Claims Integrity Investigator II

Qlarant; Arizona; Presencial; USD 60.000 - 90.000; Jornada completa

Descripción de la vacante

Qlarant is seeking a qualified investigator to ensure integrity in claims processing and support audits and investigations focused on fraud, waste, or abuse. The role requires attention to detail, data analysis, and effective communication with stakeholders.

The candidate should have a Bachelor's degree and 2–4 years of experience, with CFE preferred. The position involves detailed documentation, reporting, and collaboration with internal teams to close cases.

Formación

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

Responsabilidades

• Conduct routine audits/investigations from start to closure into customer claims and assess claim validity.
• Provide customer service by addressing inquiries and concerns and escalate investigations as needed.
• Compile detailed records of audit/investigation findings, ensuring accuracy and regulatory compliance.
• Apply knowledge to create strategies to identify and prevent fraudulent activities, safeguarding claims integrity.
• Conduct interviews with witnesses, claimants, and stakeholders to gather information and perspectives.
• Communicate findings to customers, claimants and stakeholders clearly and professionally; manage expectations.
• Assist in training and supporting other auditors/investigators to improve processes.

Conocimientos

Analytical skills

Attention to detail

Interviewing witnesses

Stakeholder communication

Audits

Investigations

Data analysis

Educación

Bachelor's degree

Descripción del empleo

Qlarant is seeking a qualified investigator to ensure integrity in claims processing and support audits and investigations focused on fraud, waste, or abuse. The role requires attention to detail, data analysis, and effective communication with stakeholders.

The candidate should have a Bachelor's degree and 2–4 years of experience, with CFE preferred. The position involves detailed documentation, reporting, and collaboration with internal teams to close cases.