Claims Audit & Fraud Investigator
Qlarant
Qlarant is seeking an individual to ensure the accuracy of claims processes, conducting audits and investigations into customer claims. The ideal candidate will possess analytical skills and attention to detail, documenting their findings and communicating effectively with stakeholders. This role requires a minimum of a Bachelor's degree and 2-4 years of experience, with 5-7 years preferred. A preference for Certified Fraud Examiner certification further enhances the candidate profile, contributing to the integrity of the claims process. #J-18808-Ljbffr Qlarant
- ...Career Enhancement is seeking a qualified candidate for a position focused on investigating health care fraud. Responsibilities include handling complex cases, preventing fraudulent claims, and documenting activities diligently. This role requires at least three years...ClaimsFull time
$61.91k - $118.25k
...seek the advice of legal counsel.Streaming Fraud Data Research & Analyst page is loaded##... ...analyst role will be responsible for investigating and documenting ongoing patterns of suspicious... ...you’ll be logging evidence, maintaining audit trails, and documenting findings for...SuggestedSummer workWork at officeImmediate startRemote workFlexible hours- ...documentation. This position involves reviewing medical records and claims to ensure compliance with regulations while providing feedback... ...education to providers. Ideal candidates will hold a CPC certification and have experience in auditing and coding. #J-18808-Ljbffr...Claims
- ...marketing, verifying insurance, credentialing, billing, support, EHR, audits, and compliance) so that you can focus on delivering great care... ...deposit every two weeks with no need to worry about unpaid claims ~ Rula pays you even when the patient no-shows, cancels late,...ClaimsContract workPart timePrivate practiceRemote work
$20 - $22 per hour
...outstanding insurance balances through payer portals, phone outreach, and claim status inquiries. Identify and resolve claim denials,... ...actions and communications in the practice management system for audit and compliance purposes. Review member ledgers for accuracy and...ClaimsLocal areaFlexible hours- ...financial operations including accounts payable, payroll, taxes, and audits. The ideal candidate needs a keen eye for detail, organizational... .... You will oversee invoicing and billing, manage unemployment claims, and ensure compliance with tax regulations. A background in...Claims
- ...responsible for performing all billing functions for the agency, ensuring claims are submitted accurately and on time to all payers. This role is... ...to facilitate recovery. Conduct thorough pre‑billing audits to verify patient eligibility, authorization validity, and documentation...Claims
- ...their revenue cycle team in Nashville, Tennessee. This role involves conducting audits of patient charts to ensure all documentation is complete and compliant, thereby supporting clean claims and timely reimbursements. We seek professionals with experience in Home Health...Claims
- ...and Quarterly Statements and related disclosures Direct the MARS audit process end-to‑end, including planning, coordination, testing... ...business Partner cross‑functionally with underwriting, actuarial, and claims teams to ensure accurate financial representation of a high‑...Claims
- ...Nashville, TN. You will drive service quality excellence by evaluating service interactions and assisting in audits related to enrollment, billing, and claims processing. This onsite role requires a BS/BA and at least 2 years of related experience. You will analyze data...Claims
- ...insurance company subsidiaries are rated A+(Superior) by A. M. Best Company. BSIG provides local underwriting, risk services, claim, marketing and audit services for agents and policyholders in Alabama, Georgia, Mississippi, South Carolina, North Carolina and Tennessee. We...ClaimsFull timeTemporary workWork experience placementWork at officeLocal area
- The State of Tennessee seeks a Revenue Special Agent for forensic tax investigations and auditing. This entry-level position involves auditing tax documents and preparing reports under supervision. A bachelor's degree in accounting and valid driver's license required. Responsibilities...
