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
- ...Summary Serves as an entry level professional who develops baseline plans for ensuring the integrity and accuracy of claims processes and protocols. Collects data for audits/investigations into claims, utilizing a combination of analytical skills and attention to detail,...ClaimsWork experience placement
- 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
...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. Assisting with further investigation and/or reports to state regulators...ClaimsHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hours- ...Qlarant is seeking an entry-level professional to ensure the accuracy and integrity of claims processes in Idaho. The role involves conducting audits and investigations into customer claims, analyzing data, and communicating findings. Candidates must have a minimum Bachelor...Claims
$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$73k
...with Accounting and Finance teams to resolve issues, improve integrations, and deliver the insights needed for better decision-making.... ...information during the hiring process. If you are contacted by someone claiming to represent us from a different email address, please treat...ClaimsFull timeRemote work- ...a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic... ...Assessment forms and completes Crime Victim's Board (CVB) claim forms. 5. Endorses clinically relevant examination findings...ClaimsFull timeWork at officeShift workNight shift
$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$23 - $30 per hour
...Command Investigations LLC is seeking an Insurance Claims Investigator with a minimum of one year of experience to become part of a dynamic team. This is... ...prior claims investigation experience who demonstrate integrity, independence, and a drive to succeed in a fast-...ClaimsHourly payFull timeSecond jobWork at officeRemote workFlexible hoursNight shift$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$100k - $130k
...leading initiatives focused on scalability, automation, data integrity, and cross-functional process transformation. This is a highly... ...and interview requests being sent by individuals falsely claiming to represent Authentic. These scams are often initiated via email...ClaimsImmediate startWorldwide$82.23k - $155.81k
...Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG)... ...promotes productivity, supports work-life integration, and ensures essential face-to-face... ...review of Diagnosis Related Group (DRG) paid claims. How you will make an impact:...ClaimsFull timeWork experience placementWork at officeLocal area- 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
$66.96k
...seeks forensic accountants/auditors (FAA) for its New York City... ...conduct complex healthcare fraud investigations. The Medicaid program... ...with ensuring the financial integrity of New York’s $96 billion Medicaid... ..., such as theft and false claims. Qualifications A minimum of...ClaimsWork experience placementWork at officeLocal areaRemote workFlexible hours- ...County community. By “Pursuing Justice with Integrity,” the BXDA places a focus on assistance... ...enthusiastic Digital Forensic Examiner II. The Digital Forensics Laboratory,... ...Subject Matter Experts to best guide ADAs and Investigators to properly seize, preserve, and collect...Work at office
$68.04k - $118.8k
...Summary of Job Conduct complex, in-depth investigations of reported fraud involving the full range of healthcare products. Develop... ...from various sources to review for suspect activity. Review claim files and develop action plans for the investigation. Conduct...ClaimsWork experience placement- ## Insurance Billing/Collection Assistant II (Remote) - Department of Medicine - Business OfficeApplyremote type: Fully Remotelocations... ...the accuracy and completeness of insurance records, and claims, contacting insurance companies as well as other related duties to...ClaimsWork experience placementWork at officeRemote work
$100k - $130k
...experience, a passion for fighting insurance fraud, and strong litigation skills. The role involves defending against claims, conducting investigations, and preparing legal documents. Compensation ranges from $100,000 to $130,000 based on experience. The firm values diversity...Claims$32 - $40 per hour
...Job Description Job Description Overview Company Overview: Advance Your Career in Insurance Claims with Allied Universal® Compliance and Investigation Services. Allied Universal® Compliance and Investigation Services is the premier destination for a career in...ClaimsWork at officeLocal area$60 - $65 per hour
...Title- EEO Investigator location - New York, NY Duration - 06/22/2026 - 08/15/2026 Shift - 9:00 AM-5:30 PM | 7.5 hours/day |37.5... ...Investigate internal complaints of discrimination, including claims of sexual harassment, while maintaining the System's compliance...ClaimsLocal areaShift work$100k - $125k
Senior Internal Auditor page is loaded## Senior Internal Auditorlocations: New York, NYtime... ...at the heart of our culture of caring, integrity and excellence and is a driving force... ...apps.**If you are contacted by someone claiming to represent Greystone and suspect the communication...ClaimsWork at officeFlexible hours$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- ...Big Leap Health is seeking a detail-oriented contractor to audit coded claims against clinical documentation, catching patterns that create compliance risk. Initially you may perform direct coding as our internal tool matures, with auditing becoming the primary focus....ClaimsFor contractorsRemote work
$70k - $90k
...Senior Investigator - Pre-Pay (Healthcare FWA) Job Location: US-Remote Overview As a Senior Investigator, you will investigate suspected... ...that may warrant further investigation. Utilizes data analytics, claims review, and industry intelligence to detect potential fraud,...ClaimsWork experience placementWork at officeRemote workWork from home- ...Description Job Description Affirmative Civil Enforcement (ACE) Investigator Employment Type: Full-Time, Experienced Department:... ...-scale hard-copy and electronic data, such as health care claims data, financial transaction data, accounting records, or bank...ClaimsFull timeWork at officeLocal areaFlexible hours
$18 - $21 per hour
...evenings, weekends and public holidays As The Asset Protection Investigator, You Will: Build awareness and inspire by performing as... ...; complete accident investigations and general liability claims reports Demonstrate a direct impact in high shortage departments...ClaimsFull timeWork experience placementLocal areaFlexible hoursWeekend workAfternoon shift$46.99k - $122.4k
...Alliance for Career Enhancement is hiring for a position focused on investigating healthcare fraud cases. The ideal candidate will have a... ...Responsibilities include handling complex cases, preventing fraudulent claims, and interacting with various stakeholders. This full-time...ClaimsFull time- A leading health organization seeks an investigator for healthcare fraud allegations. Responsibilities include conducting investigations, analyzing claims data, and preparing reports. A bachelor's degree and 1+ years in medical claim analysis are essential. Preferred candidates...ClaimsRemote work
$26 - $30 per hour
...Overview Investigator - Network Services Manhattan, NY area Immediate need for an undercover investigator within the largest worldwide investigative... ...investigations providing: Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations,...ClaimsHourly payFull timeH1bH2bLocal areaImmediate startWorldwideFlexible hoursNight shift$80k - $150k
...Overview CGS Federal (Contact Government Services) is seeking a Senior Auditor to assist district legal staff by conducting medical claims data analysis, forensic investigations, financial damages, statistical sampling, and ability-to-pay analyses. These efforts support...ClaimsFull timeFlexible hours
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