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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

Vacancy posted 21 hours ago
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