Claims Integrity Auditor II

Qlarant; Utah; On-site; USD 60,000 - 90,000; Full time

Job summary

Qlarant, a not-for-profit organization, seeks an investigator to ensure integrity in claims processing. You will conduct audits/investigations from start to closure, gather evidence, and prepare reports for audits or legal matters.

You will interview witnesses and claimants, analyze data, and coordinate with internal teams to resolve cases and prevent fraud, waste, and abuse. Minimum requirement is a Bachelor's degree with 2–4 years of experience; a Certified Fraud Examiner is preferred.

Qualifications

• Bachelor's degree required.
• 2–4 years of experience required; 5–7 years preferred.
• Certified Fraud Examiner preferred.

Responsibilities

• 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.

Skills

Auditing

Investigations

Data analysis

Attention to detail

Communication

Customer service

Interviewing witnesses

Education

Bachelor's Degree

Job description

Qlarant, a not-for-profit organization, seeks an investigator to ensure integrity in claims processing. You will conduct audits/investigations from start to closure, gather evidence, and prepare reports for audits or legal matters.

You will interview witnesses and claimants, analyze data, and coordinate with internal teams to resolve cases and prevent fraud, waste, and abuse. Minimum requirement is a Bachelor's degree with 2–4 years of experience; a Certified Fraud Examiner is preferred.