Qlarant

Auditor

• Conduct routine and impartial audits/investigations from start to closure into fraud, waste, and abuse allegations
• Collect and analyze data and information to assess allegation validity
• Review documentation and interview witnesses, claimants, and other stakeholders
• Identify opportunities to proactively target fraud, waste, and abuse
• Address customer inquiries and concerns and escalate matters as needed
• Compile organized records and document all findings
• Prepare recommendations for management and comprehensive reports for legal or audit/investigative purposes
• Communicate findings, updates, and expectations to customers, claimants, and stakeholders
• Coordinate with internal teams to ensure proper processing in compliance with legal and regulatory standards
• Assist with training and supporting other auditors/investigators
• Plan and arrange own work while working with a manager to prioritize projects

Field Auditor/Investigator II

• Conduct routine and impartial audits/investigations from start to closure into fraud, waste, and abuse allegations
• Collect data and information for USDA SNAP Retailer investigations
• Review documentation and analyze data to assess allegation validity
• Identify opportunities to proactively target fraud, waste, and abuse
• Provide accurate recommendations to management for resolution and closure
• Document and input findings and prepare comprehensive reports for legal or audit/investigative purposes
• Address customer inquiries and concerns and escalate audits/investigations as needed
• Compile detailed, organized records while ensuring legal and regulatory compliance
• Conduct interviews with witnesses, claimants, and other stakeholders
• Communicate with internal teams to ensure proper processing of audits/investigations
• Communicate findings to customers, claimants, and stakeholders, managing expectations and providing updates
• Assist with training and supporting other auditors/investigators
• Plan and arrange own work while working with the manager to prioritize projects

• Conduct routine and impartial audits/investigations from start to closure into fraud, waste, and abuse allegations
• Collect data and information for USDA SNAP Retailer investigations
• Address customer inquiries and concerns and escalate audits/investigations as needed
• Compile detailed and organized records of audit/investigation findings
• Create and implement strategies to identify and prevent fraudulent activities
• Interview witnesses, claimants, and other stakeholders
• Communicate with internal teams to ensure proper processing of audits/investigations
• Communicate findings to customers, claimants, and stakeholders, managing expectations and providing updates
• Provide training and support to other auditors/investigators
• Plan and arrange own work while working with the manager to prioritize projects
• Prepare comprehensive reports for legal or audit/investigative purposes
• Provide accurate recommendations to management for resolution and closure

Director

• Plan, direct, and lead large-scale or distinct projects for assigned contracts
• Ensure projects align with strategic objectives and meet scheduling, funding, quality, and efficiency parameters
• Conduct advanced project planning, including timelines, resource allocation, cost projections, and budgets
• Liaise with contract contacts and external/internal customers; coordinate meetings and attend committee meetings
• Evaluate projects and provide strategic recommendations to senior management regarding status, compliance, risks, and efficiencies
• Lead project teams by formulating work plans, assigning duties, and coordinating activities
• Develop innovative project processes and deliverables
• Facilitate meetings, focus groups, and internal and external committees
• Maintain operational efficiency, contract compliance, and timely deliverables
• Evaluate and modify schedules or plans based on status reports; prepare written reports, articles, and proposals
• Develop and conduct training programs and resources for internal and external customers
• Audit and modify complex processes to enhance service delivery
• Manage team performance through feedback and formal performance reviews

Director – Projects

Nurse

• Perform medical record and claims review for Medicare, Medicaid, and/or other claims data
• Ensure applicable guidelines have been followed
• Assess potential overpayment, fraud, waste, and abuse
• Review beneficiary, provider, and/or pharmacy cases
• Complete desk reviews and field audits
• Consult with benefit integrity investigation experts and pharmacists
• Complete case summaries and provide results to investigators
• Perform case-specific or plan-specific data entry and reporting
• Participate in internal and external focus groups as required
• Participate in provider onsite visits and beneficiary interviews for field audits/investigations
• Testify at legal proceedings as necessary
• Provide job-specific orientation and training
• Help develop training content, resources, and programs

