Health Fraud Investigator I - Medicare C&D - Entry Level

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 looking 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. This is an immediate opening.
The Investigator I is an entry level professional position that 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

• Has the responsibility and authority to perform their job and provide customer satisfaction.
• Conducts interviews of witnesses, informants, and subject area experts and targets of 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.
• Based on contract requirements, may refer potential adverse decisions to the Lead Investigator/Manager/Medical Director or designee.
• 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.
• Identifies opportunities to improve processes and procedures.
• Testifies at various legal proceedings as necessary.
• Determines investigation or case appropriateness of fraud, waste and abuse issues in accordance with pre-established criteria.
• 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.

Required Skills

• Ability to work independently with minimal supervision.
• Ability to effectively resolve complex issues.
• Ability to grasp and adapt to changes in procedure and process.
• Ability to utilize Microsoft Office and other applications to meet contract deliverables.
• Ability to communicate effectively with all members of the team to which he/she is assigned.

Required Experience

• Bachelor's Degree or four years’ experience in a related field that demonstrates expertise in reviewing, analyzing, and making appropriate decisions. Equivalent education and experience may be combined.
• Experience in investigations/fraud detection, law enforcement, or federal/state healthcare programs is preferred.

Certificates, Licenses, Registrations: Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator preferred
Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.