Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

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 2 days ago
Similar jobs that could be interesting for youBased on the Claims Integrity Auditor & Investigator II in New York, NY vacancy
  • $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... 
    Claims
    Hourly pay
    Full time
    Temporary work
    Local area
    Monday to Friday
    Flexible hours

    Hispanic Alliance for Career Enhancement

    New York, NY
    2 days ago
  • 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... 
    Claims
    Remote work

    MedReview Inc.

    New York, NY
    3 days ago
  • $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

    Hispanic Alliance for Career Enhancement

    New York, NY
    6 days ago
  • $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... 
    Claims
    Full time

    Hispanic Alliance for Career Enhancement

    New York, NY
    6 days ago
  •  ...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... 
    Claims
    Full time

    Hispanic Alliance for Career Enhancement

    New York, NY
    3 days ago
  • $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... 
    Claims
    Full time
    Work at office
    Remote work
    Work from home
    Flexible hours
    3 days per week

    Oscar Health

    New York, NY
    11 days ago
  • 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... 
    Claims
    Flexible hours

    Origin Investigations Inc.

    New York, NY
    6 days ago
  • 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

    LE0010 Stanford Health Care

    New York, NY
    3 days ago
  • $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... 
    Claims
    Remote job
    Full time

    RCM Healthcare Services

    New York, NY
    5 days ago
  • $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... 
    Claims
    Full time
    Part time
    Work at office
    Remote work
    Flexible hours

    Centene Corporation

    New York, NY
    3 days ago
  •  ...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 ("... 
    Claims
    Local area
    Worldwide
    Flexible hours
    3 days per week

    Intuitive

    New York, NY
    3 days ago
  •  ...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... 
    Claims
    Work at office

    Constructive Partnerships Unlimited

    New York, NY
    6 days ago
  • $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... 
    Claims
    Remote job

    Performant Healthcare, Inc.

    New York, NY
    6 days ago
  • 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... 

    NYU Langone Medical Center

    New York, NY
    2 days ago
  • $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... 
    Claims
    Hourly pay
    Full time
    Second job
    Work at office
    Remote work
    Flexible hours
    Night shift

    Command Investigations LLC

    New York, NY
    a month ago
  • $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... 
    Claims
    Work at office
    Flexible hours

    Foot Locker, Inc.

    New York, NY
    2 days ago
  • $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... 
    Claims
    Full time
    Remote work

    Tempus

    New York, NY
    4 days ago
  • 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... 

    Cqmedical

    New York, NY
    4 days ago
  • $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 pay
    16 hours
    Full time
    Work at office
    Remote work
    Flexible hours
    Shift work
    Night shift
    Weekend work

    Command Investigations

    New York, NY
    4 days ago
  • 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... 

    Unchain Data

    New York, NY
    2 days ago
  •  ...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

    MetroPlusHealth

    New York, NY
    5 days ago
  • 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... 
    Claims
    Remote job
    Work from home

    Machinify

    New York, NY
    3 days ago
  • $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... 
    Claims
    Hourly pay
    Work at office

    Socket.dev

    New York, NY
    2 days ago
  • $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... 
    Claims
    Work at office
    Remote work
    Work from home

    Brex

    New York, NY
    3 days ago
  • $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... 
    Claims
    Work at office

    Trend Health Partners

    New York, NY
    5 days ago
  • $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... 
    Claims
    Full time
    Work at office

    MetroPlus Health Plan

    New York, NY
    a month ago
  • $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... 
    Claims
    Full time
    Work at office
    Flexible hours

    Oscar Health

    New York, NY
    3 days ago
  • $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... 
    Claims
    Worldwide

    Starr Companies

    New York, NY
    2 days ago
  • 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... 
    Claims
    Work at office
    Night shift

    Erie Insurance

    New York, NY
    2 days ago
  • 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

    Xtend Healthcare

    New York, NY
    3 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Claims Integrity Auditor & Investigator II. Be the first to apply!