Claims Integrity Auditor & Investigator II
Qlarant
Qlarant is seeking an experienced candidate to ensure integrity in claims processes. This role requires conducting thorough audits/investigations, analyzing data to assess claims validity, and providing recommendations for resolution. You will compile detailed records and communicate findings to various stakeholders. The ideal candidate holds a Bachelor's degree, possesses strong analytical skills, and has 2-4 years of relevant experience. A Certified Fraud Examiner certification is preferred. This position is pivotal in safeguarding the claims process while adhering to industry regulations. #J-18808-Ljbffr
$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 and assisting with further investigation and/or reports to state regulators...ClaimsHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hours- A healthcare integrity solutions provider is looking for an Outpatient Payment Integrity Coder Auditor in New York City. In this role, you will audit outpatient medical claims for coding accuracy and compliance with CMS guidelines. The ideal candidate must have advanced...ClaimsRemote work
$46.99k - $122.4k
Hispanic Alliance for Career Enhancement in Georgia is hiring a Program Integrity Auditor responsible for auditing healthcare records. This role requires 3-5 years of experience in claims data review and medical coding standards (CPT, HCPCS, ICD-10). Candidates should hold...Claims$46.99k - $122.4k
...Hispanic Alliance for Career Enhancement is seeking a Program Integrity Auditor based in New Jersey. This role involves auditing medical... ...standards. The ideal candidate will have 3-5 years of experience in claims data interpretation and hold certifications such as CPC or...ClaimsFull time- ...Hispanic Alliance for Career Enhancement is hiring a Program Integrity Auditor in New York, NY. This full-time position involves auditing medical... .... Ideal candidates will have 3-5 years of experience in claims data review, industry coding guidelines, and hold a valid CPC...ClaimsFull time
$75.35k - $98.89k
...hiring a Senior Analyst, Special Investigations Unit Clinical Investigator... ...billing patterns within claims and clinical documentation,... ...clinical expertise to protect the integrity of healthcare spend. You... ...Certified Professional Medical Auditor (CPMA), Certified Fraud...ClaimsFull timeWork at officeRemote workWork from homeFlexible hours3 days per week- Origin is seeking an experienced SIU Investigator to join our growing team in Las Vegas, Nevada... ...into suspected fraudulent insurance claims through surveillance, interviews, evidence... ...quality investigations. At Origin, we value integrity, professionalism, sound judgment, and...ClaimsFlexible hours
- Stanford Health Care is seeking a Patient Account Representative (PAR II) to support the Patient Financial Services team in processing insurance balance patient claims. The role focuses on accounts receivable follow-up, denial review, payment posting, and reconciliation...Claims
$85k - $95k
...Coding Reviewer to support inpatient coding validation and payment integrity initiatives. This remote, full-time role offers a salary of $85... ...benefits, 401(k) match, and PTO. You will review inpatient claims to validate ICD-10 coding and DRG assignments, perform coding and...ClaimsRemote jobFull time$70.1k - $126.2k
...fraud, waste, and abuse (FWA) investigations involving providers, members... ...utilizing referrals, claims data, medical records, interviews... ...Compliance, Legal, Payment Integrity, Provider Relations, government... ...Professional Medical Auditor (CPMA), or other related investigative...ClaimsFull timePart timeWork at officeRemote workFlexible hours- ...the global Employment Legal team, the Sr. Investigations and Employment Advisory Specialist will... ...hostile work environment or harassment claims, discrimination, etc. using Intuitive methodology... ...process can take 3 to 6+ months) or (ii) implement a Technology Control Plan ("...ClaimsLocal areaWorldwideFlexible hours3 days per week
- ...Incident Management Investigator Specialist I The Incident Management Investigator Specialist... ...Management Investigator Specialist II and Incident Management Investigator with... ...business conduct, the NYS and federal false claims acts, whistleblower protections and mandatory...ClaimsWork at office
$69.3k - $78k
A healthcare payment integrity company is seeking a Medical Review Nurse II - Clinical Validation to perform medical claims audits for Government and Commercial Payers. The position requires an active RN license and a minimum of five years nursing experience. Responsibilities...ClaimsRemote job- Location: New York, United StatesCompany: NYU Langone HealthPosted: 2026-08-13NYU Langone Health is seeking a Revenue Integrity Analyst based in Manhattan to manage charge capture initiatives and enhance revenue management. The role includes conducting audits, analyzing...