Nurse Specialist II

Human Resources

• Lead day-to-day administration of employee benefits programs
• Administer leave of absence programs, including FMLA, state-mandated programs, short-term and long-term disability, and company-sponsored leave
• Manage complex leave cases with employees, managers, payroll, and vendors
• Own new-hire benefits enrollment and provide guidance on plan options, eligibility, deadlines, and enrollment decisions
• Analyze HCM and benefits reports for enrollments, leave usage, data accuracy, and compliance
• Resolve employee questions about benefits eligibility, coverage, and claims
• Maintain benefits processes in alignment with company policies and federal, state, and local requirements
• Serve as primary benefits contact for vendors, payroll, and HR partners
• Lead benefits audits and open enrollment activities, including planning, data validation, communications, issue resolution, and follow-up
• Educate employees on wellness programs, benefit options, and available resources
• Identify service issues and process gaps and implement improvements
• Plan and arrange own work while coordinating project priorities with the manager

Benefits Specialist IV

Paralegal

• Support the legal team with legal and regulatory assistance for investigations, appeals, hearings, external stakeholder requests, and administrative responsibilities
• Prepare responses to congressional inquiries, FOIA requests, RFIs/RFAs, and external communications
• Review, quality-check, and finalize witness documents for administrative hearings
• Review discovery requests and assign staff for responses and document collection
• Attend administrative hearings and provide written summaries
• Draft legal documents, including FOIA responses and payment suspension rebuttals
• Identify responsive documents and custodians for litigation holds and FOIA requests
• Coordinate collection of responsive documents and maintain active-request records
• Attend meetings, maintain case files, and provide administrative support
• Assist with process improvements and efficiency efforts

Paralegal II

Supervisor

• Oversee audits/investigations and audit/investigation workload
• Evaluate potential Medicare and/or Medicaid fraud, waste, and abuse or compliance cases and determine appropriate referrals
• Review incoming leads, assign work to auditors/investigators, and supervise provider vetting
• Review audit/investigation plans, priorities, files, information requests, reports, and correspondence for quality and appropriateness
• Supervise and conduct interviews, onsite audits/investigations, and site verifications as needed
• Lead audit/investigation projects, develop strategies, conduct stakeholder meetings, review project actions, and document findings
• Coordinate with Data and Medical Review departments
• Prepare and present audits/investigations, overpayments, and questions for stakeholder meetings
• Document case information and file reviews in case tracking systems
• Review findings and approve courses of action, closing summaries, and administrative remedies
• Prepare the team’s audits/investigations for Major Case Coordination meetings and perform quality assurance reviews
• Communicate with law enforcement and regulatory agencies regarding further investigations, prosecution, or regulatory/administrative remedies
• Collect and submit information requested by CMS, law enforcement, and other stakeholders, including FOIA requests
• Collaborate with other program integrity contractors
• Testify at legal or administrative proceedings as necessary
• Manage team performance through feedback and formal performance reviews to support service delivery, engagement, motivation, and development

Supervisor – Audit, Investigation

• Ensure the integrity and accuracy of claims processes and protocols
• Collect data for audits and investigations into claims
• Review documentation and interview involved parties
• Identify fraud, waste, abuse, and discrepancies in claims submissions
• Analyze data to assess claims validity
• Recommend claim resolution and closure to management
• Document and input findings
• Conduct impartial audits and investigations from start to closure
• Address customer inquiries and concerns and escalate matters as needed
• Compile organized audit and investigation records
• Create and implement strategies to identify and prevent fraudulent activities
• Communicate with internal teams to process audits and investigations properly
• Communicate findings and updates to customers, claimants, and stakeholders
• Assist with training and supporting other auditors/investigators
• Plan and arrange own work while working with a manager to prioritize projects

Auditor/Investigator II

• Conduct routine and impartial audits/investigations of customer claims from start to closure
• Ensure accurate and fair assessments of claims validity
• Address customer inquiries and concerns and escalate audits/investigations as needed
• Compile detailed records of audit/investigation findings in compliance with legal and regulatory requirements
• Create and implement strategies to identify and prevent fraudulent activities
• Interview witnesses, claimants, and other stakeholders
• Communicate with internal teams to ensure proper processing of audits/investigations
• Communicate findings to customers, claimants, and stakeholders, managing expectations and providing updates
• Assist with training and supporting other auditors/investigators
• Plan and arrange own work while collaborating with the manager to prioritize projects