Integrity Management Services, Inc.

Role Description We are seeking a Senior Investigator to join our team. In this role, the Senior Investigator will conduct investigations that support healthcare program integrity initiatives by identifying potential fraud, waste, and abuse (FWA), analyzing complex information, and developing investigative findings. The Senior Investigator will use a variety of investigative techniques and analytical tools to identify subjects, develop cases, document findings, and recommend appropriate administrative or enforcement actions. This position works both independently and collaboratively with investigators, analysts, subject matter experts, and program leadership. Responsibilities - Conduct background research to identify relevant information regarding individuals, organizations, or entities under review. - Conduct investigations involving potential fraud, waste, and abuse. - Analyze healthcare and operational data to identify trends, anomalies, and potential indicators of fraud. - Review applicable laws, regulations, policies, and guidance to support investigative activities. - Collect, review, and analyze records and documentation relevant to investigations. - Conduct interviews and maintain accountability for evidentiary materials in accordance with established procedures. - Document investigative findings and prepare clear, well-supported reports and recommendations. - Coordinate with internal staff, legal counsel, government stakeholders, and law enforcement agencies, as appropriate. - Collaborate with investigators, analysts, program managers, and subject matter experts to develop investigative strategies and resolve cases. - Enter and maintain investigative information in case management and tracking systems. - Present investigative findings and recommendations to management and clients. - Assist with identifying emerging fraud schemes and recommending new investigative priorities. - Prepare recurring and ad hoc reports regarding investigative activities and case status. - Meet established quality standards and project deadlines. Qualifications - Bachelor's degree in criminal justice, law enforcement, healthcare administration, data analysis, or a related field, or equivalent combination of 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 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) preferred (or may be required based on contract requirements). - Ability to maintain confidentiality and exercise sound judgment. - Ability to work independently and collaboratively within a team environment. - Strong organizational skills with the ability to prioritize multiple assignments and meet deadlines. - Proficiency with Microsoft Office applications, including Word and Excel. - Passion for 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

Role Description We are seeking a Statistician to join our Data Analytics team. In this role, the Statistician will provide statistical and analytical support for healthcare data analysis projects using a variety of statistical methods and analytical tools. Working under the guidance of senior analytical staff, the Statistician will develop, analyze, and interpret complex datasets to support program integrity, healthcare operations, and business decision-making. This position works both independently and collaboratively with data analysts, statisticians, and project leadership to produce high-quality deliverables for clients. Responsibilities - Perform data extraction, cleaning, validation, transformation, and maintenance across multiple data sources. - Conduct statistical analyses and quantitative data mining to identify trends, patterns, anomalies, and other meaningful insights. - Develop reports, dashboards, summaries, and visualizations to communicate analytical findings. - Compile, validate, interpret, and present data to support operational and business objectives. - Perform statistical programming and data analysis using analytical software and programming languages. - Design and execute database queries to retrieve and analyze data from large datasets. - Prepare clear, concise, and accurate reports, memoranda, data files, and presentations for internal and external stakeholders. - Communicate analytical methods, assumptions, and results to both technical and non-technical audiences. - Support internal quality reviews, audits, and data validation activities. - Participate in team projects, methodology discussions, and continuous process improvement initiatives. - Stay current on statistical methods, healthcare industry trends, data analytics technologies, and applicable regulations. - Perform ad hoc analyses and other duties as assigned. - Maintain compliance with all applicable privacy, security, and confidentiality requirements. - Adhere to IntegrityM policies and client requirements governing the protection of sensitive information. Qualifications - Bachelor's degree in Statistics, Biostatistics, Mathematics, Computer Science, Data Science, or a related quantitative field. - Minimum of two years of experience using statistical programming languages (e.g., SAS, Python, R, or SQL). - Preferred experience with statistical methodologies and relational databases. - Minimum of three years of experience analyzing healthcare, health insurance, or government healthcare program data. - Preferred experience working with healthcare claims, clinical, financial, or administrative datasets. - Advanced knowledge of statistical analysis, quantitative methods, and analytical problem solving. - Proficiency with Python, Databricks, SAS, SQL, Excel, Word, PowerPoint, and other analytical tools. - Experience developing queries, analyzing large datasets, and interpreting complex data. - Strong written and verbal communication skills with the ability to explain technical concepts to non-technical audiences. - Strong organizational, analytical, and problem-solving skills. - Ability to work independently while collaborating effectively within a multidisciplinary team. - Ability to manage multiple priorities and meet established deadlines. - Passion for supporting healthcare program integrity and IntegrityM's mission, vision, values, and operating principles. 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

