Auditor/Investigator II jobs in United States
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Qlarant · 3 weeks ago

Auditor/Investigator II

positionUnited States
timeFull-time
remoteRemote
seniorityMid, Senior Level
money$56K/yr - $84K/yr
date2+ years exp

Qlarant is a not-for-profit corporation that partners with public and private sectors to deliver high quality health care and human services programs. The Auditor/Investigator II role involves monitoring the processing of electronic medical records and supporting the research of prepay and post-pay record questions.

Information ServicesInformation Technology

Responsibilities

Monitors QMS procedures, work instructions, and job aids. Provides first level review for changes
Supports problem-solving solutions for system issues
Provides expertise for implementing, deactivation, monitoring, quality assurance, and reporting of prepay edits
Facilitates meetings and coordinates presentations
Tracks and analyzes data and reports for prepay committee edit effectiveness; creates presentations
Assigns incoming and outgoing external contractor communications; monitors completion of requests
Researches prepay and post-pay record questions. Reports quality assurance for appeal requests, recalculations, and redeterminations
Schedules coordination of ad hoc calls with external contractors or law enforcement; takes minutes
Reviews and comments on Medicare JOAs
Creates templates and content for the external contractor annual fraud and abuse training

Qualification

Medicaid investigationsManaged Care auditingCertified Fraud ExaminerData analysisProblem-solvingPresentation skillsCommunication skills

Required

Minimum Bachelor's Degree required
2 - 4 years of experience required
Prior experience in Medicaid investigations or either working with a Managed Care Plan/Organization or auditing the Managed Care Plan/Organization is highly desired

Preferred

5 - 7 years preferred
Certified Fraud Examiner preferred

Company

Qlarant

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Qlarant is a not-for-profit, nationally respected in fighting fraud, waste, and abuse—improving program quality, and optimizing performance.
dateFounded in 1973
location
Easton, Maryland, USA
people-size501-1000 employees
web-link
https://www.qlarant.com/

Funding

Current Stage
Late Stage

Leadership Team

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Christine Leister
Chief Financial Officer
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Recent News

Qlarant
Will Mapp Graduates from Leadership Maryland’s Executive Program
2025-12-04
PR Newswire
Qlarant Selected as Agile4Vets Team Member
2025-09-17
Qlarant Foundation
Qlarant Foundation Launches Strategic Partnership with Catchafire to Support Nonprofit Growth
2025-07-15
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