Qlarant Looking for Healthcare Fraud Investigator – Medicare Parts C&D – Remote at Remote Full Time

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 an experienced healthcare fraud investigator with a track record of successful outcomes and exceeding expectations? As an Investigator at Qlarant, 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 based in our Baltimore or Easton, MD offices or home-based in most states. This is an immediate opening.

Our investigators independently perform in-depth evaluation and make field level judgments related to investigations of potential Medicare and Medicaid fraud, waste and abuse investigations or cases that meet established criteria for referral to the Centers for Medicare & Medicaid for administrative action or to the OIG for criminal action.

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.

Required Skills

• Ability to work independently with minimal supervision.
• 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.

Required Experience

• High School diploma/GED required; Bachelor’s Degree preferred.
• One or more of the following strongly 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 investigations experience in a federal or state healthcare program or a related investigative field.
• Prior successful experience with CMS and OIG/FBI/DEA or similar agencies strongly preferred.

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