Role Description This position supports identification and selection of a business leader who owns strategy and execution for expansion into state markets for IntegrityM. The role focuses on building and advancing a state market strategy, with emphasis on state health and human services programs, including Medicaid managed care and related oversight activities. - The selected leader brings deep experience working with state clients and plays a central role in expanding IntegrityM beyond its federal base. - This individual builds the new State market practice by aligning company capabilities with state needs, shaping growth strategy, and leading execution from opportunity identification through delivery. - This role serves as the primary leader for state market development. - Responsibilities include: - Relationship development - Portfolio growth - Capture strategy - Initial delivery oversight until work scales - The leader collaborates with internal teams to support procurement, pricing, and execution while driving client diversification and revenue growth. - This leader builds, grows, and delivers IntegrityM’s state market presence. - The role requires ownership of the full lifecycle from market entry through execution, with support from internal teams. - Success depends on the ability to establish relationships, drive strategy, secure work, and guide early delivery while scaling a sustainable market presence. Qualifications - Minimum of ten years working with state health and human services programs and/or state managed care environments - At least seven years of government healthcare payer experience - Experience managing teams with client contract responsibility, including both business development and delivery - Demonstrated experience in: - Driving growth with existing clients and winning new state clients - Building and launching services in new markets - Managing long sales cycles, including qualification, capture management, competitive positioning, and price to win - Identifying and developing partnerships to maximize market success - Leading conference strategy and execution, including team coordination, sponsorships, presentations, and prospect identification - Proven ability to establish and grow a new market practice, including developing strategy, refining tactics, and scaling across multiple states - Experience serving in a dual role as growth leader and program leader, with accountability for both winning and delivering work Requirements - Strong relationship development skills with state clients and stakeholders - Ability to connect market needs with organizational capabilities and translate strategy into actionable plans - Skilled leader with ability to mentor team members and drive high motivation - Excellent collaboration skills with peers across growth, delivery, and leadership teams - Resilience and patience required to navigate state procurement cycles and market entry challenges - Knowledge of CRM processes, including pipeline management and opportunity tracking - Ability to iterate market entry strategies across states and support expansion of account management structure as growth occurs - Strong business acumen, including understanding of state environments, funding structures, and program oversight - Project and program management experience preferred

