Fraud Investigation Coordinator II

Qlarant; Dallas (TX); On-site; USD 55,000 - 75,000; Full time

Job summary

Qlarant is seeking a detail-oriented investigator to perform in-depth reviews of complaints and investigative leads related to potential fraud in Medicare/Medicaid programs. You will support field judgments and escalate cases to Lead Investigator as needed.

Under close supervision, you will work with the manager to prioritize tasks, maintain case records, and draft comprehensive reports for administrative action or law enforcement referral.

Qualifications

• High School Diploma or GED required.
• Healthcare or insurance industry experience preferred.
• Medicare/Medicaid experience a plus.

Responsibilities

• Reviews complaint data to ensure case tracking is correctly populated and updated.
• Maintains data records in case tracking systems for timely processing.
• Screens incoming fraud leads by extracting information from sources to draft a comprehensive case file.
• Communicates with complainants and beneficiaries to obtain clarification and verify services.
• Operates systems to obtain claims, enrollment, and provider/beneficiary data.
• Prepares intake investigation report with relevant facts, risks, and leads.

Skills

Fraud investigation

Data review

Case management

Communication

Attention to detail

Education

High School Diploma or GED

Healthcare/insurance experience

Medicare/Medicaid experience

Job description

Qlarant is seeking a detail-oriented investigator to perform in-depth reviews of complaints and investigative leads related to potential fraud in Medicare/Medicaid programs. You will support field judgments and escalate cases to Lead Investigator as needed.

Under close supervision, you will work with the manager to prioritize tasks, maintain case records, and draft comprehensive reports for administrative action or law enforcement referral.