Claims Audit & Fraud Investigator
Qlarant
Qlarant is seeking a professional to ensure the integrity of claims processes by conducting audits and investigations into customer claims. This role requires a blend of analytical skills and attention to detail, as you will collect data, interview stakeholders, and provide recommendations for claim resolution. The ideal candidate will have a Bachelor's degree and two to four years of relevant experience. A Certified Fraud Examiner designation is preferred. The position emphasizes communication skills and compliance with legal standards. #J-18808-Ljbffr Qlarant
- ...auditor. As a premium auditor, you will work independently in the field, meeting with various businesses to conduct insurance premium audits. The purpose of a premium audit is to review accounting records and conduct a thorough interview to validate the assignment of the...SuggestedFull timeWork from homeFlexible hours3 days per week
- Santander US is looking for a Manager, Claims & Fraud Operations to lead investigative teams focused on mitigating fraud-related losses. This role requires strong operational oversight and collaboration with law enforcement to ensure compliance and efficiency in fraud prevention...Claims
- ...Description Alan Gray LLC is a leading audit and advisory firm with over 30 years of... ...to support projects and engagements. Claims Auditor: The claim auditor will review... ...files under review. Key Objectives: Investigative and evaluate property claims, including...ClaimsTemporary work
- ...will handle all functions related to the collection of necessary claim documentation, claim submission, collections, and follow‑through... ...with payers to resolve outstanding claims issues as needed. Audit file submissions and work through any variances, collaborate with...ClaimsHourly payRemote workFlexible hours
- ...support day‑to‑day cash operations and claims‑related financial processes within a specialty... .... Perform bank reconciliations and investigate discrepancies across banking and accounting... ...activities, including 1099 processing, audits, and internal controls. Process accounts...ClaimsFull timeRemote workFlexible hours
- Job Summary Ensures the integrity and accuracy of claims processes and protocols. Collects data for audits/investigations into claims, utilizing a combination of... ...and closure. Identifies opportunities to target fraud, waste, and abuse or discrepancies in claims submissions...ClaimsWork experience placement
$250k
...Providing management oversight to Third Party Administrators DBA claims personnel by monitoring claims online using the Third Party... ...and Third Party Administrator’s claim personnel. Assisting with audits of Third Party Administrators. Interfacing with underwriting on...Claims$60k
...Insurance team, with a focus on Total Loss Claims and Lienholder-Initiated Damage Claims.... ..., expertise in claims handling and auditing, and the ability to build effective relationships... ...trends and areas for improvement Investigations & Problem Resolution Conduct in-depth...ClaimsFull timeWork experience placementImmediate startRemote workWork from homeFlexible hours- .... Responsibilities include performing comprehensive DRG validation and readmission reviews while documenting findings and managing claims. An excellent compensation package and benefits are provided, underscoring our commitment to employee well-being. #J-18808-Ljbffr Zelis...ClaimsRemote job
- Starr Adjustment Services, Inc. is seeking an experienced claims manager to oversee Third Party Administrators and ensure excellent claims... ...managing relationships, reviewing claims, and participating in audits at various locations including Boston and others. The ideal...Claims
- ...Career Enhancement in Boston is seeking a dedicated professional to excel in Medicare and Medicaid High Dollar claim processing. The role emphasizes quality audits and a commitment to exceeding client expectations in a hybrid work environment. Qualified applicants will...Claims
- ...firm in Boston is seeking a Quality Assurance Specialist to perform inpatient DRG validation audits. The role requires at least 5 years of experience in reviewing ICD-10 claims and an understanding of coding standards. Responsibilities include conducting quality assurance...ClaimsRemote jobFull time
- EmergencyMD is seeking an Experienced Field Investigator to perform surveillance and investigative activities focused on identifying potential fraudulent insurance claims. This role involves both stationary and mobile surveillance, obtaining high-quality video evidence...Claims
- ...a focus on contract pharmacy management through 340B ESP, 340B audit preparation, wholesaler drug pricing file accuracy, and ongoing... ...setup, registration, and ongoing compliance monitoring. Validate claims data submitted through TPAs and resolve data mismatches or...ClaimsContract workFixed term contractWork experience placement