$36.83 - $42.74 per hour
...Auditor to ensure the accuracy and compliance of risk adjustment coding for providers and patients. The role requires auditing documentation and claims, identifying inaccuracies, and translating findings into educational insights for providers. Candidates should have at...ClaimsRemote jobHourly pay- ...an HR Compliance Coordinator for a 3+ month hybrid contract position in Brentwood, TN. The role involves coordinating unemployment claims and background screenings, ensuring compliance with HR policies and state laws. Candidates should have 2+ years of HR experience and...ClaimsContract workWork at office
- ...operational processes across complex portfolios. Assist with valuation, claims, and financial reporting. Partner cross‑functionally with underwriting, research, and external stakeholders. Contribute to audits, tax processes, and investor reporting. Help improve systems,...Claims
$45k - $52.5k
...accuracy Quickly identify and resolve account errors, claim rejections, and system issues that may cause... ...corrections, identify system gaps in reporting, and audit submitted claims for potential errors Investigate escalated insurance billing inquiries and inaccuracies...ClaimsFull timeTemporary workWork at officeLocal area- ...A reputable insurance firm based in Goodlettsville is seeking Independent Insurance Claims Adjusters. This role offers flexibility, competitive compensation, and the opportunity to make a real difference in the lives of those affected by disasters. Candidates with experience...Claims
- ...Company is seeking skilled and experienced Field Investigators to join our team on an "as needed" basis. This role... ...investigative services. We investigate all types of insurance claims including workers' compensation, suspected fraud, liability and aimed at mitigating expenses for...ClaimsFlexible hours
$19 per hour
...to insurers, responsible parties and others to follow up on rejected claims and to garner accurate insurance information Assist Business Manager with credit card payments, statement inquiries, audits, and collections Work collaboratively with co-workers to ensure all deadlines...ClaimsFull timeTemporary workWork at officeMonday to FridayFlexible hours- ...A leading claims adjusting firm is seeking Licensed Claims Adjusters to join their dynamic team in Tennessee. This role offers opportunities for career growth and the chance to make a positive impact on clients' lives. Whether you're an experienced adjuster or new to...Claims
$58.9k - $80.07k
...The Investigator within the Special Investigations Unit (SIU) will be responsible for effectively... ...of alleged misconduct and Fraud, Waste and Abuse by providers, representatives... ...related field, or five years of insurance claims investigation experience or professional...ClaimsTemporary workWork experience placementLocal areaRemote work- ...Auditor specializes in reviewing and analyzing medical records, claims and workflow processes to ensure accuracy, completeness, and compliance... ..., and reimbursement processes. Responsibilities Using audit tools, authoritative references, CMS and CPT guidelines, bell...ClaimsWork at officeLocal area
- ...Orthos Inc is looking for a Billing Specialist to manage patient inquiries and review insurance claims. This remote position requires candidates to reside in certain states and have at least 2 years of medical billing experience. The ideal candidate should be knowledgeable...ClaimsRemote work
- ...An established claims adjustment firm in Brentwood, Tennessee seeks Independent Claims Adjusters. This position is ideal for experienced professionals and newcomers alike, with strong training programs available to launch your career. Enjoy flexibility, autonomy, and...ClaimsFlexible hours
- ...Forensic Accountant. For State purposes, a Forensic Accountant: Forensic accountants are experienced auditors, accountants, and investigators of legal and financial documents that are hired to look into possible suspicions of fraudulent activity within a company; or are...Temporary work
- ...organization, including accounts payable, payroll, servicing, taxes, audits, and software management. The ideal candidate will have strong... ...any software issues. Unemployment: Administer unemployment claims and related documentation. Keep track and document when an employee...ClaimsBi-weekly payContract workFor subcontractorWork at office
$62.1k - $105.3k
Job Description Responsible for investigating and analyzing complex, multi-discipline coverage and claims referred to the Special Investigation Unit (SIU) for potential fraud. Tasks include conducting background searches, scene investigations, gathering recorded statements...Claims- ...Boundaries. This position is responsible for managing the full ABA claims lifecycle after submission , with a strong focus on aging,... ...including aging trends and denial patterns Perform quality assurance audits to ensure billing and follow-up timelines are consistently met...ClaimsRemote work
- Allied Universal is hiring a Surveillance Investigator in Nashville, TN. The role involves performing discreet surveillance of claimants to assist in insurance claims administration. Ideal candidates should possess a Private Investigator’s license, a high school diploma...Work experience placementFlexible hours
- Healthcare Fraud Investigator Employment Type: Full-Time, Mid-Level Department: Litigation Support CGS is seeking a Healthcare Fraud Investigator... ...Relevant Healthcare Fraud experience including compliance, auditing duties, and other duties in Section 3. Relevant experience...Full timeWork experience placementWork at officeLocal area
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Claims Audit & Fraud Investigator. Be the first to apply!
- claims coordinator Nashville, TN
- medical claims auditor Nashville, TN
- claims associate Nashville, TN
- work from home fraud jobs Nashville, TN
- fraud prevention Nashville, TN
- fraud specialist Nashville, TN
- fraud manager Nashville, TN
- compliance audit Nashville, TN
- audit senior Nashville, TN
- audit part time Nashville, TN

