Fraud & Claims Investigator II

Qlarant; Los Alamitos (CA); On-site; USD 60,000 - 90,000; Full time

Job summary

Qlarant is seeking an experienced professional to conduct claims audits and investigations, collecting data for audits, and identifying fraud or discrepancies. You will gather information from interviews and records, prepare comprehensive reports, and ensure regulatory compliance throughout the process.

Strong analytical skills and attention to detail are essential, along with the ability to communicate findings clearly to management and stakeholders.

Qualifications

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

Responsibilities

• Audit/investigations from start to closure for claims.
• Provide customer service and escalate as needed.
• Record findings with accuracy and regulatory alignment.
• Identify and deter fraud and abuse in claims data.
• Interview witnesses and claimants for information.
• Communicate results to stakeholders clearly.
• Assist in training other auditors/investigators.

Skills

Audits/Investigations

Analytical skills

Interviews

Customer service

Regulatory understanding

Education

Bachelor's Degree

Job description

Qlarant is seeking an experienced professional to conduct claims audits and investigations, collecting data for audits, and identifying fraud or discrepancies. You will gather information from interviews and records, prepare comprehensive reports, and ensure regulatory compliance throughout the process.

Strong analytical skills and attention to detail are essential, along with the ability to communicate findings clearly to management and stakeholders.