Claims Audit & Fraud Investigator
Qlarant
Qlarant is seeking a skilled auditor to ensure the integrity of claims processes in Arizona. The role involves conducting audits and investigations into customer claims, while employing strong analytical skills to identify potential fraud and discrepancies. The ideal candidate will have a Bachelor's Degree and 2-4 years of relevant experience, with a preference for Certified Fraud Examiners. Strong attention to detail and customer service skills are essential for success in this position. #J-18808-Ljbffr Qlarant
$46.99k - $122.4k
CVS Health is seeking a dedicated professional for the role focused on healthcare fraud investigation. The successful candidate will handle complex cases, prevent fraudulent claims, and cooperate with law enforcement. Qualifications include 3 years of experience in fraud...ClaimsFull time$70.29k - $117.16k
Capital Insurance Group is looking for an SIU Investigator based in Phoenix, AZ. The role involves investigating suspicious claims, identifying potential fraud, and providing training to claims staff. Candidates should have 5-7 years of insurance or investigative experience...Claims- Zurich 56 Company Ltd is seeking an experienced Claims Fraud Investigator for their Claims Fraud and Investigation team. This role offers the flexibility of fully remote work from several states including Arizona, Nevada, California, or Utah. The ideal candidate will conduct...ClaimsRemote job
$53k - $66k
Turo Inc. is seeking a Claims SIU Specialist to investigate claims related to suspected fraud and policy violations. This hybrid role requires strong analytical and investigative skills, with a minimum of 2 years' experience in claims handling or fraud investigations....Claims- Turo Inc is seeking a skilled Claims Total Loss Specialist in Phoenix, Arizona, responsible for investigating and resolving complex claims. The ideal candidate will demonstrate strong judgment and analytical skills to assess claims. This position entails working in-office...ClaimsWork at office3 days per week
$57k - $68k
Turo Inc. is seeking a Total Loss Claims Specialist to manage and investigate claims involving higher complexity. The ideal candidate will be responsible for assessing coverage, analyzing damages, and negotiating resolutions while exercising independent judgment. They will...Claims- Turo Inc. is seeking a Claims Specialist to handle high-complexity claims, requiring analysis of policies and customer communication. This role involves investigating claims, negotiating resolutions, and providing recommendations on processes. The ideal candidate will demonstrate...Claims
- ...Employee Benefits Corporation is hiring for a Fraud Prevention Analyst. In this role, you’ll... ...products and operations. You’ll combine investigation, analytics, and risk management to... ...investigations, determine root cause, and document audit‑ready findings with clear...Work at officeRemote workFlexible hours
$65.9k - $107.9k
Zurich is seeking an experienced Claims Fraud Investigator to join its Claims Fraud and Investigation team. At Zurich North America Claims, we recognize that flexibility and work-life balance are key considerations when choosing your next career move. Our hybrid work model...ClaimsTemporary workFor contractorsApprenticeshipWork at officeLocal areaRemote work$24.99 per hour
...Summary Under the direction of the CRP Fraud Ops Supervisor, the CRP Fraud Operations... ...responsible for providing backup fraud investigation services for, debit and credit cards,... ...initiative regarding check or debit card fraud claims within the parameters of the...ClaimsHourly payFull timeTemporary workPart timeWork experience placementBank staffWork at officeLocal areaVisa sponsorshipWork visa- ...Specifically, we are presently seeking motivated Investigative Analysts to work with us performing... ...* Reviewing incident reports, such as fraud and other law violations, strategizing... ...documents and interviews to support their claims and record their findings * Working...ClaimsContract workWork at officeImmediate start
- U-Haul is seeking a full-time Fraud Investigator based in Phoenix, Arizona, to lead the identification, investigation, and prosecution of fraudulent claims against Repwest Insurance Company and its insureds. You will direct and train personnel to detect fraud, collaborate...ClaimsFull time
$24.99 per hour
...Summary Under the direction of the CRP Fraud Ops Supervisor, the CRP Fraud Operations... ...subpoena requests and provide backup fraud investigation services for debit and credit cards, new... ...discretionary judgment regarding claim handling. Utilize investigative tools and...ClaimsHourly payFull timeTemporary workPart timeBank staffWork at officeLocal areaVisa sponsorshipWork visa$33.5 - $38.5 per hour
