Audit/Investigation Coordinator II

This is a Fully Remote Job
1. About Our Client:
The organization is a not-for-profit corporation collaborating with public and private sectors to enhance the quality, safety, and efficiency of health care and human services programs. It operates across multiple domains including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. The organization also leads national efforts to combat fraud, waste, and abuse in large institutions and supports underserved communities through its Foundation's grant opportunities.
2. About the Opportunity:
The Audit/Investigation Coordinator II performs detailed evaluations and makes field-level judgments on complaints and investigative leads related to potential fraud, such as Medicare and Medicaid cases. This role is responsible for preparing comprehensive case files, recommending investigations, and supporting administrative or law enforcement follow-up. The position contributes to maintaining program integrity by ensuring accurate and timely processing of fraud-related inquiries.
3. Responsibilities:
Review complaint data to ensure accurate case tracking and updates within established timeframes.
Maintain data records in case tracking systems for timely case processing.
Screen incoming fraud leads using multiple resources to assess the scope and draft comprehensive case files.
Communicate with complainants and beneficiaries to clarify complaints and verify services.
Use systems to obtain claims, enrollment, and provider or beneficiary information.
Prepare intake investigation reports summarizing facts, risks, and leads for further investigation.
Process requests for information and integrate findings into audit or investigation files.
Recommend improvements to fraud audit and investigation procedures aligned with industry best practices.
4. Requirements:
High School Diploma or GED minimum.
2 to 4 years of relevant experience required; 5 to 7 years preferred.
5. Pay Range and Compensation Package:
The pay range and compensation package for this role will be determined based on the candidate’s experience, skills, and other relevant factors.
Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.
Note:
TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.

Work arrangement
Yes