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Jobs Search
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
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.
Required Skills
EDUCATION (EDUCATION CAN BE SUBSTITUTED FOR EXPERIENCE):
WORK EXPERIENCE (EXPERIENCE CAN BE SUBSTITUTED FOR EDUCATION)
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.
The U.S. healthcare job market is robust and consistently expanding. Key factors contributing to this growth include:
Several roles are particularly sought-after in the U.S. healthcare landscape:
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: