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. Assisting with further investigation and/or reports to state regulators...ClaimsHourly payFull timeTemporary workLocal areaMonday 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$46.66k
...This position is located in Oklahoma City, Oklahoma. Background Investigator I/II/III Annual Salary: Level I C44A - $43,410.00 + Full State Employee Benefits Level II C44B - $46,664.80 + Full State Employee Benefits Level III C44C- $51,331.28 + Full State Employee Benefits...SuggestedWork at officeLocal area- CVS Health is seeking a Program Integrity Auditor to review medical, behavioral, transportation, and other provider records to ensure proper... ...is required to qualify. Qualifications include 3-5 years in claims review and coding (CPT/HCPCS/ICD-10), associate degree or equivalent...Claims
- ...culture. Our Enterprise Data & Analytics, Claims Analytics, and Technology teams are... ...scalable data models, data structures, and data integrations Work with modern cloud platforms... ...and a passion for learning Data Engineer II (up to 5+ years) Own development of pipelines...ClaimsRemote jobPermanent employmentFull timeTemporary workWork from homeFlexible hours
- Oklahoma Farm Bureau Insurance Company seeks a claims professional to investigate out-of-state claims, gather necessary information, and evaluate losses to expedite settlements. The role involves obtaining statements, reviewing coverage, setting reserves, and coordinating...ClaimsWork at office
- ...Career Enhancement is seeking a Sr. Analyst, Fraud, Waste, and Abuse in Massachusetts. The role involves analyzing claims data to identify and investigate fraud. Responsibilities include collaborating with various stakeholders to ensure compliance with regulatory standards...ClaimsFull timeWork experience placement
- 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 insurance...ClaimsWork at office2 days per week3 days per week
$22 - $25 per hour
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 insurance claim investigation. As a global leader,...ClaimsWork experience placement$21 - $25 per hour
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 insurance claim investigation. As a global leader,...ClaimsFull timePart timeWork at officeLocal area$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... ...regulatory standards, and procedures to investigate, evaluate and settle moderate Homeowner's...ClaimsSeasonal workLocal areaFlexible hours$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$85.39k - $116.98k
...Developer (Angular/NodeJS) - II Location: Remote Department... ...EDI healthcare records Integrate with internal platform APIs,... ...Interchange X.12 (EDI) Medical Claims ~ X.12 medical claims (837,... ...to a government security investigation and must meet eligibility requirements...ClaimsFull timeRemote work$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- ...risk, complex audits; assist external auditors and state and federal examiners and provide... .... Perform specialized and complex investigations as requested by management. Including the... ...player and positive attitude Demonstrate integrity and ethics in handling confidential...
- ...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
- Oklahoma Farm Bureau Insurance is seeking an experienced claims adjuster to investigate out-of-state claims, gather statements and reports, and determine coverage and loss liability. The role involves setting reserves, preparing summaries, and settling within authority...ClaimsWork at office
- Globe Life is looking for a Contestable Analyst to review and process contestable life claims. This role involves investigating claims, contacting various third parties for information, and maintaining production quotas. Candidates must be detail-oriented and proficient...Claims
$76.83k - $142.21k
Mercury Insurance Company is seeking a Property Claims Field Adjuster II in Oklahoma City to investigate and resolve property claims. This position requires strong customer service skills and the ability to manage claims efficiently. Ideal candidates should have a bachelor...ClaimsRemote job$76.83k - $142.21k
Mercury Insurance Services, LLC is seeking a Property Claims Field Adjuster II to join their team in Oklahoma City. In this role, you will investigate and resolve homeowner claims while providing excellent customer service. This position requires field inspections and...ClaimsRemote jobFlexible hours- Love's Travel Stops is seeking a Human Resources Representative II based at their corporate office in Oklahoma City. In this role, you... ...employees and managers with inquiries, managing unemployment claims, and ensuring compliance with legal standards. The ideal candidate...ClaimsWork at office
- 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 jobWork from homeFlexible hours
- Mercury Insurance is seeking a Property Claims Field Adjuster II in Oklahoma City to assist homeowners with claims after damage events. The candidate will perform field inspections and utilize virtual technology to provide great service. The ideal candidate should have...ClaimsRemote jobFlexible hours
$87.5k
...Brief summary of purpose: The SIU Code Auditor will conduct coding audits of medical records... ...as the company's designated Special Investigation Unit (SIU) for fraud, waste, and abuse (... ...education, and regulatory support: Assist with claim denial reporting, respond to regulatory...ClaimsLocal area- 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
- ...retirement accounts Employee Referral Bonus Program Essential Job Duties Conduct pre‑pay and post‑pay audits to ensure accurate claims payments and denials Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of claims...ClaimsRemote jobFull timeTemporary workWork at officeLocal area2 days per week3 days per week
- Mercury Insurance Company is seeking a Property Claims Field Adjuster II in the United States with a focus on homeowners claims. After training... ...You'll apply company policies and regulatory standards to investigate, evaluate, and settle moderate homeowner claims promptly,...ClaimsRemote job
- ...Administrative Assistant II Positions in this job family are assigned responsibilities for providing administrative support to program... ...functions, such as preparing invoices and payments of claims, requisitions, purchase orders, bookkeeping or accounting, and other...ClaimsWork at office
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