Supervisor – Field Audit/Investigation

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

📋 Description

• Manage audits and investigations, along with the overall audit/investigation workload.

• Conduct thorough evaluations and make informed field-level decisions regarding potential fraud, waste, and abuse in government programs.

• Review incoming audits/investigations and leads, assigning tasks to auditors and investigators accordingly.

• Assess providers and/or retailers in collaboration with agencies and law enforcement, overseeing the vetting procedure.

• Evaluate audit/investigation plans, operational strategies, priorities, files, requests, data, reports, and correspondence to ensure quality and relevance.

• Oversee and perform interviews, onsite audits/investigations, site verifications, and liaise with law enforcement agencies.

• Lead audit/investigation initiatives by developing strategies, organizing stakeholder meetings, reviewing project actions, and documenting findings.

• Collaborate with senior leadership, Data and Medical Review departments, program integrity contractors, regulators, and law enforcement authorities.

• Prepare, present, and summarize audit/investigation outcomes, overpayments, and inquiries for stakeholder meetings.

• Document case details and review findings in tracking systems.

• Assess whether issues of fraud, waste, and abuse align with established criteria.

• Review findings with auditors and investigators, approving recommended actions and closing summaries.

• Prepare team audits/investigations for client presentations and conduct quality assurance reviews.

• Initiate and maintain communication with law enforcement and regulatory bodies concerning further investigations, prosecutions, or administrative remedies.

• Oversee administrative remedies such as payment suspensions, revocations, and provider education initiatives.

• Collect and provide information requested by internal and external stakeholders, including CMS, USDA, law enforcement, and FOIA requests.

• Provide testimony in legal or administrative proceedings as required.

• Manage team performance through consistent feedback and formal performance evaluations.

⛳️ Requirements

• A Bachelor's degree is required; education may be substituted with relevant experience.

• A minimum of 5–7 years of experience is required; 8–11 years is preferred, with experience being a substitute for education.

• Certification as a Fraud Examiner or Accredited Healthcare Anti-fraud Investigator is preferred.

• Capability to oversee audits/investigations related to government program fraud, waste, and abuse.

• Familiarity with compliance cases involving Medicare, Medicaid, and/or the Supplemental Nutrition Assistance Program.

• Proficiency in conducting interviews, onsite audits/investigations, site verifications, and collaborating with law enforcement.

• Skill in preparing and presenting findings to customers, stakeholders, regulatory agencies, and law enforcement.

• Ability to testify in legal or administrative proceedings when necessary.

• Successful completion of pre-employment background checks and drug screenings is required.

🏝️ Benefits

• Equal Opportunity Employer for Minorities, Females, Protected Veterans, and Individuals with Disabilities.

• A drug-free workplace environment.

• Pre-employment background checks and drug screenings are required as part of the contingent offer process.