Claims Integrity Auditor & Investigator II
Qlarant
Qlarant is looking for a skilled auditor in the United States, Massachusetts to ensure the integrity and accuracy of claims processes. This role involves conducting routine audits, providing detailed reports, and implementing strategies to prevent fraud. Applicants should have a Bachelor's degree, relevant experience in claims auditing, and preferably hold a Certified Fraud Examiner credential. This position offers an opportunity to make a significant impact on claims resolution and compliance. #J-18808-Ljbffr Qlarant
- Job Summary Ensures the integrity and accuracy of claims processes and protocols. Collects data for audits/investigations into claims, utilizing a combination of analytical skills... ...providing training and support to other auditors/investigators, contributing to the...ClaimsWork experience placement
$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$37.87 - $59.63 per hour
...within Intermountain's policies and procedures. Revenue Integrity Analyst II Service Areas: Emergency/Trauma, Transport, Behavioral Health... ...and evaluates system automation by comparing the charge/claim data to the clinical record. Leverages other system functionalities...ClaimsHourly payWork at officeRelocationMonday to FridayFlexible hours$24.5 - $26 per hour
...amazing team and work remote from home! The Default FHA Claims QA Analyst II will work under moderate supervision, responsible for reviewing... ...is part of The Carrington Companies, which provide integrated, full-lifecycle mortgage loan servicing assistance to borrowers...ClaimsRemote workWork from home$37.31 - $58.75 per hour
...edits. Audit and evaluate system automation by comparing charge/claim data to the clinical record and leveraging other system... ...revenue monitoring. Mentor and support training of other revenue integrity analysts. Skills Data Analysis Healthcare Regulations Process Improvement...ClaimsHourly payMonday to FridayFlexible hours$52.35k
Oklahoma Watch Inc. is seeking a Social Services Investigator II based in Oklahoma City. The role involves investigating allegations of abuse and neglect, conducting interviews, and preparing reports. Applicants should hold a Bachelor's degree and have at least three years...Full time$46.99k - $122.4k
The Hispanic Alliance for Career Enhancement is seeking a Program Integrity Auditor to review medical records for compliance with coding standards in the United States, Massachusetts. Responsibilities include auditing provider records, identifying billing patterns, and...Full time$62.86k - $116.36k
...experience, then our Mercury Insurance Property Claims team could be the place for you! Upon... .... The Property Claims Field Adjuster II will learn apply knowledge of current Company... ...regulatory standards, and procedures to investigate, evaluate and settle moderate Homeowner's...ClaimsSeasonal workLocal areaFlexible hours- ...American Health Communities is seeking a Claims Auditor in Oklahoma City, OK. This role involves ensuring accurate claims payment, regulatory compliance, and providing exceptional customer service. Ideal candidates will have at least two years of experience in health...ClaimsWork at office2 days per week3 days per week
$52.35k
Job Overview Position Title: Social Services Investigator II Agency: Oklahoma State Department of Health, Office of Client Advocacy Location: Oklahoma City, Tulsa, or Stillwater Compensation: Up to $52,351.20, based on education and experience Employment: Full Time, Monday...Full timeContract workWork at officeMonday to FridayFlexible hoursWeekend work$52.35k
## Social Services Investigator IIApplylocations: Oklahoma County: Tulsa County: Payne Countytime type: Full timeposted on: Posted Todaytime... ...id: JR61564**Job Posting Title**Social Services Investigator II**Agency**340 OKLAHOMA STATE DEPARTMENT OF HEALTH**Supervisory Organization...Full timeContract workPart timeWork at officeVisa sponsorshipMonday to FridayFlexible hoursWeekend work- ...based on company discretion.***About the Role:**As a Senior AML Investigator - Financial Crimes, you'll work remotely to provide expertise... ...of an increase in recruitment scams where individuals falsely claim to represent AML RightSource. These scammers may ask for money...ClaimsFull timeWork at officeLocal areaRemote workWork from home
$43.89k - $69k
...Experienced Anti-Money Laundering (AML) Investigator As an Experienced Anti-Money Laundering (AML) Investigator, you will leverage your... ...of an increase in recruitment scams where individuals falsely claim to represent AML RightSource. These scammers may ask for money...ClaimsOngoing contractFull timeWork at officeLocal areaWork from homeMonday to Friday$40k