Role Description We are seeking a creative Federal Proposal Writer to join our team. The right candidate will be a strong collaborator, highly organized to help manage marketing needs, and rapidly synthesize information from disparate sources to draft compelling, persuasive content. Projects will include (but not be limited to) formal proposals, marketing collateral, blogs, whitepapers, and other business development material. Responsibilities - Work closely with the Marketing team, Business Development Team, Executive team, subject matter experts, and other IntegrityM personnel to produce winning content. - Responsible for creation, edits, and final review of proposed publications. - Help manage marketing needs via Trello/other digital PM tools. - Gather necessary information from program personnel and research applicable policy, regulations, and best practices to support the team in developing, writing, formatting, and editing technical and non‐technical information for reports, white papers, blogs, marketing collateral, procedures, processes, briefs, and other forms of documentation. - Provide technical and editorial document review and written feedback on documents. - Maintain regular and frequent direct communication with subordinates to clearly articulate goals and priorities, and build trust and confidence. - Meet with proposal team to strategize win themes and proposal approaches. - Interview technical subject matter experts and develop written narrative from these interviews. - Write a variety of proposal sections, including executive summaries, technical approaches, management plans, and other content, and integrate proposal content authored by other writers into cohesive, compliant technical proposals with the flow of one voice. - Proofread and edit all work product: Review all proposals for consistent style and formatting according to company style guidelines. Ensure accurate spelling, punctuation, and grammar. - Stay informed of market developments in creative areas through reading, industry involvement, and research to determine competitive factors our company must address to stay viable and profitable. Qualifications - 5+ years’ experience as a content writer/editor. Federal Proposal writing experience a strong plus. - Bachelor’s degree in English, Technical Writing, Communications; preferred. - Administrative/project coordination experience preferred. - Highly organized and can help manage marketing needs via Trello/other digital PM tools. - Experienced in the art of persuasive writing in proposals, blogs, whitepapers, etc. - Excellent verbal communication skills including a robust vocabulary and thorough understanding of proper English language usage. - Excellent listening skills including the ability to interview staff and translate information into a clear, compelling message. - Excellent written communication, including proofreading, grammar, spelling, and editing skills. - Must be comfortable collaborating with senior staff and operating in a fast-paced environment while adapting to changing project requirements. - Strong time management habits and ability to meet deadlines. - Strong visual organization skills with keen attention to detail. - Self-motivated and able to work with minimal supervision. - Proficient with MS Office (Word, Excel, PowerPoint), skilled in Internet usage and research. - Knowledge of government contracting; preferred analytics and/or solutions. - Digital Marketing & Graphic Design experience is a plus. - Experience with HHS & CMS. Benefits - Flexible workplace offering an exceptional quality of life. - Corporate-driven sustainability initiatives. - Creative solutions that exceed goals and foster a dynamic, idea-driven environment. - Opportunities for professional development. Company Description Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste, and abuse in government programs. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review. At IntegrityM, we offer a culture of opportunity, recognition, collaboration, and supporting our community. We thrive off of these fundamental elements that make IntegrityM a great place to work. IntegrityM is an Equal Opportunity Employer and we do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, and gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Role Description We are seeking a detail-oriented SIU Investigator to join our team. In this role, you will play a crucial role in ensuring the accuracy, compliance, and integrity of healthcare claims through comprehensive audits, analyses, and process improvements. The SIU Investigator (Analyst) primary responsibility is to detect, investigate, and produce change in aberrant behavior observed in our healthcare customer's claims and enrollment data. You will work both independently and with a team of clinical SMEs to analyze data, assess exposure, and manage investigative caseload from identification through to resolution including overpayment recovery, measuring behavior change and completing necessary reporting for FWA recoupments and savings. Qualifications - Bachelor's degree in Criminal Justice or a related field, OR at least 3 years of insurance claims investigation experience or professional investigation experience with law enforcement agencies. - Minimum of 2 years of experience in healthcare claims analysis, auditing, payment integrity, or a related field. - Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity. - Experience handling confidential information and following policies, rules, and regulations. - Experience with commercial, Medicare, or Medicaid claims is highly preferred. - Strong analytical and problem-solving skills, with attention to detail and accuracy. - Excellent communication skills, both written and verbal, for effective collaboration with internal teams and external providers. - Proficiency in Microsoft Office, particularly Excel, and familiarity with claims processing or audit software is a plus. Requirements - Identify and conduct investigations into known or suspected FWA with high autonomy. - Develop documentation to substantiate findings, including formal reports, graphs, audit logs, and other supporting documentation. - Perform root cause analysis to inform future algorithmic identification of similar claims or cases and associated savings (i.e., help move identified case types from "pay-and-chase" to preventive edits and pre-payment activity). - Participate in the development and presentation of FWA-related education for assigned Customers. - Perform coding reviews for flagged claims, to support Coding team (if applicable). Preferred Qualifications - Certifications: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML (Anti-Money Laundering) and Fraud Professional (CAFP), or similar desired. - Additional Certifications: Certified Professional Coder (CPC) or similar desired.

Role Description We are seeking a detail-oriented SIU Investigator to join our team. In this role, you will play a crucial role in ensuring the accuracy, compliance, and integrity of healthcare claims through comprehensive audits, analyses, and process improvements. The SIU Investigator (Analyst) primary responsibility is to detect, investigate, and produce change in aberrant behavior observed in our healthcare customer's claims and enrollment data. You will work both independently and with a team of clinical SMEs to analyze data, assess exposure, and manage investigative caseload from identification through to resolution including overpayment recovery, measuring behavior change and completing necessary reporting for FWA recoupments and savings. Qualifications - Bachelor's degree in Criminal Justice or a related field, OR at least 3 years of insurance claims investigation experience or professional investigation experience with law enforcement agencies. - Minimum of 2 years of experience in healthcare claims analysis, auditing, payment integrity, or a related field. - Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity. - Experience handling confidential information and following policies, rules, and regulations. - Experience with commercial, Medicare, or Medicaid claims is highly preferred. - Strong analytical and problem-solving skills, with attention to detail and accuracy. - Excellent communication skills, both written and verbal, for effective collaboration with internal teams and external providers. - Proficiency in Microsoft Office, particularly Excel, and familiarity with claims processing or audit software is a plus. Requirements - Identify and conduct investigations into known or suspected FWA with high autonomy. - Develop documentation to substantiate findings, including formal reports, graphs, audit logs, and other supporting documentation. - Perform root cause analysis to inform future algorithmic identification of similar claims or cases and associated savings (i.e., help move identified case types from "pay-and-chase" to preventive edits and pre-payment activity). - Participate in the development and presentation of FWA-related education for assigned Customers. - Perform coding reviews for flagged claims, to support Coding team (if applicable). Preferred Qualifications - Certifications: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML (Anti-Money Laundering) and Fraud Professional (CAFP), or similar desired. - Additional Certifications: Certified Professional Coder (CPC) or similar desired.

