Healthcare Jobs in USA

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Healthcare Fraud investigator II at Qlarant
Remote, Oregon, USA - Full Time
Skills Needed
Disabilities, Certified Fraud Examiner
Qualification
Graduate
Experience Required
Minimum 2 year(s)
B2B Healthcare Writer | Freelance at StudioNorth
United States, , USA - Full Time
Skills Needed
Value Propositions, Collaboration, Trade Shows, Demographics, White Papers, Writing, Social Media
Qualification
Graduate
Product Manager - Healthcare SaaS at Saisystems Health
Shelton, CT 06484, USA - Full Time
Skills Needed
A/B Testing, User Research, Rice, Product Management, Metrics, Product Requirements, Strategy
Qualification
Graduate
Healthcare Operations Supervisor at Servicon
Los Angeles, CA 90033, USA - Full Time
Skills Needed
Good Communication Skills
Qualification
Graduate
Field Assistant Wound Healthcare at Omni Wound Physicians
Norwood, Massachusetts, USA - Full Time
Skills Needed
Email, Slack, Scheduling, Wound Care, Cpi, Documentation, Training, Medical Equipment, Intellectual Disabilities, Patient Care, Schedules
Qualification
Graduate
Healthcare Payer Contract Analyst at Rivet
Remote, Oregon, USA - Full Time
Skills Needed
Email, Fee Schedules, Thinking Skills, Customer Interaction
Qualification
Graduate
Jr. Healthcare Operations Analyst at Duty First Consulting
Vienna, Virginia, USA - Full Time
Skills Needed
It, Professional Network, Teams, Color, Interpersonal Skills, Disabilities, Deliverables
Qualification
Graduate
Experience Required
Minimum 1 year(s)
Healthcare Engagement Specialist at I3 Strategy Partners
Houston, Texas, USA - Full Time
Skills Needed
Community Organizations
Qualification
Graduate
Healthcare Compliance Specialist at Evergreen Healthcare
Salt Lake City, UT 84120, USA - Full Time
Skills Needed
Sharepoint, Hipaa, Confidentiality, Oig, Excel, Microsoft Word, Communication Skills, Cms, Powerpoint, Healthcare Compliance
Qualification
Graduate
Call Center Operator - Healthcare at Mercy Medical Center
Baltimore, MD 21202, USA - Full Time
Skills Needed
Customer Service, Ged, Educational Materials, Referrals, Scanning, Epic
Qualification
Diploma
Experience Required
Minimum 1 year(s)
Call Center Operator - Healthcare at Mercy Medical Center
Baltimore, MD 21202, USA - Full Time
Skills Needed
Epic Systems, Ged
Qualification
Diploma
Experience Required
Minimum 1 year(s)
Healthcare Regulatory Specialist at PROGYNY INC
Remote, Oregon, USA - Full Time
Skills Needed
Good Communication Skills
Qualification
Graduate
Experience Required
Minimum 5 year(s)
Director of Healthcare Operations at Array Behavioral Care
United States, , USA - Full Time
Skills Needed
Good Communication Skills
Qualification
Graduate
Experience Required
Minimum 5 year(s)
Healthcare Marketing Coordinator at Elevation Group Healthcare
Marietta, GA 30060, USA - Full Time
Skills Needed
Seo, Analytical Skills, Content Marketing, Healthcare Marketing, B2b Marketing, Teams, Dental Insurance, Health Insurance, Communication Skills, Healthcare Industry, Life Insurance, Flexible Schedule, Email Marketing, Long Term Care
Qualification
Graduate
Reimbursement Analyst- Healthcare at Genesa Reimbursement Group
Dallas, Texas, USA - Full Time
Skills Needed
Microsoft Excel
Qualification
Graduate
Experience Required
Minimum 1 year(s)
Account Executive-Home Healthcare at NURSES CARE INC
Cincinnati, Ohio, USA - Full Time
Skills Needed
Communication Skills, Teamwork, Presentation Skills, Management Skills, Healthcare Industry, Dental Insurance, Flexible Schedule, Case Management, Collaboration, Vision Insurance, Healthcare Marketing, Health Insurance, Life Insurance
Specialization
Nursing social worker marketing or other related fields
Qualification
Graduate
Experience Required
Minimum 2 year(s)
Healthcare Practice Administrator at Jorie AI
McAllen, TX 78503, USA - Full Time
Skills Needed
Eligibility, Denials, Communication Skills
Qualification
Graduate
Experience Required
Minimum 5 year(s)
Healthcare Collections Specialist at Firstsource Healthcare
Remote, Oregon, USA - Full Time
Skills Needed
Creativity, Time Management, Professional Manner
Qualification
Diploma
Project Coordinator - Healthcare at STUDIO PLUS ARCHITECTS INC
Tampa, FL 33606, USA - Full Time
Skills Needed
Research, Licensure, Budget Tracking, Enscape, Adaptation, Autocad, Decision Making, Architecture
Specialization
Architecture, architecture
Qualification
Graduate
Healthcare Collections Supervisor at Ga Foods
Saint Petersburg, FL 33716, USA - Full Time
Skills Needed
Sap, Nav, Finance, Credit Bureau, Excel, Financial Modeling
Qualification
Diploma
Experience Required
Minimum 2 year(s)
Healthcare Fraud investigator II at Qlarant
Remote, Oregon, USA -
Full Time


