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Qlarant · 11 hours ago

Audit/Investigation Coordinator II

Los Alamitos, CA

Full-time

Onsite

Mid, Senior Level

2+ years exp

Qlarant is a not-for-profit corporation that partners with public and private sectors to enhance the delivery of health care and human services programs. The Audit/Investigation Coordinator II performs in-depth evaluations and makes judgments related to potential fraud investigations, ensuring accurate case tracking and compliance with established criteria.

Information ServicesInformation Technology

Responsibilities

Reviews complaint data including allegations, subjects of the complaint, and facts of the complaint to ensure case tracking system is correctly populated and updated per pre-established timeframes

Maintains data records in the case tracking systems to ensure timely processing of cases

Screens incoming fraud leads by extracting information from sites related to the subject(s), utilizing a variety of resources and systems to capture the scope of fraud, and evaluating relevant legislation to draft a case file that is comprehensive and accurate

Confers with complainants and beneficiaries, as needed, to obtain clarification regarding complaints and to verify services to assist in drafting contact reports

Operates systems to obtain claims, enrollment, and provider/beneficiary information

Prepares intake investigation report, collecting all relevant facts, risks, and leads to recommend investigations to Lead Investigator

Processes requests for information (RFIs), as needed, to various contractors, reviews information upon receipt, and incorporates findings into audit/investigation file to ensure thorough audit/investigation files are delivered

Recommends opportunities to improve fraud audit/investigation processes and procedures ensuring industry best practices are being followed