Role Description This position supports identification and selection of a business leader who owns strategy and execution for expansion into state markets for IntegrityM. The role focuses on building and advancing a state market strategy, with emphasis on state health and human services programs, including Medicaid managed care and related oversight activities. - The selected leader brings deep experience working with state clients and plays a central role in expanding IntegrityM beyond its federal base. - This individual builds the new State market practice by aligning company capabilities with state needs, shaping growth strategy, and leading execution from opportunity identification through delivery. - This role serves as the primary leader for state market development. - Responsibilities include: - Relationship development - Portfolio growth - Capture strategy - Initial delivery oversight until work scales - The leader collaborates with internal teams to support procurement, pricing, and execution while driving client diversification and revenue growth. - This leader builds, grows, and delivers IntegrityM’s state market presence. - The role requires ownership of the full lifecycle from market entry through execution, with support from internal teams. - Success depends on ability to establish relationships, drive strategy, secure work, and guide early delivery while scaling a sustainable market presence. Qualifications - Minimum of ten years working with state health and human services programs and/or state managed care environments - At least seven years of government healthcare payer experience - Experience managing teams with client contract responsibility, including both business development and delivery - Demonstrated experience in: - Driving growth with existing clients and winning new state clients - Building and launching services in new markets - Managing long sales cycles, including qualification, capture management, competitive positioning, and price to win - Identifying and developing partnerships to maximize market success - Leading conference strategy and execution, including team coordination, sponsorships, presentations, and prospect identification - Proven ability to establish and grow a new market practice, including developing strategy, refining tactics, and scaling across multiple states - Experience serving in a dual role as growth leader and program leader, with accountability for both winning and delivering work Requirements - Strong relationship development skills with state clients and stakeholders - Ability to connect market needs with organizational capabilities and translate strategy into actionable plans - Skilled leader with ability to mentor team members and drive high motivation - Excellent collaboration skills with peers across growth, delivery, and leadership teams - Resilience and patience required to navigate state procurement cycles and market entry challenges - Knowledge of CRM processes, including pipeline management and opportunity tracking - Ability to iterate market entry strategies across states and support expansion of account management structure as growth occurs - Strong business acumen, including understanding of state environments, funding structures, and program oversight - Project and program management experience preferred

Role Description We are seeking a detail-oriented SIU Analyst/Investigator to join our team. In this role, you will play a crucial role in ensuring the accuracy, compliance, and integrity of healthcare claims through comprehensive audits, analyses, and process improvements. The SIU Investigator (Analyst) primary responsibility is to detect, investigate, and produce change in aberrant behavior observed in our healthcare customer's claims and enrollment data. You will work both independently and with a team of clinical SMEs to analyze data, assess exposure, and manage investigative caseload from identification through to resolution including overpayment recovery, measuring behavior change and completing necessary reporting for FWA recoupments and savings. Key Responsibilities - Identify and conduct investigations into known or suspected FWA with high autonomy. - Develop documentation to substantiate findings, including formal reports, graphs, audit logs, and other supporting documentation. - Perform root cause analysis to inform future algorithmic identification of similar claims or cases and associated savings (i.e., help move identified case types from "pay-and-chase" to preventive edits and pre-payment activity). - Participate in the development and presentation of FWA-related education for assigned Customers. - Perform coding reviews for flagged claims, to support Coding team (if applicable). Qualifications - Bachelor's degree in Criminal Justice or a related field, OR at least 3 years of insurance claims investigation experience or professional investigation experience with law enforcement agencies. - Minimum of 2 years of experience in healthcare claims analysis, auditing, payment integrity, or a related field. - Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity. - Experience handling confidential information and following policies, rules, and regulations. - Experience with commercial, Medicare, or Medicaid claims is highly preferred. - Strong analytical and problem-solving skills, with attention to detail and accuracy. - Excellent communication skills, both written and verbal, for effective collaboration with internal teams and external providers. - Proficiency in Microsoft Office, particularly Excel, and familiarity with claims processing or audit software is a plus. Preferred Qualifications - Certifications: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML (Anti-Money Laundering) and Fraud Professional (CAFP), or similar desired. - Additional Certifications: Certified Professional Coder (CPC) or similar desired.

