Identifies and evaluates potential risks to program integrity and develops strategies to mitigate these risks.
Installs best of class measures to maintain and improve the quality of program activities, ensuring they meet established standards.
Formulates and implements strategies to detect and prevent fraud within programs, including establishing controls and monitoring systems.
Acts independently to assess existing processes for efficiency, effectiveness, and compliance.
Collaborates with other departments, stakeholders, and external entities to ensure a holistic approach to program integrity.
Conducts advanced investigations into potential instances of fraud, misconduct, or non-compliance; takes appropriate corrective actions.
Maintains accurate documentation of program activities and produces regular reports on program integrity metrics and compliance status.
Instructs program staff on relevant compliance and integrity matters to ensure understanding and adherence to policies.
Manages team performance through regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development.
Level of Supervision Received
Drives work independently and escalates questions and issues, as needed
Education (can be substituted for experience)
Minimum Bachelor's Degree required
Work Experience (can be substituted for education)
8 - 11 years of experience required; 12 - 14 years preferred
Certification(s)
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.
Qlarant is a drug-free workplace. All offers of employment are contingent upon successful completion of pre-employment background and drug screens.
