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.
Qlarant has exciting opportunities for experienced Unemployment Fraud Investigators. These positions are home based. The preferred location is the State of Nevada, but other locations will be considered. Please note: This position is contingent upon contract approval.
This position independently performs in-depth evaluation and makes field level judgments related to investigations of potential Unemployment Insurance fraud, waste and abuse investigations or cases that meet established criteria for referral 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 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
LANGUAGE SKILLS
- Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and policy and procedure manuals.
- Ability to write routine reports and correspondence.
- Ability to speak effectively before groups of customers or employees of organization.
MATHEMATICAL SKILLS
- Ability to perform standard mathematical functions.
- Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
REASONING ABILITY
- Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
- Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
- Ability to define problems, collect data, establish facts, and draw valid conclusions.
COMPUTER SKILLS
- Proficiency with the use of personal computers and the Internet.
- Advanced proficiency with spreadsheet software.
- Familiarity with database software and data management is preferred.
- Intermediate MS Office skills.
OTHER SKILLS AND ABILITIES
- Ability to work independently with minimal supervision
- Ability to grasp and adapt to changes in procedures and processes.
- Ability to effectively resolve complex issues.
- Familiarity with automation techniques for analytic tasks.
- Ability to work with highly sensitive information while preserving the confidentiality of the information.
- Working knowledge of unemployment insurance fraud detection and pursuit issues
Required Experience
A Bachelor's Degree or one or more of the following:
- certification in an applicable program such as Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator Certification
- successful completion of a law enforcement academy
Experience in unemployment insurance fraud investigation/detection.
Intermediate level proficiency with Microsoft Office applications to include Word and Outlook.
Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.