+--------------------------------------------------------------------------+ | 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. | | | | We have immediate openings for experienced Healthcare Fraud | | Investigators. This position could be based in our Los Alamitos, CA | | office or home based for well qualified candidates.  Preference will be | | given to candidates residing in the UPIC Western Jurisdiction. We offer | | an excellent benefits package that includes healthcare, two retirement | | plans and a generous leave program.  | | | | As a Healthcare Fraud Investigator II working on our Unified Program | | Integrity Contractor (UPIC) team for the Western Jurisdiction, | | you can contribute to our efforts to make a positive difference in the | | future of the Medicare and Medicaid programs.  Our UPIC West team | | identifies and investigates fraud, waste and abuse in the Medicare and | | Medicaid programs covering 13 states and 3 territories. | | | | This position independently performs in-depth evaluation and makes field | | level judgments related to investigations of potential Medicare 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.
• Ability to utilize Microsoft Office (Excel, Word and Outlook) and other applications to meet contract deliverables.

Required Experience

• A Bachelor's Degree and two years’ experience in investigations/fraud detection or healthcare programs. Equivalent education and experience may be combined. 
• Experience in health care fraud investigation/detection strongly preferred.
• Prior successful experience with CMS and OIG/FBI or similar agencies preferred.
• Certification in an applicable program such as Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator Certification or successful completion of a law enforcement academy preferred.

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

• 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 (Excel, Word and Outlook) and other applications to meet contract deliverables.