$23 - $30 per hour
...Description Job Description Description: Command Investigations LLC is seeking an Insurance Claims Investigator with a minimum of one year of... ...prior claims investigation experience who demonstrate integrity, independence, and a drive to succeed in a fast-paced...ClaimsHourly payFull timeSecond jobWork at officeRemote workFlexible hoursNight shift$70k - $80k
...globally. Foot Locker is seeking a Lease Auditor to be a member of the Lease Audit Team.... ...and exhibits Foot Locker’s Core Values of integrity, leadership excellence, service,... ...activities, and/or to discuss details of claims. Participate in cost recovery strategic...ClaimsWork at officeFlexible hours$100k - $150k
...world datasets, including administrative claims, electronic health records (EHR), and/or... ...working style, eagerness to learn, and high-integrity work ethic.Sharp attention to detail and... ....Experience working in oncology Phase II-IV clinical trials and/or experience with...ClaimsFull timeRemote work- CQ Medical is seeking a Quality Systems Specialist II to independently lead complaint investigations, return material evaluations, and CAPA activities within a robust Quality Management System. The role requires strong root cause analysis, risk assessment, and cross-functional...
$25 - $30 per hour
Description Command Investigations, LLC is looking for Surveillance Investigators to become part of a dynamic team. This is a great opportunity... ...with prior investigative experience who demonstrate integrity, independence, and a drive to succeed in a fast-paced investigative...Hourly pay16 hoursFull timeWork at officeRemote workFlexible hoursShift workNight shiftWeekend work- Polymarket is seeking a Senior Investigation Analyst to protect market integrity. You will own investigations end-to-end, coordinating with law enforcement and regulators as needed. Leverage on-chain analysis and surveillance tools to build defensible cases from initial...
- ...Certified Coder to support fraud detection and investigations in the Special Investigations Unit. The... ...will review medical records and claims, conduct audits, and collaborate with... ...analytical skills, communication, and integrity in handling sensitive healthcare information...Claims
- Machinify is a leading healthcare intelligence company. The Medical Review Nurse II audits home health claims, working remotely with a multi-location team to ensure compliance and high-quality documentation. The role emphasizes strong clinical judgment, coding accuracy...ClaimsRemote jobWork from home
$31.25 - $38.46 per hour
...episode of care. This position is responsible for auditing inpatient claims and documenting the results of those audits, with a focus on... ...this time). Responsibilities Analyzes and Audits Claims. Integrates medical chart coding principles, clinical guidelines and objectivity...ClaimsHourly payWork at office$93.6k - $117k
...What you’ll doAs a Data Analyst II (DA), you will play a central... ...analyses and deep dives to investigate business questions, surface... ...quality checks to ensure the integrity and robustness of datasets used... ....com domain. Any outreach claiming to be from Brex via other sources...ClaimsWork at officeRemote workWork from home$85k - $90k
TREND Health Partners is a tech-enabled payment integrity company. Our mission is to facilitate... ...parental leave, and more. The Nurse Coder DRG Auditor’s primary responsibility is to review medical records and associated claim information to validate accuracy of DRG assignments...ClaimsWork at office$54k - $64.47k
Claims Examiner II Job Ref: TE0165 Category: Claims Department: CLAIMS Location: 50 Water Street, 7th Floor, New York, NY 10004... ...Examiners within the department. Professional Competencies Integrity and Trust Customer Focus Functional/Technical skills Written...ClaimsFull timeWork at office$72.8k - $95.5k
...Hi, we're Oscar. We're hiring an Analyst II, Actuarial to join our Actuarial. Oscar is... ...setting process with respect to IBNR claims, Risk adjustment and Shared Savings deals... ...onboarding of analysts by collaborating and integrating them into existing processes. Compliance...ClaimsFull timeWork at officeFlexible hours$80k - $95k
Staff Auditor - Managing General Agents (MGAs) and Third Party Administrators (TPAs) page... ..., collect premiums and adjudicate claims on behalf of Starr Companies.**Responsibilities... ....* Professionalism, dependability, integrity and trustworthiness combined with a cooperative...ClaimsWorldwide- Division or Field Office: Law Division Department of Position: Claims Legal Department Work from: Corporate Office, Erie PA Salary Range:... ...hiring manager will consider candidates for the Counsel I, Counsel II, or Counsel III positions. Level of position offered will depend...ClaimsWork at officeNight shift
- Xtend Healthcare is seeking a DRG Revenue Integrity Auditor to perform DRG validation and chart reviews for inpatient records. You will apply ICD-10-CM/PCS coding guidelines to ensure accurate classifications and compliant documentation. This remote role offers a salaried...Remote job
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