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
- ...reporting aimed at identifying fraudulent, wasteful, or abusive claim submissions. The role includes preliminary research of... ...concise reports. The ideal candidate will have 5-7 years of FWA investigation experience, strong data analysis skills, and the ability to translate...Claims
- Jobtailor in Boston, MA is hiring an investigator to conduct complex criminal and civil investigations into Medicaid fraud and abuse. You will review complaints, access Medicaid claims, and develop investigative plans. The role requires strong analytical and communication...Claims
- ...at identifying potential fraudulent, wasteful, or abusive claim submissions. In addition to performing analytics, the... ...Essential Functions Responsible for conducting confidential investigations of suspected fraud, waste & abuse (FWA) involving medical providers, plan...ClaimsContract workWork at officeLocal areaFlexible hours
$40 - $60 per hour
Alan Gray Inc. is seeking a Claims Auditor Property in Boston, MA. This temporary position requires expertise in property claim handling and involves auditing claim files for best practices. The ideal candidate will have a minimum of 5 years of insurance claim experience...ClaimsHourly payTemporary work- PaymentWorks is hiring an Analyst for our Fraud Operations team. The Fraud Operations Analyst plays a key role in identifying, investigating, and preventing fraudulent activity in... ...ensure full visibility and compliance with audit standards Consistently meet time-sensitive...SuggestedFlexible hours
- 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
- ...Health Plan Holding Company, Inc. is seeking a Data Analyst to conduct confidential investigations of suspected fraud, waste and abuse, and to perform analytic reporting across claims and provider data. Hybrid role with on-site presence at Assembly Row, Somerville roughly...Claims
$40 - $60 per hour
...or an alternative application process. Claims Auditor Property (Temporary/Project Based... ...0.00 Hourly Alan Gray LLC is a leading audit and advisory firm with over 30 years of... ...the files under review. Key Objectives: Investigative and evaluate property claims, including...ClaimsHourly payTemporary work$85k - $100k
...Intercare, InterMed, George Hills, and AS&G Claims Administration, we are a people-focused,... ...review balance-sheet reconciliations; investigate and clear variances rather than carrying... ...documentation for the annual external audit; serve as a primary point of contact for...ClaimsFull timeRemote work- 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
- .... 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...ClaimsRemote work
$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- Role, Inc. is seeking a Fraud Prevention Specialist to monitor and investigate fraud activities in Natick, MA. Responsibilities include analyzing fraud claims and maintaining investigations while ensuring compliance with bank policies. The ideal candidate will have a Bachelor...Claims
- ...based role. You will enter charges, demographics, and insurance details with precision to ensure clean claims and fast submission. The job emphasizes HIPAA compliance, audit-ready records, and collaboration with the Revenue Cycle team. Ideal candidates have high attention...ClaimsRemote work
- A government service provider seeks a Senior Auditor in Boston to perform financial analysis and investigations for claims and settlements. The role requires a minimum of 5 years of experience in forensic accounting or litigation consulting. Responsibilities include analyzing...Claims
- ...Specialist. Position Summary This role focuses exclusively on claim submission, denial management, and accounts receivable follow-up... ...team on claim corrections Maintain clean system notes and audit trail 30-60-90 Day Plan 30–60–90 Day Success Plan – First...ClaimsRemote work
- ...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
- ...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
$29 - $52 per hour
...a Compliance Auditor for a remote position based in Massachusetts. You will be responsible for reviewing healthcare claims to identify potential fraud and abuse, collaborating with other auditors, and documenting your findings in our systems. The role requires a High...ClaimsRemote jobHourly pay- ...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
- ...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
- ...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
- ...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
- ...assist the district legal staff by conducting medical claims data analysis, forensic investigations, financial damages, statistical sampling, and ability‑... ...accounting, litigation consulting, and/or health care fraud analysis. Resume must demonstrate clear understanding...ClaimsFull timeFlexible hours
- ...protection, Bank Secrecy Act and anti-money laundering requirements. Have familiarity with the proper oversight, training, monitoring and auditing of a financial company's compliance management system. Have strong analytical, multi-tasking, writing, and communication skills....
$100k - $130k
...products prepared by third parties. Prepares amended returns, claims for refunds and applications for abatement as needed to determine the proper tax liability. Conducts and participates in audits of a client's tax return(s) with federal and state tax authorities...ClaimsWork at officeLocal areaFlexible hoursShift work- ...Interpersonal Skills. Experience & Education All candidates must complete the 2026 Statewide Police Lieutenant Promotional Examination E&E Claim application online. The E&E claim requires evidence of relevant experience and education; submission through the online claim...ClaimsPermanent employmentLocal area
- ...insurance operating companies, globally. We collaborate with Finance, Claims, Operations, Marketing and Risk Management, among other... ...process, support and be the point person for Actuarial for the annual audit reviews, independent reserve reviews, internal audit and SOX...ClaimsLocal area
$120k - $160k
...Position Profile Weaver is seeking an experienced and motivated Audit Manager to join our Banking and Insurance practice within the Financial... ...: Loss reserves (including IBNR), premium revenue recognition, claims processing and liabilities, reinsurance, and policy liabilities...ClaimsFlexible hours- ...contractual and regulatory compliance, analyzing claims and incident trends. This role is part... ...and Legal departments during claim investigations, providing timely documentation,... ...Safety workshops. Ongoing Compliance & Audit Oversight • Partner with field operations...ClaimsWork at officeRemote work2 days per week
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