Auditor/Investigator II

This is a fully remote position, open to applicants in Arizona, +9 more states.

📋 Description

• Ensure the accuracy and integrity of claims processes and protocols.

• Gather data for audits and investigations related to claims.

• Review documentation and conduct interviews with involved parties.

• Detect fraud, waste, abuse, and inconsistencies in claims submissions.

• Analyze data to determine the validity of claims.

• Advise management on claim resolution and closure.

• Document and record findings appropriately.

• Perform impartial audits and investigations from initiation to completion.

• Address customer inquiries and concerns, escalating issues as necessary.

• Maintain organized records of audits and investigations.

• Develop and implement strategies to identify and prevent fraudulent activities.

• Collaborate with internal teams to ensure proper processing of audits and investigations.

• Communicate findings and updates to customers, claimants, and stakeholders.

• Assist in training and supporting other auditors and investigators.

• Plan and organize own work while collaborating with a manager to prioritize projects.

⛳️ Requirements

• A minimum of a Bachelor's Degree is required; education may be substituted for experience.

• 2–4 years of experience is required; 5–7 years is preferred.

• Certification as a Fraud Examiner is preferred.

• Capability to conduct claims audits and investigations from initiation to completion.

• Strong analytical skills and attention to detail.

• Proficiency in reviewing documentation and analyzing claims data.

• Ability to interview witnesses, claimants, and stakeholders effectively.

• Familiarity with legal, regulatory, and industry requirements.

• Skills to prepare comprehensive reports for legal or audit/investigative purposes.

• Proficient in communicating with customers, claimants, internal teams, and other stakeholders.

🏝️ Benefits

• Employment offers are contingent upon the successful completion of pre-employment background checks and drug screenings.

• We are an Equal Opportunity Employer.

• Enjoy a drug-free workplace environment.