A leading insurance auditing firm is seeking a Premium Insurance Field Auditor to ensure accurate insurance policy premiums. This position requires data collection from insured businesses and conducting remote audits. Ideal candidates should have a background in financial...Hourly payFor contractorsRemote workFlexible hours- ...for someone who knows the pharmacy billing world, enjoys solving claim and coverage issues, and wants to be part of a stable, service‑... ...patient, insurance, and billing records within pharmacy systems Audit patient files and documentation to support compliance and third‑...ClaimsFull time
- ...Company Overview Transtar Insurance Brokers, Inc. and Blue Star Claims LLC are leaders in transportation-focused insurance and claims... ...forecasts to ownership and senior management. Compliance, Audit & Risk Management Ensure compliance with, internal accounting...ClaimsLocal area
- Job Summary Ensures the integrity and accuracy of claims processes and protocols. Collects data for audits/investigations into claims, utilizing a combination of... ...and closure. Identifies opportunities to target fraud, waste, and abuse or discrepancies in claims submissions...ClaimsWork experience placement
- ...driver qualification requirements, vehicle safety standards, insurance, claims, and legal documentation. Collaborate with Safety to manage driver compliance programs, reporting processes, and audit readiness. Partner with HR and Safety to maintain fleet‑related policies...ClaimsContract workWork at officeLocal areaMonday to FridayFlexible hours
$21 - $24 per hour
...Required Responsible for processing customer bills and insurance claims in an accurate and timely manner. This includes assisting with... ...information into billing system. Maintain and continually audit patient files and corresponding documentation necessary to defend...ClaimsTemporary workWork at officeMonday to FridayFlexible hoursWeekend work- ...Coding Auditor to extract clinical information and ensure accurate reimbursement processes. This role involves reviewing hospital claims and making crucial coding decisions while working in a metrics-driven environment. Ideal candidates will possess relevant certifications...ClaimsRemote work
$94.64k - $118.27k
...provide a knowledgeable Customer Service staff and quick and fair claims service with 24/7 claims reporting. We partner with experienced... ...work product in the Claims Department by means of our internal audits as well as your own observations thru file reviews. You will be...ClaimsFull timeTemporary workFlexible hours- ...time payments in AZ360 HRM, prepare manual journal entries for payroll errors, audit payroll record and reconciliations. Complete research requests for payroll. Process travel reimbursement claims. Prepare agency transfers. Required Skills 3+ Years in an Accounting...ClaimsContract work
- Blue Cross Blue Shield of Arizona is looking for a Clinical Analyst to assess member utilization and predict future healthcare spending. The successful candidate will collaborate with multidisciplinary teams to enhance customer relationships and service, while also identifying...Claims
- ...Ethos, a leader in insurance claims investigation, is looking for an Experienced Field Investigator in Phoenix, Arizona. The role involves conducting surveillance to identify potential fraudulent claims while preparing detailed reports for clients. Candidates must have...ClaimsNight shift
- ...care, using clinical knowledge in alignment with state/federal guidelines and Molina policies. This role involves evaluating medical claims, facilitating appeals, and resolving issues while ensuring compliance with regulations. Candidates must possess at least 2 years of...ClaimsRemote job
- Valenz is hiring a Clinical Bill Review Analyst to review claims, catch billing discrepancies, and identify savings opportunities. This... ...fully remote role requires at least 3 years of experience in auditing, claims, or billing within the healthcare industry. Candidates...ClaimsRemote jobFlexible hours
$21.1 - $49.08 per hour
4004 Aetna Medicaid Administrators is looking for a Quality Assurance professional to conduct audits on Medicare and Medicaid claim processing. The ideal candidate will have experience in claim processing or auditing, possess strong analytical and communication skills,...ClaimsHourly payFull time- ...Phoenix, Arizona, is seeking a skilled Medical Billing Auditor for quality control in billing practices. This role involves auditing medical claims, managing insurance verifications, and ensuring compliance with various regulations. The ideal candidate will have at least...ClaimsFlexible hours
$43.89k - $85.07k
...Corporation is seeking an Analyst, Network Management to join their specialized Pharmacy Audit division. This role entails conducting compliance audits and verifying pharmacy-submitted claims related to Medicare, ensuring adherence to CMS standards. The ideal candidate will...ClaimsFull time$48.3k - $65.9k
Humana Inc is looking for a Medical Coding Coordinator to perform advanced administrative duties remotely. This role includes extracting clinical information, assigning medical codes like ICD-10-CM, and analyzing data. Candidates must have a coding certification and at ...ClaimsRemote job
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