routine and impartial audits/investigations from start to closure into customer claims
Ensure accurate and fair assessments of claims validity
Address customer inquiries and concerns and escalated audits/investigations as needed
Compile detailed records of audit/investigation findings in compliance with legal and regulatory requirements
Create and implement strategies to identify and prevent fraudulent activities
Conduct interviews with witnesses, claimants, and other stakeholders
Communicate with internal teams to ensure proper processing of audits/investigations
Communicate findings clearly and professionally and provide updates
Assist with training and support for other auditors/investigators
Plan and arrange own work while working with a manager to prioritize projects

Requirements

• Minimum Bachelor's Degree required; education can be substituted for experience
• 2–4 years of experience required; 5–7 years preferred
• Healthcare fraud experience desired
• Knowledge of Medicare preferred
• Certified Fraud Examiner certification preferred
• Successful completion of pre-employment background and drug screens
• Ability to conduct audits/investigations, review claims documentation, analyze data, interview stakeholders, and prepare reports
• Ability to communicate with customers, claimants, stakeholders, and internal teams while adhering to legal and regulatory standards

Core Competencies

Demonstrates expertise in conducting audits and investigations, ensuring compliance with legal and regulatory standards while effectively communicating findings. Proficient in analyzing claims documentation and implementing strategies to prevent fraudulent activities.

Highest-signal resume keywords

• Conducting Audits/Investigations
• Healthcare Fraud Experience
• Certified Fraud Examiner
• Claims Documentation Review
• Data Analysis

Hard Skills

• Audit Conducting
• Investigation Techniques
• Claims Analysis
• Report Preparation
• Data Analysis

Soft Skills

• Effective Communication
• Customer Service
• Problem Solving
• Team Collaboration
• Training and Support

Certifications & Qualifications

• Certified Fraud Examiner

Industry Keywords

• Healthcare Fraud
• Medicare
• Legal Compliance
• Regulatory Standards
• Fraud Prevention Strategies