Healthcare Fraud Investigator

Qlarant, Inc., 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're a national leader in fighting fraud, waste and abuse for large organizations across the country.

Are you searching for an opportunity to begin your career in Healthcare Fraud investigation?  Do you have a track record of successful outcomes and exceeding expectations?  As an Investigator I on Qlarant's I-MEDIC investigations team, you will play a key role on a team that detects and prevents fraud, waste and abuse in the Medicare Part C (Medicare Advantage) and Part D (Prescription Drug Coverage) programs on a national level.  The position could be home-based in most states.  

Qlarant offers a very competitive benefits program that includes health, dental, vision, long and short term disability, generous vacation, sick and holiday leave, and two retirement plans.  If you're looking for a position that offers growth opportunities and a collaborative work environment, this may be the perfect fit for you.

Please note:  This is an entry level position with a hiring range commensurate with the level of education and experience required.

The Investigator I performs evaluations of investigations and makes field level judgments of potential Medicaid and/or Medicare fraud, waste and abuse that meet established criteria for referral to law enforcement or administrative action.  Essential duties and responsibilities include the following. Other duties may be assigned

Essential Duties and Responsibilities include the following. Other duties may be assigned

• Utilizes leads provided by the team and referrals from government and private agencies, works with the team to prioritize complaints for investigation, and then investigates, conducts interviews and reviews information to make potential fraud determination.
• Determines investigation or case appropriateness of fraud, waste and abuse issues in accordance with pre-established criteria.
• Based on contract requirements, may refer potential adverse decisions to the Lead Investigator/Manager/Medical Director or designee.
• Conducts interviews of witnesses, informants, and subject area experts and targets of investigations.
• Identifies, collects, preserves, analyzes and summarizes evidence, examining records, verifying authenticity of documents, may provide information to support the preparation of attestations/referrals or supervising the preparation of attestations/referrals as needed.
• Drafts investigation reports, evaluates investigation reports, and promotes effective and efficient investigations.
• Initiates and maintains communications with law enforcement and appropriate regulatory agencies including presenting or assisting with presenting investigation or case findings for their consideration to further investigate, prosecute, or seek other appropriate regulatory or administrative remedies.
• Testifies at various legal proceedings as necessary.
• Identifies opportunities to improve processes and procedures.
• Has the responsibility and authority to perform their job and provide customer satisfaction.

• Ability to work independently with minimal supervision once trained.
• Ability to communicate effectively with all members of the team to which he/she is assigned.
• Ability to grasp and adapt to changes in procedure and process. 
• Ability to effectively resolve complex issues. 
• Ability to mentor other associates.

• A Bachelor's Degree or an equivalent combination of education and exeperience.
• One or more of the following are preferred:
  • certification in an applicable program such as Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator Certification
  • successful completion of a law enforcement academy
  • experience in health care fraud investigation/detection.
• Must possess experience in a federal or state healthcare programs or a related field that demonstrates expertise in reviewing, analyzing, and making appropriate decisions. Prior successful experience with CMS and OIG/FBI or similar agencies preferred.

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