Top 6 Fraud remote Jobs in North Dakota

Auditor/Investigator I
Qlarant —North Dakota
- $47,911 - $71,508 a year
- Full-time
- Remote
- Analysis skills
- Bachelor's degree
- Entry level
Quick Apply
Auditor/Investigator II
Qlarant —North Dakota
- $57,512 - $85,839 a year
- Full-time
- Remote
- Mid-level
- Analysis skills
- Bachelor's degree
Quick Apply
Senior Investigator, Special Investigations Unit (Aetna SIU)
CVS Health —North Dakota
- $46,988 - $112,200 a year
- Full-time
- Remote
- Mid-level
- 3 years
- Analysis skills
- Health insurance
- Dental insurance
Certified Professional Coder, Special Investigations Unit (Aetna SIU)
CVS Health —North Dakota
- $43,888 - $93,574 a year
- Full-time
- Remote
- Microsoft Excel
- Research
- Mid-level
- Health insurance
- Dental insurance
11d
Compliance UM Nurse (Wed - Sun)
Humana —North Dakota
- $71,100 - $97,800 a year
- Overtime
- Remote
- Microsoft Word
- Nursing
- Microsoft Excel
- Paid parental leave
- Paid holidays
4d

More jobs to discover

Find similar jobs that you might be interested in.

Auditor/Investigator II
Qlarant —North Dakota
Plans and arranges own work; works with manager to prioritize projects. Applies functional knowledge to create and implement strategies to identify and prevent…
$57,512 - $85,839 a year
Quick Apply

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Compliance Manager
Mission Lane —Columbus, OH
You can hold your own in a conversation about AI-driven collections models or evolving contacting strategies. Professional certification: CRCM and/or CAMS.
$129,000 - $140,000 a year

I want to receive the latest job alert for fraud remote in north dakota

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

fraud remote jobs near north dakota

Auditor/Investigator I

Qlarant -
North Dakota

Quick Apply

Job Details

Full-time
$47,911 - $71,508 a year

Qualifications

Stakeholder management

Full Job Description

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for underserved communities.

Best People, Best Solutions, Best Results

Job Summary:

Serves as an entry level professional who develops baseline plans for ensuring the integrity and accuracy of claims processes and protocols. Collects data for audits/investigations into claims, utilizing a combination of analytical skills and attention to detail, reviewing documentation, interviewing involved parties, and communicating with various stakeholders to gather relevant information for successful resolution and closure. Identifies opportunities to target fraud, waste, and abuse or discrepancies in claims submissions. Adheres to industry regulations and company policies for managerial follow-up. Analyzes data in order to effectively assess the validity of claims. Provides accurate recommendations to management for claim resolution and closure. Documents and inputs all findings, while preparing comprehensive reports that may be used for legal or audit/investigative purposes.

Essential Functions:

Conducts routine and impartial audits/investigations into customer claims, ensuring accurate and fair assessments of claims validity.
Provides customer service by addressing inquiries and concerns, and escalates audit/investigation, as needed.
Compiles detailed and organized records of audit/investigation findings, ensuring accuracy and compliance with legal and regulatory requirements.
Applies functional knowledge to create and implement strategies to identify and prevent fraudulent activities, safeguarding the integrity of the claims process.
Conducts interviews with relevant witnesses, claimants, and other stakeholders to gather additional information and perspectives on claims.
Communicates with appropriate internal teams to ensure the proper processing of audits/investigations, while adhering to legal and regulatory standards.
Ensures that all audit and investigative documents and records are processed into the database in a timely and accurate manner.
Communicates audit/investigation findings clearly and professionally to customers, claimants, and other stakeholders, managing expectations and providing updates.
Supports management in regular audit and investigation proceedings, ensuring full compliance with all applicable regional and federal standards, regulations, and protocols.

Level of Supervision Received:
Under general supervision, proceeds alone on regular duties, referring questionable cases to manager.

Education (can be substituted for experience):
Minimum Bachelor's Degree required

Work Experience (can be substituted for education):
0 - 2 years of experience required; 2 - 4 years preferred

Certification(s):
Certified Fraud Examiner or Accredited Heathcare Anti-Fraud Investigator preferred

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.

Qlarant is a drug-free workplace. All offers of employment are contingent upon successful completion of pre-employment background and drug screens.

Quick Apply

Refine Your Search

fraud remote jobs in north dakota

Auditor/Investigator I

Auditor/Investigator II

Senior Investigator, Special Investigations Unit (Aetna SIU)

Certified Professional Coder, Special Investigations Unit (Aetna SIU)

Compliance UM Nurse (Wed - Sun)

More jobs to discover

Explore jobs in cities nearby

I want to receive the latest job alert for fraud remote in north dakota

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected