Claims Integrity Auditor & Investigator II
Qlarant
Qlarant is seeking an individual to ensure the integrity and accuracy of claims processes in the United States, Kentucky. The candidate will conduct audits and investigations into customer claims, focusing on identifying fraud, waste, and discrepancies while adhering to industry regulations. The ideal candidate should have a Bachelor's degree and 2-4 years of experience in claims processing, with a Certified Fraud Examiner designation preferred. Strong analytical skills and attention to detail are essential for this role. #J-18808-Ljbffr Qlarant
- Job Summary Ensures the integrity and accuracy of claims processes and protocols. Collects data for audits/investigations into claims, utilizing a combination of analytical skills... ...providing training and support to other auditors/investigators, contributing to the...ClaimsWork experience placement
$46.99k - $122.4k
...a time. Position Summary The Program Integrity Auditor is responsible for the review of records... ..., recoupment of funds or rebilling of claims, and referral to state regulators for... ...internal staff. Assisting with further investigation and/or reports to state regulators...ClaimsHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hours$17.78 per hour
...IIJoin a team that CARES!Here at ODMHSAS, we believe in I.C.A.R.E. - Integrity, Compassion, Accountability,Respect, and Excellence. Our mission... ...dates: 5 /5/2026-until filledFull-timeHourly payrate: Level II- $17.78Shift differentials applicable when workingPrimary...SuggestedWeekend work$17.78 per hour
...HEALTH AND SUBSTANCE ABUSE SERV. Job Posting Title Forensic Officer II Supervisory Organization Oklahoma Forensic Center Job Posting... ...a team that CARES! Here at ODMHSAS, we believe in I.C.A.R.E. - Integrity, Compassion, Accountability, Respect, and Excellence. Our...SuggestedHourly payFull timePart timeFlexible hoursShift workWeekend work- The Oklahoma Forensic Center in Vinita, OK is hiring a Forensic Officer II to join its security team. This full-time position supports 24/7 operations, with shift differential applying and primary hours from 2:30 pm to 11:00 pm. Minimum qualifications include a basic security...SuggestedFull timeShift workAfternoon shift
- Position Title Professional Coding Specialist II Department Revenue Integrity Remote Eligibility Candidates must reside and work full-time in AR,... ...considerations, and telehealth coding rules as relevant to pro fee claims. Provide real-time guidance to peers on standard coding...ClaimsFull timeWork at officeRemote workFlexible hours
- ...Job Summary The Internal Auditor is assigned to conduct reviews of assigned organizational and functional activities and evaluate the adequacy... ...corrective action taken to improve deficient conditions. Level II – Develops audit programs and performs audit procedures. Level...Full timeWork at officeRemote workFlexible hours
- ...Enhancement is looking for a Sr. Analyst focused on Fraud, Waste, and Abuse (FWA) in Oklahoma. This role involves reviewing claims data, investigating FWA complaints, and ensuring compliance with regulatory standards. The ideal candidate has 3-5 years of experience,...ClaimsFull time
- The State of Oklahoma is seeking a Forensic Officer II for the Oklahoma Forensic Center in Vinita, OK. This full-time role involves ensuring safety and security in a 24-hour inpatient facility providing jail competency services. Qualified candidates will have security...Hourly payFull timeAfternoon shift
- ...Management in Kentucky is seeking a Physician Coding Specialist II to monitor and analyze unresolved third party accounts. The role... ...negotiating resolutions, and ensuring timely payments of outstanding claims. The ideal candidate will exhibit strong knowledge of insurance...Claims
$56.2k - $101k
...Purpose Please note: Candidates must reside within the state of Kentucky. Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential...ClaimsFull timePart timeWork at officeRemote workFlexible hours- ...ISO ClaimSearch®, the insurance industry’s premier and only all claims database. He/she will work closely with a small number of... ...APIs/REST services • Experience in automating complex systems integration (End-To-End) • Experience integrating the execution of Selenium...Claims
- ...maintain a provider education program focused on coding, documentation, and billing integrity. You will establish workflows, monitoring, referrals, and reporting standards while analyzing claims data for outlier patterns. The role requires 8+ years in a related field, CPC/...Claims
- MSIG USA is hiring a Workers' Compensation Delegated Claims Audit Specialist to conduct audits of WC claims to ensure compliance and accuracy. The ideal candidate will have over 5 years of experience in claims auditing, particularly in multi-jurisdictional settings. The...Claims