Start Date

Immediate

Expiry Date

16 Nov, 25

Salary

0.0

Posted On

16 Aug, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

No

Skills

Disabilities, Certified Fraud Examiner

Industry

Financial Services

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 under-served communities.

JOB SUMMARY:

Ensures 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 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 Duties and Responsibilities include some or all of the following. Other duties may be assigned.

  • Conducts routine and impartial audits/investigations from start to closure 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.
  • Communicates audit/investigation findings clearly and professionally to customers, claimants, and other stakeholders, managing expectations and providing updates.
  • Assists in providing training and support to other auditors/investigators, contributing to the continuous improvement of investigative processes.

Required Skills

EDUCATION (EDUCATION CAN BE SUBSTITUTED FOR EXPERIENCE):

  • Minimum Bachelor’s Degree
  • Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator preferred

WORK EXPERIENCE (EXPERIENCE CAN BE SUBSTITUTED FOR EDUCATION)

  • Minimum of 2-4 years experience
  • Minimum of 5-7 years experience preferred
    Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities
Responsibilities
  • Conducts routine and impartial audits/investigations from start to closure 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.
  • Communicates audit/investigation findings clearly and professionally to customers, claimants, and other stakeholders, managing expectations and providing updates.
  • Assists in providing training and support to other auditors/investigators, contributing to the continuous improvement of investigative processes
Healthcare Fraud investigator II at Qlarant
Remote, Oregon, USA - Full Time
Skills Needed
Disabilities, Certified Fraud Examiner
Qualification
Graduate
Experience Required
Minimum 2 year(s)
B2B Healthcare Writer | Freelance at StudioNorth
United States, , USA - Full Time
Skills Needed
Value Propositions, Collaboration, Trade Shows, Demographics, White Papers, Writing, Social Media
Qualification
Graduate
Product Manager - Healthcare SaaS at Saisystems Health
Shelton, CT 06484, USA - Full Time
Skills Needed
A/B Testing, User Research, Rice, Product Management, Metrics, Product Requirements, Strategy
Qualification
Graduate
Healthcare Operations Supervisor at Servicon
Los Angeles, CA 90033, USA - Full Time
Skills Needed
Good Communication Skills
Qualification
Graduate
Field Assistant Wound Healthcare at Omni Wound Physicians
Norwood, Massachusetts, USA - Full Time
Skills Needed
Email, Slack, Scheduling, Wound Care, Cpi, Documentation, Training, Medical Equipment, Intellectual Disabilities, Patient Care, Schedules
Qualification
Graduate
Healthcare Payer Contract Analyst at Rivet
Remote, Oregon, USA - Full Time
Skills Needed
Email, Fee Schedules, Thinking Skills, Customer Interaction
Qualification
Graduate
Jr. Healthcare Operations Analyst at Duty First Consulting
Vienna, Virginia, USA - Full Time
Skills Needed
It, Professional Network, Teams, Color, Interpersonal Skills, Disabilities, Deliverables
Qualification
Graduate
Experience Required
Minimum 1 year(s)
Healthcare Engagement Specialist at I3 Strategy Partners
Houston, Texas, USA - Full Time
Skills Needed
Community Organizations
Qualification
Graduate
Healthcare Compliance Specialist at Evergreen Healthcare
Salt Lake City, UT 84120, USA - Full Time
Skills Needed
Sharepoint, Hipaa, Confidentiality, Oig, Excel, Microsoft Word, Communication Skills, Cms, Powerpoint, Healthcare Compliance
Qualification
Graduate
Call Center Operator - Healthcare at Mercy Medical Center
Baltimore, MD 21202, USA - Full Time
Skills Needed
Customer Service, Ged, Educational Materials, Referrals, Scanning, Epic
Qualification
Diploma
Experience Required
Minimum 1 year(s)
Call Center Operator - Healthcare at Mercy Medical Center
Baltimore, MD 21202, USA - Full Time
Skills Needed
Epic Systems, Ged
Qualification
Diploma
Experience Required
Minimum 1 year(s)
Healthcare Regulatory Specialist at PROGYNY INC
Remote, Oregon, USA - Full Time
Skills Needed
Good Communication Skills
Qualification
Graduate
Experience Required
Minimum 5 year(s)
Director of Healthcare Operations at Array Behavioral Care
United States, , USA - Full Time
Skills Needed
Good Communication Skills
Qualification
Graduate
Experience Required
Minimum 5 year(s)
Healthcare Marketing Coordinator at Elevation Group Healthcare
Marietta, GA 30060, USA - Full Time
Skills Needed
Seo, Analytical Skills, Content Marketing, Healthcare Marketing, B2b Marketing, Teams, Dental Insurance, Health Insurance, Communication Skills, Healthcare Industry, Life Insurance, Flexible Schedule, Email Marketing, Long Term Care
Qualification
Graduate
Reimbursement Analyst- Healthcare at Genesa Reimbursement Group
Dallas, Texas, USA - Full Time
Skills Needed
Microsoft Excel
Qualification
Graduate
Experience Required
Minimum 1 year(s)
Account Executive-Home Healthcare at NURSES CARE INC
Cincinnati, Ohio, USA - Full Time
Skills Needed
Communication Skills, Teamwork, Presentation Skills, Management Skills, Healthcare Industry, Dental Insurance, Flexible Schedule, Case Management, Collaboration, Vision Insurance, Healthcare Marketing, Health Insurance, Life Insurance
Specialization
Nursing social worker marketing or other related fields
Qualification
Graduate
Experience Required
Minimum 2 year(s)
Healthcare Practice Administrator at Jorie AI
McAllen, TX 78503, USA - Full Time
Skills Needed
Eligibility, Denials, Communication Skills
Qualification
Graduate
Experience Required
Minimum 5 year(s)
Healthcare Collections Specialist at Firstsource Healthcare
Remote, Oregon, USA - Full Time
Skills Needed
Creativity, Time Management, Professional Manner
Qualification
Diploma
Project Coordinator - Healthcare at STUDIO PLUS ARCHITECTS INC
Tampa, FL 33606, USA - Full Time
Skills Needed
Research, Licensure, Budget Tracking, Enscape, Adaptation, Autocad, Decision Making, Architecture
Specialization
Architecture, architecture
Qualification
Graduate
Healthcare Collections Supervisor at Ga Foods
Saint Petersburg, FL 33716, USA - Full Time
Skills Needed
Sap, Nav, Finance, Credit Bureau, Excel, Financial Modeling
Qualification
Diploma
Experience Required
Minimum 2 year(s)

