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.

Looking a career in healthcare fraud investigation? Qlarant has an immediate opening for a Healthcare Fraud Investigator I. This position could be based in our Dallas, TX office or home based within the UPIC Southwest jurisdiction (Texas, Oklahoma, Colorado, Arkansas, Louisiana, Mississippi and New Mexico). Applicants residing outside the jurisdiction must indicate they are willing to relocate with minimal assistance to be considered. Applicants from the South Texas Valley area are urged to apply.

Please note: This is not a senior level position and the salary is commensurate with the requirements stated below. We offer an excellent benefits package that includes healthcare, two retirement plans and a generous leave program.

As a Healthcare Fraud Investigator I working on our Unified Program Integrity Contractor (UPIC) team for the Southwest Jurisdiction, you can contribute to our efforts to make a positive difference in the future of the Medicare and Medicaid programs. Our UPIC Southwest team identifies and investigates fraud, waste and abuse in the Medicare and Medicaid programs covering 7 states.

The Investigator I is an entry level professional 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.

• 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, examines records, verifies authenticity of documents, and may provide information to support the preparation of attestations/referrals.
• 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

• 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.
• Ability to utilize Microsoft Office and other programs to meet contract requirements.

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