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
- ...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
$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... ..., and abuse investigatory and audits required. Knowledge of CPT/HCPCS/...ClaimsHourly payFull timeTemporary workLocal area- 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
$26.2 - $38.5 per hour
...comprehensive estimate of damages for 1st and 3rd party material damage claims leading to the proper disposition. This is a Field position for... ...Possesses strong estimating fundamentals in order to create or audit estimates of damages on 1st and 3rd party material damage losses...ClaimsHourly payWork at officeWork from homeVisa sponsorshipWork visa- ...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...- ...collections, and accounts receivable functions Monitor and resolve claim denials, coding issues, and reimbursement discrepancies Analyze... ..., reimbursement methodologies, and payer requirements Oversee audits, documentation standards, and revenue integrity processes...ClaimsFull timeWork at officeMonday to Friday
- ...Minimum Qualifications Three years of experience in accounting, auditing, banking, compliance management, financial operations, or... ...Accountant (CPA) license, Certified Financial Examiner (CFE), Certified Fraud Examiner (CFE), or Certified Internal Auditor (CIA) designation...Full timeWork experience placementWork at office
$46.99k - $122.4k
...validating deliverables to ensure outputs are complete, accurate, and audit‑ready. The role partners closely with internal and external... ...environments Experience working with medical and/or pharmacy claims data Education Bachelor's degree or equivalent experience Job...ClaimsRemote jobFull timeLocal area$40k
...Our team is essential to our success. Full‑time Role specifics: Claims Background - Workers compensation lost‑time claims with 1‑3... ...Full‑time The Oncology Claims Analyst 1 will coordinate coding audits and educational functions for FMOLHS and the Oncology Service Line...ClaimsHourly payFull timeImmediate start$43.89k - $102.08k
...reporting inventories Escalate missing information or delays Audit & Control Responsibilities Maintain documentation according to... ...environments preferred Experience working with medical and/or pharmacy claims data preferred Education Bachelor’s degree or equivalent...ClaimsRemote jobHourly payFull timeTemporary workLocal area- ...requirements of the statutes. Position Overview The Compliance Investigator 1-3 position is responsible for independently investigating... ...Natchitoches Experience Three years of experience in accounting, auditing, administrative services, building inspection, real estate...Full timeContract workFor contractorsWork experience placementFor subcontractorLocal area
$43.3k - $79.31k
...implementation and operation of the Diversion Control Program. Conducts investigative research via the Internet and public record databases.... ...data on a monthly basis, as directed. Assists with DC pre-audit preparation and interviews with state and federal regulators....Full timeWork at officeLocal area$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- Great American Insurance Group is seeking a part-time Crop Adjuster in Louisiana to manage claims for various crops. Responsibilities include field inspections, evaluating coverage, and ensuring compliance with regulations. The role demands proficiency in claims handling...ClaimsPart timeSeasonal work
$46.99k - $112.2k
The Hispanic Alliance for Career Enhancement is hiring a Sr. Analyst for Fraud, Waste, and Abuse in Missouri. This role involves detecting and investigating fraud cases within healthcare services and ensuring compliance with regulatory standards. Candidates should have...Claims$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- ...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
$100k - $231.54k
...development of scalable data pipelines and reporting frameworks using claims, encounters, pharmacy, and clinical data Lead advanced... ...revenue projections, and state payments Ensure readiness for state audits and external reviews through robust data validation and...ClaimsHourly payFull timeTemporary workLocal area$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
- 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
- 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
- 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
- Holmes Murphy is hiring a Workers’ Compensation Claims Specialist to join Creative Risk Solutions (CRS). The role focuses on handling WC claims across jurisdictions, with licensing required or obtainable within three months. You’ll work in a collaborative environment that...Claims
- Sedgwick Claims Management Services Ltd is seeking a Claims Team Lead for its Auto | Complex Bodily Injury division. The role involves supervising teams of examiners, ensuring compliance with audit requirements, and providing technical direction on claims. Strong leadership...Claims
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