Healthcare Jobs in USA

The healthcare sector in the United States is a vast and dynamic field, offering a multitude of career opportunities. From clinical roles to administrative positions, the industry caters to a wide range of professionals. As per the stats, there will be 600,000 job vacancies in the healthcare sector by 2030. The growth of this sector is driven by an aging population, advances in medical technology, and ongoing public health initiatives. This environment creates a fertile ground for job seekers - from new graduates to experienced professionals—to find rewarding careers that make a significant impact on community health and well-being.

Healthcare Job Market in USA

The U.S. healthcare job market is robust and consistently expanding. Key factors contributing to this growth include:

  1. Aging Population: Increased need for chronic disease management, long-term care, and specialized medical services.
  2. Technological Advancements: Innovations in telemedicine, electronic health records, and medical devices are reshaping the way healthcare is delivered.
  3. Policy and Regulatory Changes: Recent healthcare reforms and policy updates have spurred investments in health infrastructure, leading to more job openings.
  4. Diverse Career Opportunities: The market spans clinical care, research, administration, and support services, offering varied pathways for career development.

High in-Demand Healthcare Job Roles in USA

Several roles are particularly sought-after in the U.S. healthcare landscape:

  1. Nurse Practitioner
  2. Physician Assistant
  3. Speech-Language Pathologist
  4. Veterinarian
  5. Nurse Anesthetist
  6. Veterinary Technologist and Technician
  7. Physical Therapist

Top Healthcare Companies Hiring Foreign Nationals in USA

Many leading healthcare organizations in the United States recognize the value that internationally trained professionals bring to the industry. Top companies known for hiring foreign nationals include:

  1. Mayo Clinic
  2. Cleveland Clinic
  3. Johns Hopkins Medicine
  4. Kaiser Permanente
  5. HCA Healthcare
  6. Ascension Health
  7. Tenet Healthcare
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