- ...A leading claims adjustment company seeks Independent Insurance Claims Adjusters in Boston, MA. This position offers a rewarding career path where you support individuals and businesses in recovery from disasters. Training programs are available to help professionals...Claims
- ...ONE80 INTERMEDIARIES INC is looking for a Claims Analyst based in New Hampshire. This role involves reviewing, analyzing, and processing insurance claims to ensure compliance and timely resolutions. The ideal candidate will have a Bachelor's degree in Business Administration...Claims
- ...looking for an Examiner II to join our Claims department. This position reports to the... ...standards, insurance policies, property claims investigative techniques, building loss estimating... ...semi‑annual Claims Department Reserve Audit. All other duties and projects as assigned...ClaimsWork at officeLocal area
- ...Assisting Corporate Controller with the annual audit and 401k audit Supporting Corporate... ...Liasing with banks for account management, fraud queries, compliance regulations and other... ...payments for suppliers, employee claims and as directed. Reporting: delivery of month...ClaimsLocal area
- ...Pittsfield Police Lieutenant Online Experience & Education (E&E) Claim This is the online Experience & Education (E&E) claim for the... ...can be claimed once you submit your online E&E claim. Claim Audits: After submission of your E&E claim AND during the life of the resulting...Claims
- ...deficit projections. Premium Management: Calculate accurate premium payments across multiple insurance channels. Audit & Reporting: Monthly audit of claim payments to ensure accuracy and reporting consistency. Primary Insurance Trends: Analyze total loss payback...ClaimsContract work
- ...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
- ...legal requests, controls testing, and audits. The ideal candidate will possess strong... ...complaints, including conducting thorough investigations, gathering all necessary documentation,... ...been made aware of individuals falsely claiming to represent Lendbuzz using lookalike...Claims
$190k - $218.67k
...trial usage (ATU), promotional effectiveness, segmentation, chart audits, target product profile (TPP) development). Develop actionable... ...Working with pharmaceutical data sources (e.g., prescriptions, sales, claims). Three years of experience: Managing multiple projects and...ClaimsRemote work- ...A leading claims adjusting firm in Massachusetts is seeking Independent Insurance Claims Adjusters to join their team. This role offers flexibility and autonomy while making a significant impact in helping clients recover from disasters. Newcomers and experienced adjusters...ClaimsFlexible hours
- ...A growing claims adjustment company seeks Independent Insurance Claims Adjusters to join their team. This role involves helping individuals and businesses recover from disasters while providing opportunities for training and professional development. Ideal candidates...ClaimsFlexible hours
- ...A leading insurance claims firm located in Revere, Massachusetts is seeking Independent Insurance Claims Adjusters. This position offers a dynamic career with flexibility, autonomy, and the opportunity to make a significant impact in the lives of others. The ideal candidate...ClaimsFlexible hours
- ...A leading claims adjusting organization in Boston is looking for Independent Insurance Claims Adjusters to join their team. This opportunity offers flexible work hours and the chance to make a significant impact by helping clients recover from disasters. Suitable candidates...ClaimsFlexible hours
$61k - $113k
...Full-Time Salary Range: USD $61000.00 - $113000.00 Job Category: Claims Description At Liberty, you'll thrive in a hybrid setting that... ...caseload of routine to moderately complex claims from the investigation of the claim through resolution. This includes making decisions...ClaimsFull timeWork experience placementWork at officeLocal areaRemote work- ...throughout the project, conduct inspections, perform audits, conduct safety training, investigate accidents and incidents, and help advance the Safety Culture... ...and reporting (accidents, injuries, third‑party claims, utility incidents, field audits, etc.). Coordinate company...ClaimsFor subcontractor
$69.6k - $99.53k
...Operations Division. This includes making decisions on abatement claims, resolving disputes, and working with taxpayers on problem... ...or equivalent part‑time professional experience in accounting, auditing, or tax examining work, or any equivalent combination of the required...ClaimsFull timePart timeWork experience placement
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Claims Audit & Fraud Investigator. Be the first to apply!
- fraud investigator Boston, MA
- bank fraud investigator Boston, MA
- claims attorney Boston, MA
- claims associate Boston, MA
- claims counsel Boston, MA
- medical claims auditor Boston, MA
- vice president claims Boston, MA
- work from home fraud jobs Boston, MA
- fraud associate Boston, MA
- product manager fraud Boston, MA



