Senior Investigator

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

📋 Description

• Perform background investigations on individuals, organizations, or entities being assessed.

• Carry out inquiries related to potential fraud, waste, and abuse.

• Examine healthcare and operational data to uncover trends, anomalies, and signs of possible fraud.

• Review relevant laws, regulations, policies, and guidance.

• Gather, evaluate, and analyze documentation and records related to investigations.

• Conduct interviews and ensure accountability for evidentiary materials.

• Document findings from investigations and draft reports and recommendations.

• Liaise with internal personnel, legal advisors, government officials, and law enforcement agencies.

• Work alongside investigators, analysts, program managers, and subject matter experts to formulate strategies and resolve cases.

• Input and manage information within case management and tracking systems.

• Present findings and recommendations to management and clients.

• Identify new fraud schemes and suggest investigative priorities.

• Prepare regular and on-demand reports regarding investigative activities and case statuses.

• Adhere to quality standards and meet project deadlines.

⛳️ Requirements

• Bachelor's degree in criminal justice, law enforcement, healthcare administration, data analysis, or a related field, or an equivalent combination of education and relevant experience.

• A minimum of two years of experience in supporting healthcare program integrity, fraud investigations, Medicare, Medicaid, commercial healthcare, or other governmental healthcare programs.

• Prior experience in conducting investigations into fraud, waste, and abuse is preferred.

• Strong skills in investigation, analysis, and problem-solving.

• Experience in reviewing healthcare claims, enrollment records, medical records, or other complex documentation.

• Proficient in analyzing complex data to identify patterns or anomalies.

• Excellent written, verbal, and interpersonal communication abilities.

• Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) preferred (or may be mandated based on contract obligations).

• Ability to maintain confidentiality and make sound judgments.

• Capability to work both independently and collaboratively in a team setting.

• Strong organizational skills with the capacity to prioritize multiple tasks and meet deadlines.

• Proficiency in Microsoft Office applications, including Word and Excel.

• Commitment to supporting healthcare program integrity and IntegrityM's mission, vision, and values.

🏝️ Benefits

• Vacation

• Sick leave

• Paid holidays

• Health insurance

• Dental insurance

• Vision insurance

• Short- and long-term disability

• Life insurance

• Employee assistance plan

• 401(K) retirement plan

• Educational benefits

• Flexible workplace

• Professional development opportunities