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
$53.96k - $86.18k
...FRAUD TEAM SUPPORT ANALYST Responsible for analytical and project support for Fraud operations, including: conducting... ...; research and respond to escalated fraud claims; malware alerts; review of department audit reports and other support activities defined by management...ClaimsRemote work- ...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...SuggestedWork at officeRemote workFlexible hours
- deltagroup is seeking a skilled investigator for their Special Investigation Unit in Phoenix,... ...role involves investigating suspicious claims and requires strong investigative abilities... ...where your expertise will help prevent fraud in various insurance claims. #J-18808-...Claims
$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- Responsibilities Provide independent ERM oversight of fraud risk across all business lines and delivery channels. Develop, maintain, and... .... 3-7 years of experience in fraud risk, ERM, GRC, compliance, audit, or financial crime. Strong understanding of fraud typologies,...SuggestedWork at office
- 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
- First Chicago Insurance Company is seeking an experienced Casualty Claims Specialist to investigate and settle automobile bodily injury claims. This role involves handling complex liability claims and requires a thorough investigation to ensure proper claim management....Claims
$33.5 - $38.5 per hour
...policy premiums. In this role, you’ll be responsible for collecting data from insured businesses, scheduling and conducting remote audit interviews, and compiling thorough audit reports for insurance providers. We contract the best because we believe great people create...Hourly payContract workFor contractorsWork experience placementLive outLocal areaRemote work- ...Insurance Field Auditor (1099/Contractor) to ensure accurate insurance policy premiums. Responsibilities include traveling for on-site audits, analyzing financial records, and preparing detailed reports. Candidates should be detail-oriented, possess excellent communication...For contractors
- .... Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across... ...plans for ensuring the integrity and accuracy of claims processes and protocols. Collects data for audits/investigations into claims, utilizing a combination of analytical...ClaimsWork experience placement
$70k
...verification, financial conversations, billing accuracy, and collections. Audit daily workflows for compliance and consistency with Imagen policies; retrain team as needed. Ensure patient credits, refunds, claims, and cash deposits are processed accurately and payments are...ClaimsDaily paidWork at officeLocal area- ...favorably adjudicated DOD background investigation for this position. Veterans,... ..., and reporting of suspected fraud, waste and abuse (FWA) cases... ...issue‑related medical claims and records for FWA and/or administrative... ..., or equivalent claim auditing experience U.S. Citizenship...ClaimsContract workFor subcontractorInterim roleRemote work
- ...healthcare. In this role, you will help produce clean, compliant claims the first time by ensuring accurate charge entry, resolving... ...rate. Maintaining 95% or higher claim accuracy during quality audits. Meeting established daily productivity goals. Preventing...ClaimsTemporary workMonday to FridayFlexible hours
- 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
- ...with a growing, well-established organization in the insurance and claims administration industry to hire an experienced Accounting &... ...applicable federal, state, and local regulations. Coordinate annual audits and serve as the primary liaison with external auditors....ClaimsWeekly payWork at officeLocal area
- ...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
$80k - $100k
...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$22 - $23 per hour
...surveillance in order to identify and apprehend shoplifters, deter shoplifting. No risk management, safety, door greeting, alarms, audits or inventory responsibilities. This position is solely focused on discreetly walking the sales floor undercover to apprehend shoplifters...Full timeLocal areaFlexible hoursWeekend work- ...Executive Management team when necessary. Manages all unemployment claims and leads all unemployment claim appeal requests and appeal... ...employee questions, 401k loan requests, distributions, 401k annual audits, etc. Training Assures employee training is in compliance with...ClaimsTemporary workWork experience placementNight shift
$25 per hour
...utilities sector. PLC’s core service is outside plant damage investigation, recovery, and prevention. Across the US and parts of Canada,... ...investigations within 7 days and then work with and support our claims managers to complete the investigation and begin the recovery...ClaimsContract workPart timeFor contractorsWork experience placementLocal areaRemote work$23.16 per hour
...Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround... ...reimbursement request is accurate by auditing the claim for duplicate line-item charges... ...claim submissions and involves the Special Investigation Unit as necessary. Identifies issues...ClaimsFor contractorsWork at officeLocal area- ...continuous improvement environment Effectively manage multiple audits and projects and respond to change with adaptability Requirements... ...7-10 years work experience in healthcare Experience in Medicare claims and claims processing requirements Medicare and/or Medicare Integrated...ClaimsWork experience placement
- ...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
$22.3 - $35.2 per hour
...accounts receivable team, ensuring accurate and timely processing of claims, including denials and the maximization of cash flow. This role... ...outstanding), and other KPIs. Support internal and external audits by providing requested documentation and explanations. Audit...ClaimsHourly payTemporary workWork at officeLocal areaFlexible hours- ...submit comprehensive reports, including site investigation reports, risk assessment reports,... ...the remediation process. Insurance Claim Support Experience providing technical... ...analysis, and reporting. Conduct periodic audits and reviews of project activities to...ClaimsRemote workWork from homeFlexible hours
$21 - $24 per hour
...Certification 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...ClaimsFull timeTemporary workWork at officeWork from homeMonday to FridayFlexible hoursWeekend work1 day per week$195.23k - $351.41k
...Opportunity As a dedicated AVP, Special Investigations Unit you will develop, implement, and execute USAA Claims Security strategy for... ...investigation of insurance fraud involving insureds, third party... ...effective systems for routine fraud auditing and identification of risks. *...ClaimsH1bWork at officeRemote workRelocation packageFlexible hours- ...ensure compliance with coding standards and identifying any fraudulent activities. Candidates should have 3-5 years of experience in claims data, be knowledgeable in coding guidelines, and hold an active CPC, CCS, or CPMA license. The ideal applicant will have strong...ClaimsFull time
- ...advising management of potential risks Investigates internal complaints of harassment/discrimination... ...Conducts internal investigations for claims from outside agencies and works with... ...location visits, investigations, agency audits, Legal issues, etc. Travel requirements...Claims
- tango is seeking a Claims Manager to lead our claims operations with a focus on issue resolution, process improvement, auditing, and cross-functional support. The role specializes in technical troubleshooting, claims reconciliation, batch processing, and collaboration...ClaimsRemote job
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