Claims Integrity Auditor & Investigator II

Qlarant; California (MO); On-site; USD 65,000 - 90,000; Full time

Job summary

Qlarant is seeking an Auditor/Investigator to ensure the integrity of claims processing, collect data for audits, and identify fraud, waste, and abuse. You will interview witnesses, review documentation, and prepare comprehensive reports for management.

Minimum Bachelor's Degree is required; 2–4 years experience is expected, with 5–7 years preferred. A Certified Fraud Examiner is preferred. Qlarant is an Equal Opportunity Employer and drug-free workplace.

Qualifications

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

Responsibilities

• Conduct routine and impartial audits/investigations from start to closure into customer claims, ensuring accurate and fair assessments of claims validity.
• Provide customer service by addressing inquiries and concerns, and escalate audit/investigation when needed.
• Compile detailed, organized records of audit/investigation findings in compliance with legal requirements.
• Apply knowledge to identify and prevent fraudulent activities within claims processes.
• Conduct interviews with witnesses, claimants, and stakeholders to gather information.
• Communicate findings to internal teams and ensure proper processing in line with standards.
• Present audit results clearly to customers and stakeholders, managing expectations.
• Assist in training and supporting other auditors/investigators.

Skills

Auditing & investigations

Data analysis

Interviews & interviewing witnesses

Regulatory compliance

Attention to detail

Communication skills

Documentation & reporting

Customer service

Education

Bachelor's degree

Certified Fraud Examiner (preferred)

Job description

Qlarant is seeking an Auditor/Investigator to ensure the integrity of claims processing, collect data for audits, and identify fraud, waste, and abuse. You will interview witnesses, review documentation, and prepare comprehensive reports for management.

Minimum Bachelor's Degree is required; 2–4 years experience is expected, with 5–7 years preferred. A Certified Fraud Examiner is preferred. Qlarant is an Equal Opportunity Employer and drug-free workplace.