Claims Audit & Fraud Investigator
Qlarant
Qlarant is looking for a dedicated professional to conduct audits and investigations into claims integrity in Missouri. The role involves analyzing data, addressing customer concerns, and communicating findings to various stakeholders. The ideal candidate will have a Bachelor's degree, experience in audits/investigations, and a strong focus on preventing fraud within claims processes. Certification as a Fraud Examiner is preferred. #J-18808-Ljbffr Qlarant
$43.89k - $76.5k
...CVSHealth is seeking an Investigator to conduct high-level investigations into healthcare fraud and abuse. The ideal candidate will have over 3 years of investigative... ...Louisiana. Responsibilities include analyzing claims data, collaborating with law enforcement, and preparing...Claims- 4004 Aetna Medicaid Administrators is looking for an Investigator to conduct high-level investigations into healthcare fraud and abuse. This role involves preventing payment of dubious claims and collaborating with stakeholders on clinical issues. Ideal candidates should...Claims
- ...timely and accurate submission of primary, secondary or other claim types to the appropriate payer source. Prepares billing reports... ...affecting billing, collections, customer service, refunds and auditing processes are communicated timely. Two (2) years’ experience in...ClaimsFull time
- 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
- ...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
$46.99k - $122.4k
...The Hispanic Alliance for Career Enhancement is seeking a dedicated investigator for healthcare fraud cases based in Missouri, Louisiana. The role requires extensive knowledge of healthcare fraud prevention and the ability to interact effectively with various stakeholders...$118.69k - $189.91k
...Lead in ensuring Financial granular detail data is appropriately auditable, snapshotted, and stored for quarterly and year end audits.... ...experience. (Highly preferred) 5+ years' experience with medical claims, Pharmacy/medical rebate data. (Highly preferred) Facets...Claims$46.99k - $122.4k
...groups in a prepayment environment Investigates to prevent payment of fraudulent claims committed by insured's, providers,... ...of company lost as a result of fraud matters. Assists team in identifying... ...waste, and abuse investigatory and audits required. Knowledge of CPT/HCPCS/...ClaimsHourly payFull timeTemporary workLocal area$50k - $70k
...Manage customer accounts and update information in the database. Assist customers with policy changes and inquiries. Process insurance claims and follow up with customers on claim status. Coordinate with underwriters to ensure timely policy issuance. Qualifications Strong...ClaimsFull timeFor contractorsLocal areaFlexible hours$46.99k - $112.2k
...Career Enhancement in Louisiana is looking for a Senior Investigator to conduct investigations of healthcare fraud and abuse. This role requires 3+ years of... ...Responsibilities include investigating Medicaid fraud claims, documenting case activities, and collaborating with...ClaimsWork at office$118.69k - $189.91k
...Ideation Lead - Drives the creation of new audit concepts, data models, and reimbursement... .... They leverage AI, vendor intelligence, claims data, and policy analysis to generate new... .... $118,691.00 - $189,906.00 JOB ALERT FRAUD: We have become aware of scams from individuals...ClaimsContract workWork at officeLocal areaRemote workFlexible hoursShift work2 days per week$55k - $68k
...Manage customer accounts and update information in the database. Assist customers with policy changes and inquiries. Process insurance claims and follow up with customers on claim status. Coordinate with underwriters to ensure timely policy issuance. Qualifications Strong...ClaimsFull timeFor contractorsFlexible hours- ...leading Third-Party Administrator (TPA) specializing in innovative claims management solutions. At CRS, we believe in doing things... ...the insured, claimants, and internal staff in a timely manner. Investigates, evaluates, and resolves lost time Workers’ Compensation...Claims
$46.99k - $112.2k
Position Summary As a Senior Investigator you will conduct high‑level, complex investigations... ...of known or suspected acts of healthcare fraud and abuse. You will routinely handle... ...Investigate to prevent payment of fraudulent claims submitted to the Medicaid lines of...ClaimsFull timeTemporary workWork at officeLocal area- ## Workers' Compensation Claims Specialist**Job Description:**Creative Risk Solutions (CRS), a proud line of business under the Holmes... ...insured, claimants, and internal staff in a timely manner.* Investigates, evaluates, and resolves lost time Workers’ Compensation...ClaimsFull time
