Fraud Investigation Coordinator II – Audit & Compliance

ADP, Inc.; Easton (MD); Presencial; USD 29 000 - 33 000; Tempo integral

Resumo da oferta

Qlarant is a not-for-profit organization dedicated to preventing fraud and improving health and human services programs. The Audit/Investigation Coordinator II supports field-level judgments on complaints and leads of potential fraud investigations related to Medicare/Medicaid.

Under close supervision, you will review data, maintain case records, screen leads, gather information from complainants, and prepare intake reports to guide investigations.

Qualificações

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

Responsabilidades

• Reviews complaint data including allegations, subjects, and facts to ensure case tracking accuracy.
• Maintains data records in case tracking systems for timely processing.
• Screens incoming fraud leads by extracting information from sites and drafting a comprehensive case file.
• Confers with complainants to obtain clarification and verify services; drafts contact reports.
• Operates systems to obtain claims, enrollment, and provider/beneficiary information.
• Prepares intake investigation reports with relevant facts, risks, and leads for investigation by Lead Investigator.
• Processes RFIs to contractors and incorporates findings into audit/investigation files.
• Recommends opportunities to improve fraud audit/investigation processes and procedures.

Formação académica

High School Diploma or GED

Descrição da oferta de emprego

Qlarant is a not-for-profit organization dedicated to preventing fraud and improving health and human services programs. The Audit/Investigation Coordinator II supports field-level judgments on complaints and leads of potential fraud investigations related to Medicare/Medicaid.

Under close supervision, you will review data, maintain case records, screen leads, gather information from complainants, and prepare intake reports to guide investigations.