Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

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

Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Claims Audit & Fraud Investigator in Boston, MA vacancy
  •  ...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... 
    Suggested
    Full time
    Work from home
    Flexible hours
    3 days per week

    RLD Associates, Inc.

    Boston, MA
    10 days ago
  • 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

    Santander US

    Boston, MA
    2 days ago
  •  ...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... 
    Claims
    Temporary work

    Alan Gray LLC

    Boston, MA
    18 days ago
  •  ...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... 
    Claims
    Hourly pay
    Remote work
    Flexible hours

    Careforth

    Boston, MA
    3 days ago
  •  ...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... 
    Claims
    Full time
    Remote work
    Flexible hours

    Compre Group

    Boston, MA
    1 day ago
  • 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... 
    Claims
    Work experience placement

    Qlarant

    Boston, MA
    4 days ago
  • $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

    Starr Adjustment Services, Inc.

    Boston, MA
    2 days ago
  • $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... 
    Claims
    Full time
    Work experience placement
    Immediate start
    Remote work
    Work from home
    Flexible hours

    First Help Financial

    Needham Heights, MA
    20 hours ago
  •  .... 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... 
    Claims
    Remote job

    Zelis Healthcare Inc.

    Boston, MA
    4 days ago
  • 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

    Starr Adjustment Services, Inc.

    Boston, MA
    2 days ago
  •  ...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

    Hispanic Alliance for Career Enhancement

    Boston, MA
    2 days ago
  •  ...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... 
    Claims
    Remote job
    Full time

    Zelis Healthcare Inc.

    Boston, MA
    4 days ago
  • 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

    EmergencyMD

    Cambridge, MA
    2 days ago
  •  ...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... 
    Claims
    Contract work
    Fixed term contract
    Work experience placement

    East Boston Neighborhood Health Center

    East Boston, MA
    23 days ago
  •  ...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

    MileHigh Adjusters Houston

    Boston, MA
    1 day ago
  •  ...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

    ONE80 INTERMEDIARIES INC

    Boston, MA
    4 days ago
  •  ...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... 
    Claims
    Work at office
    Local area

    MPIUA

    Boston, MA
    2 days ago
  •  ...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... 
    Claims
    Local area

    Unispace

    Boston, MA
    1 day ago
  •  ...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

    GovernmentJobs.com

    Boston, MA
    4 days ago
  •  ...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... 
    Claims
    Contract work

    Lendbuzz

    Boston, MA
    2 days ago
  •  ...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... 
    Claims
    Flexible hours

    J T Becker & Co Inc

    Boston, MA
    15 days ago
  •  ...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

    Lendbuzz

    Boston, MA
    20 hours ago
  • $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... 
    Claims
    Remote work

    Servier Group

    Boston, MA
    1 day ago
  •  ...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... 
    Claims
    Flexible hours

    MileHigh Adjusters Houston

    Medford, MA
    1 day ago
  •  ...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... 
    Claims
    Flexible hours

    MileHigh Adjusters Houston

    Cambridge, MA
    1 day ago
  •  ...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... 
    Claims
    Flexible hours

    MileHigh Adjusters Houston

    Revere, MA
    1 day ago
  •  ...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... 
    Claims
    Flexible hours

    MileHigh Adjusters Houston

    Boston, MA
    1 day ago
  • $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... 
    Claims
    Full time
    Work experience placement
    Work at office
    Local area
    Remote work

    Liberty Mutual Insurance

    Boston, MA
    1 day ago
  •  ...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... 
    Claims
    For subcontractor

    AmeriTech Contracting LLC

    Chelsea, MA
    2 days ago
  • $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... 
    Claims
    Full time
    Part time
    Work experience placement

    Commonwealth of Massachusetts

    Boston, MA
    1 day ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Claims Audit & Fraud Investigator. Be the first to apply!