- J T Becker & Co Inc is looking for skilled Field Investigators to join our team in Louisiana, Missouri, on an 'as needed' basis. This role... ...providing expert investigative services, focusing on insurance claims including workers' compensation and liability. Ideal...Flexible hours
- J T Becker & Co Inc is looking for skilled Field Investigators in Louisiana, MO. This role offers flexible hours for licensed investigators to conduct various insurance claim investigations, including surveillance and SIU assignments. The ideal candidate will have experience...Flexible hours
- J T Becker & Co Inc is looking for skilled Field Investigators to join their team in Louisiana, Missouri. This position offers flexible... ...expert investigative services in various insurance claims, including fraud and liability. The ideal candidate will conduct investigations...Flexible hours
- J T Becker & Co Inc is hiring Field Investigators for an as-needed role. This position offers flexible hours for licensed investigators providing expert services in various insurance claims including fraud and liability. The ideal candidate will conduct surveillance and...Flexible hours
- Project Duration: 06/29/2026 – 09/11/2026 Classification: Chief Inspector Project Overview: Involves excavation, pile driving, and pouring of multiple foundations. Work will overlap significantly with activities at adjacent project, requiring a Chief I level inspector ...
- A leading Third-Party Administrator is seeking a Workers’ Compensation Claims Specialist in Louisiana, requiring 3-5 years of related claims handling experience. Responsibilities include managing claims, entering information on systems, and resolving issues between insured...Claims
- Ahhmgt is seeking a Billing Specialist in DeQuincy, LA. The role involves the timely submission of various claims and preparing reports for leadership. Candidates should have two years of experience in insurance billing, preferably in Medicare or Medicaid. The ideal applicant...ClaimsFull time
- A leading claims solutions provider is looking for Independent Adjusters to evaluate exterior and minor interior property damage. Responsibilities include drafting detailed damage descriptions and using Xactanalysis software. Candidates should hold a current Xactimate...ClaimsFlexible hours
- ...designing and managing a provider education program aimed at addressing billing inconsistencies. Responsibilities include analyzing claims data, drafting provider education letters, and assessing changes in provider behavior. Candidates should have a bachelor's degree...Claims
$50k - $100k
...Filing lawsuits Drafting and answering discovery Preparing clients for depositions, mediations, motion hearings, and trials Evaluating claims with claims representatives Collaborating with paralegals and legal secretaries to propound and respond to written discovery, order...ClaimsFull timeLocal areaShift work- ...Professional focused on supporting neurovascular neurosurgery. This full-time position entails accurate medical coding and billing, timely claims submission, and collaboration with healthcare professionals. Ideal candidates will have a medical coding certification, experience...ClaimsFull time
- Practical Adult Insights in Louisiana, MO, seeks a catastrophe adjuster to inspect property damage from disasters like earthquakes and floods. Responsibilities include evaluating damage and communicating findings to policyholders. A high-school diploma, state license, and...Claims
- ...insurance provider is seeking a temporary Workers' Compensation Claims Adjuster to manage complex claims across the United States.... ...indemnity claims, negotiating settlements, and ensuring prompt investigations. Candidates should possess a Bachelor's degree and at least two...ClaimsRemote jobTemporary work
- ACCIONA is seeking a Prime Contracts Administrator in Lake Charles, LA, committed to managing contractual claims and providing support on commercial functions. The candidate should possess a bachelor's degree with over 5 years of experience in commercial management within...ClaimsRelocation
$40k - $60k
...service. Service can include responding to inquiries regarding insurance availability, eligibility, coverages, policy changes, transfers, claim submissions, and billing clarification. Use a customer-focused, needs-based review process to educate customers about insurance...ClaimsFull timeFor contractors
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