Remote Claims Auditor & Investigator

ADP, Inc.; Arizona; Hybrid; USD 58,000 - 86,000; Full time

Job summary

Qlarant, a not-for-profit organization dedicated to improving health care program quality, seeks a Special/Analyst II to ensure integrity and accuracy of claims processes. You will collect data for audits, review documentation, interview involved parties, and communicate with stakeholders to drive successful resolutions.

You will apply analytic techniques to identify fraud, waste, and abuse, document findings, and prepare reports for audits or legal proceedings.

Qualifications

• Minimum Bachelor's Degree required
• 2 - 4 years of experience required; 5 - 7 years preferred

Responsibilities

• Conducts routine audits/investigations from start to closure into customer claims, ensuring fair assessments of validity.
• Provides customer service by addressing inquiries and concerns, and escalates as needed.
• Compiles detailed records of audit/investigation findings with compliance.
• Applies knowledge to create strategies to identify and prevent fraudulent activities.
• Interviews relevant witnesses, claimants, and stakeholders for information.

Skills

Analytical skills

Attention to detail

Data analysis

Interviews

Communication

Education

Bachelor's Degree

Job description

Qlarant, a not-for-profit organization dedicated to improving health care program quality, seeks a Special/Analyst II to ensure integrity and accuracy of claims processes. You will collect data for audits, review documentation, interview involved parties, and communicate with stakeholders to drive successful resolutions.

You will apply analytic techniques to identify fraud, waste, and abuse, document findings, and prepare reports for audits or legal proceedings.