Senior Investigator

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

📋 Description

• Perform background research to uncover pertinent information about individuals, organizations, or entities undergoing review.

• Execute investigations related to potential fraud, waste, and abuse.

• Assess healthcare and operational data to pinpoint trends, irregularities, and possible indicators of fraud.

• Review relevant laws, regulations, policies, and guidance to facilitate investigative endeavors.

• Gather, review, and analyze records and documentation pertinent to investigations.

• Conduct interviews and ensure accountability for evidentiary materials in line with established protocols.

• Record investigative findings and compile clear, well-supported reports and recommendations.

• Collaborate with internal staff, legal counsel, government representatives, and law enforcement agencies, as necessary.

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

• Enter and maintain investigation-related information in case management and tracking systems.

• Present investigative findings and recommendations to management and clients.

• Assist in identifying emerging fraud schemes and suggest new investigative priorities.

• Prepare regular and ad hoc reports concerning investigative activities and case status.

• Adhere to established quality standards and 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 related to fraud, waste, and abuse is preferred.

• Strong investigative, analytical, and problem-solving abilities.

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

• Proficient in analyzing intricate data and identifying patterns or anomalies.

• Excellent written, verbal, and interpersonal communication skills.

• Certification as a Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) is preferred (or may be required based on contract stipulations).

• Ability to maintain confidentiality and demonstrate sound judgment.

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

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

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

• A commitment to supporting healthcare program integrity and aligning with 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