Fraud Investigation Coordinator II

Qlarant; Easton (MD); On-site; USD 55,000 - 75,000; Full time

Job summary

Qlarant, a not-for-profit organization based in Maryland, seeks a Fraud Investigator to perform in-depth evaluations and field-level judgments on complaints and leads related to potential Medicare/Medicaid fraud. You will help refer cases to appropriate agencies for action and support ongoing investigations.

Under close supervision, you will collaborate with management, gather facts, and draft intake reports.

Qualifications

• Minimum High School Diploma or GED required.
• 2–4 years of experience; 5–7 years preferred.

Responsibilities

• Reviews complaint data to ensure case tracking is accurate and timely.
• Maintains data records in case systems for efficient processing.
• Screens fraud leads using external resources to draft comprehensive case files.
• Interviews complainants and beneficiaries for clarification and verification.
• Obtains claims, enrollment, and provider/beneficiary information from systems.
• Prepares intake investigation reports with relevant facts, risks, and leads.
• Assesses opportunities to improve fraud audit/investigation processes and procedures.

Education

High School Diploma or GED

Job description

Qlarant, a not-for-profit organization based in Maryland, seeks a Fraud Investigator to perform in-depth evaluations and field-level judgments on complaints and leads related to potential Medicare/Medicaid fraud. You will help refer cases to appropriate agencies for action and support ongoing investigations.

Under close supervision, you will collaborate with management, gather facts, and draft intake reports.