Healthcare Fraud Investigations Coordinator II

Qlarant; Texas; On-site; USD 60,000 - 90,000; Full time

Job summary

Qlarant is a not-for-profit organization dedicated to safeguarding health care programs across the country. This role involves evaluating complaints and investigative leads related to potential fraud, referring cases to the appropriate agency for action, and supporting the investigative team.

Under close supervision, you will review data, maintain case records, and draft intake reports. The position requires strong analytical skills and attention to detail in a fast-paced environment.

Qualifications

• Minimum 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 on schedule.
• Maintains data records in case tracking systems for timely processing.
• Screens fraud leads by extracting information from sites and evaluating relevant legislation to draft a comprehensive file.
• Confers with complainants and beneficiaries to obtain clarification and verify services.
• Operates systems to obtain claims, enrollment, and provider/beneficiary information.
• Prepares intake investigation report with relevant facts, risks, and leads.
• Processes RFIs to contractors and incorporates findings into the investigation file.
• Offers opportunities to improve fraud audit/investigation processes and procedures.

Skills

Fraud investigation

Data extraction

Case management

Communication with complainants

Education

High School Diploma or GED

Healthcare or insurance industry experience preferred

Medicare/Medicaid experience a plus

Tools

Case tracking systems

Job description

Qlarant is a not-for-profit organization dedicated to safeguarding health care programs across the country. This role involves evaluating complaints and investigative leads related to potential fraud, referring cases to the appropriate agency for action, and supporting the investigative team.

Under close supervision, you will review data, maintain case records, and draft intake reports. The position requires strong analytical skills and attention to detail in a fast-paced environment.