- ...Revenue Cycle Supervisor - Coding the Physician Coding Specialist II monitors and analyzes unresolved third party accounts for multi-... ...appropriate resolutions to ensure timely payments of outstanding claims. What You Will Do Analyzes, on a daily basis and in accordance with...ClaimsRelief
$63k - $108k
...operations and detail exposures according to manual rules. Verify claims data. Determine and/or develop premium basis and classification... ...and schedule territory and inventory to optimize efficiencies, auditor expectations and meet internal and external customer needs....ClaimsFor subcontractorRemote workNight shift- ...provider education program for coding, documentation, and billing integrity issues Establish program workflows, referral criteria,... ...and referral to SIU when concerning behavior persists Analyze claims, coding, utilization, reimbursement, and provider billing data...Claims
- ...to the Vice President of ClaimSearch, responsible for leading integration and externalization strategy for ClaimSearch to bring more value... ...product roadmaps You will bring deep and broad understanding of claim handling processes, a creative mindset towards identification...Claims
$90k - $110k
...and surplus to assess and price risk with speed and precision Claims Solutions — supports end-to-end claims handling with analytic... ...the most efficient Specialty Business Solutions — provides an integrated suite of software for full end-to-end management of insurance...ClaimsWork experience placement$42.45k
...requisition id: JR56859**Job Posting Title**Administrative Assistant II**Agency**131 DEPARTMENT OF CORRECTIONS**Supervisory Organization*... ...functions, such as preparing invoices and payments of claims, requisitions, purchase orders, bookkeeping or accounting, and other...ClaimsFull timePart timeWork at office- ...business process owners, senior leadership, the Financial Audit Committee, and the Executive Office. We are looking for a Staff Internal Auditor to join our US team, based in Ohio. Responsibilities Conduct local financial and operational audits, including planning, developing...Work at officeLocal area
- ...of experience working in an internal audit and/or public accounting capacity.* Audit Certification encouraged - Certified Internal Auditor (CIA), Certified Public Accountant (CPA), or Certified Information System Auditor (CISA) are preferred.* Good understanding of the...Night shift
$20 - $21 per hour
...applications. Understand and honor high level of confidentiality. Promote integrity. Strong work ethics Insurance processor duties: Research and... ...clients to the appropriate system invoice. Research insurance claim payments in the AS/400 to identify correct claim based on...ClaimsHourly pay- ...current market, competitive, and technological landscape, and integrate them into ISO's Personal Lines programs. Conduct research on... ...and surplus to assess and price risk with speed and precision Claims Solutions - supports end-to-end claims handling with analytic...ClaimsWork at office
- ...grow with us! Lemieux & Associates, a national leader in the investigative industry, is seeking experienced Field Investigators in the Queens... ...have surveillance experience as a Private Investigator, SIU/Claims investigation experience and reside in the Queens or...ClaimsFull timeWork at office
$90.32k - $135.48k
Technical Agronomist II - Western Kentucky YOUR TASKS AND RESPONSIBILITIES Plan and execute field‑scale testing programs, including... ...policies and manage the proper use of Product Performance Inquiry claims in alignment with guidelines; Travel approximately 60% of the time...ClaimsLocal areaImmediate start$23 per hour
...reconciling items are resolved timely, completely and accurately; bills/credits all assigned shipper loads as appropriate; processes claims for returned product; ensures all holds are processed in a timely and accurate manner; ensures all physical inventories are...Claims- ...Description Job Description Company Info: Daniel J. Hannon & Associates, Inc. (DJH) is a Long Island-based insurance claims adjusting/investigating firm which works on behalf of insurance companies, TPAs, law firms and municipalities primarily in the NYC tri-state...ClaimsFull timeImmediate startFlexible hours
$23 per hour
...saving medications. Supportive culture: We value teamwork, respect, integrity, and passion . Growth opportunities: We invest in your... ...by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests. How...ClaimsFull timeTemporary workRemote workRelocation package- .... • Strong understanding of insurance data domains: policy, claims, billing, underwriting, actuarial, and regulatory reporting.... ...systems and migration to cloud-based data platforms • Define data integration strategies across internal systems (e.g., Duck Creek) and...Claims
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