Senior Investigator
New
I
Integrity Management Services, Inc.Healthcare program integrity
Workable workplace: remote; Workable locations: Alexandria, Virginia, United StatesFull-TimeSenior
Salary45,000 - 65,000 USD per year
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Job Details
- Experience
- Two or more years of experience supporting healthcare program integrity, fraud investigations, Medicare, Medicaid, commercial healthcare, or other government healthcare programs.
- Required Skills
- Data AnalysisMicrosoft Excel
Requirements
- Bachelor's degree in criminal justice, law enforcement, healthcare administration, data analysis, or a related field, or equivalent education and relevant experience.
- Two or more years of experience supporting healthcare program integrity, fraud investigations, Medicare, Medicaid, commercial healthcare, or other government healthcare programs.
- Experience conducting fraud, waste, and abuse investigations is preferred.
- Strong investigative, analytical, and problem-solving skills.
- Experience reviewing healthcare claims, enrollment records, medical records, or other complex documentation.
- Experience analyzing complex data and identifying patterns or anomalies.
- Strong written, verbal, and interpersonal communication skills.
- Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) certification preferred, and may be required by contract.
- Ability to maintain confidentiality, exercise sound judgment, and work independently and collaboratively.
- Strong organizational skills, including prioritizing assignments and meeting deadlines.
- Proficiency with Microsoft Office applications, including Word and Excel.
Responsibilities
- Conduct background research on individuals, organizations, or entities under review.
- Investigate potential fraud, waste, and abuse.
- Analyze healthcare and operational data to identify trends, anomalies, and potential fraud indicators.
- Review laws, regulations, policies, and guidance relevant to investigations.
- Collect, review, and analyze investigative records and documentation.
- Conduct interviews and maintain accountability for evidentiary materials.
- Document investigative findings and prepare reports and recommendations.
- Coordinate with internal staff, legal counsel, government stakeholders, and law enforcement agencies as appropriate.
- Maintain investigative information in case management and tracking systems, and prepare recurring and ad hoc reports.
- Present findings and recommendations to management and clients, and help identify emerging fraud schemes and investigative priorities.
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