Role Description In this role, the Medicaid Audit and Compliance Specialist will be responsible for performing and reporting on Medicaid Managed Care Plans and providers to identify potential fraud, waste, and abuse; issue findings and recommendations; and identify improper payments. Audit assignments can be programmatic or financial and may range from desk reviews and/or onsite review activities as determined by federal and state regulations. Specific review types may include: - Case management - Program payment appropriateness - Program and policy compliance - Billing, coding, and medical record documentation reviews - Research and analysis of industry trends The Medicaid Audit and Compliance Specialist will perform audits as assigned which consist of but are not limited to: - Performing licensing and exclusion reviews on providers - Working with the medical staff to ensure services are reimbursed meet regulatory requirements - Working independently as well as collaboratively with other audit staff Qualifications - Bachelor’s Degree in finance, accounting or related field required - 5-7 Years of related experience in finance, accounting, or auditing - Intermediate knowledge of internal audit policies and operating principles - Intermediate knowledge and experience in auditing Medicare/Medicaid and other government payment and oversight programs (CMS, HRSA, OIG, DOE, Dept. of Commerce etc.) - Knowledge and experience in the application of government accounting principles and standards, including Generally Accepted Government Auditing Standards (GAGAS) - Experienced investigative skills - Strong data analysis skills - Knowledge of medical terminology, ICD-9-CM, ICD-10-CM HCPCS level II and CPT codes - Experience in reviewing claims for appropriate billing and medical coding requirements, performing medical review, and/or developing fraud cases - Strong oral and written communication skills, strong interpersonal skills, and superior organizational abilities - Ability to take initiative, to maintain confidentiality, to meet deadlines, and to work in a team environment - Ability to report work activity on a timely basis - Ability to work independently and as a member of a team to deliver high quality work - Ability to multitask and prioritize assignments while meeting deadlines - Proficiency in Microsoft Office, specifically Microsoft Word and Excel - Passion and alignment with IntegrityM’s mission, vision, values and operating principles Requirements - Must pass post hire background screening checks - For remote work, required to have wired and/or wireless internet access

Role Description IntegrityM is seeking an experienced Audit Manager to lead and oversee complex healthcare program audits in support of federal oversight initiatives. This full-time leadership role is responsible for managing audit engagements, supervising professional staff, ensuring compliance with government auditing standards, and delivering high-quality audit reports to support program integrity objectives. The ideal candidate brings strong experience in healthcare auditing, deep knowledge of federal health program requirements, and demonstrated success managing audit teams in a regulated environment. Key Responsibilities - Lead and manage multiple audit engagements from planning through reporting and follow-up. - Develop audit work plans, risk assessments, and testing methodologies. - Ensure compliance with applicable federal regulations, program guidance, and Government Auditing Standards (GAGAS). - Supervise, mentor, and evaluate audit staff. - Review workpapers, findings, and reports for accuracy, quality, and adherence to standards. - Communicate audit results and recommendations to senior leadership and external stakeholders. - Identify emerging risks and recommend process improvements. - Support continuous enhancement of audit methodologies and internal quality controls. Qualifications - Minimum of three (3) years of management experience in the auditing field. - Demonstrated knowledge of federal healthcare programs, related regulations, manuals, coverage and payment rules, and Government Auditing Standards (GAGAS). - Experience auditing managed care or health plan organizations preferred. Requirements - Bachelor’s degree in accounting or equivalent from an accredited institution required. - Master’s degree preferred. - Current Certified Public Accountant (CPA) license preferred. Core Competencies - Strong leadership and team management skills. - Advanced knowledge of audit principles, risk assessment, and internal controls. - Excellent analytical, organizational, and problem-solving abilities. - Strong written and verbal communication skills. - Ability to manage competing priorities in a deadline-driven environment.