...Entry-Level Anti-Money Laundering (AML) Investigator No prior experience required! We provide comprehensive training to help you build... ...of an increase in recruitment scams where individuals falsely claim to represent AML RightSource. These scammers may ask for money...ClaimsOngoing contractFull timeWork at officeLocal areaWork from homeMonday to Friday$69k - $75.6k
...Internal Auditor II Agency: 695 Oklahoma Tax Commission Supervisory Organization: Division Directors Job Type: Regular Full time Compensation: Salary - Level I $69,000 - Level II $75,600 WHY YOU'LL LOVE IT HERE! Transparency. Fairness. Compliance....Full timeWork at officeFlexible hours- ...An insurance company in Oklahoma City is seeking a Property Claims Field Adjuster II to investigate and resolve homeowner claims using both field and virtual inspections. This role requires 3-5 years of experience in property claims, a valid driver’s license, and strong...ClaimsRemote workWork from homeFlexible hours
$71.1k - $97.8k
...community and help us put health first The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records... ...medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-...ClaimsBi-weekly payContract workTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to Friday$22 - $25 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 experience placementWork at officeLocal area$21 - $25 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...ClaimsPart timeWork experience placementWork at officeLocal area$60k
Job Posting Title Auditor I, II Agency 340 OKLAHOMA STATE DEPARTMENT OF HEALTH Supervisory Organization 340 Internal Audit Job Posting End Date Refer to the date listed at the top of this posting, if available. Continuous if date is blank. Note: Applications will be accepted...Full timePart timeFor contractorsWork at officeVisa sponsorshipMonday to FridayFlexible hours- Oklahoma Heart Hospital is seeking a Hospital Revenue Integrity Specialist to evaluate and ensure accurate charges for hospital claims. The role involves reviewing clinical documentation, validating claims data, and collaborating with clinical leadership to prevent revenue...Claims
- Oklahoma Heart Hospital, L.L.C. is seeking a Hospital Revenue Integrity Specialist to evaluate charges for hospital claims and ensure compliance with regulations. This role involves collaboration with clinical staff to prevent revenue leakage and optimize billing processes...Claims
- ...Mercury Insurance Services, LLC is hiring a Property Claims Field Adjuster II in Oklahoma City. In this role, you will investigate and resolve homeowner claims, primarily conducting both field and virtual inspections. An ideal candidate should possess a bachelor's degree...Claims
$26.66 per hour
...PTO accrual beginning Day 1 Note: Benefits may vary based upon position type and or level. Job Summary The Physician Compliance Auditor II audits and evaluates compliance activities to ensure documentation meets standards. Establishes audit scope, uses tools,...Work experience placementImmediate startRemote work$26.66 - $40 per hour
Baylor Scott & White Health in Oklahoma City is hiring a Physician Compliance Auditor II for a 100% remote role. The position requires advanced knowledge of CPT, ICD-10, and HCPCS coding standards, along with at least four years of auditing experience. Key responsibilities...Remote job$46.99k - $122.4k
...complex cases involving behavioral health or multi-disciplinary provider groups in a prepayment environment Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc. Researches and prepares cases for clinical and legal...ClaimsHourly payFull timeTemporary workLocal area$46.99k - $122.4k
The Hispanic Alliance for Career Enhancement is seeking a Health Care Fraud Investigator to manage complex cases and aid in preventing fraudulent claims. The role demands 3 years of experience in health care fraud investigations, familiarity with comprehensive coding standards...ClaimsFull time$51.44k - $66.13k
Affirmative Civil Enforcement (ACE) Investigator Employment Type: Full-Time, Department: Legal Services Responsibilities: Generate new investigations... ...of large‑scale hard‑copy and electronic data (healthcare claims, financial transactions, accounting records, bank records) to...ClaimsFull timeWork at officeLocal areaFlexible hours$43.89k - $76.5k
...family and one community at a time. Position Summary The Special Investigations Unit (SIU) Investigator is responsible for thoroughly... ...federal and state requirements, as well as payer billing and claims guidelines. Communicate case outcomes to healthcare providers...ClaimsHourly payFull timeTemporary workLocal area- ...Group, founded in 2005, is a leading provider of risk mitigation solutions. We specialize in workers' compensation investigations , surveillance, and claims support for clients across multiple industries. About The Role Work from your home office while conducting field...ClaimsPart timeWork from homeHome office
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