Senior Investigator

This is a fully remote position, open to applicants in United States.

📋 Description

• Assist the Investigation Lead with the operational functions of the task order, which includes evaluating the practices of dispensers, pharmacies, and manufacturers to ensure compliance with Negotiation Program standards.

• Contribute to the formulation of compliance requirements for investigations, reporting, and market surveillance activities.

• Aid in the design of investigation processes and strategies that guarantee timely, comprehensive, and impartial investigations that align with program timelines and quality benchmarks.

• Detect and evaluate potential risks or violations through data analysis, stakeholder interviews, audits, and tips received through oversight channels.

• Support the intake, triage, and prioritization of investigative issues in line with CMS compliance goals.

• Collaborate with data analysts, auditors, compliance officers, legal professionals, and other stakeholders to gather and evaluate evidence.

• Prepare investigation plans, memoranda, and final reports that include actionable findings and recommendations.

• Coordinate with CMS, OIG, and other federal oversight organizations on escalated issues that necessitate enforcement or corrective measures.

• Ensure a secure, well-documented chain of evidence is maintained throughout each case in accordance with federal regulations.

• Develop and enhance investigation protocols, standard operating procedures, and escalation processes in collaboration with complaint/dispute and auditing teams.

• Mentor junior team members and act as a subject matter expert in investigative methods and healthcare program integrity.

⛳️ Requirements

• Bachelor’s degree with 5 years of relevant professional experience, or

• Associate's degree with 8 years of relevant professional experience, or

• High school diploma with 9 years of relevant professional experience.

• Proven knowledge of Medicare Part D, drug pricing, manufacturer rebate structures, or government pricing programs.

• Excellent analytical and investigative abilities.

• Familiarity with federal healthcare regulations, particularly those relating to pharmaceutical pricing and compliance with government programs.

• Outstanding communication and writing skills, capable of conveying complex findings to both technical and non-technical audiences.

• Strong project management capabilities with the ability to handle multiple investigations concurrently.

• Experience with case management systems, e-discovery tools, and data analytics platforms.

🏝️ Benefits

• Comprehensive medical, dental, and vision insurance, along with telehealth services and a confidential Employee Assistance Program.

• Paid time off beginning at 3.5 weeks annually, which increases with tenure, plus 11 paid holidays.

• 401(k) retirement plan featuring an employer match of up to 4% of eligible compensation after six months of employment.

• Company-sponsored basic life, accidental death and dismemberment, as well as short- and long-term disability insurance.

• Opportunities for professional growth and tuition reimbursement programs, each providing up to $1,500 annually for eligible employees after six months of service, pending approval.