An elevated approach to program analysis.
Senior Investigator
Location
Virginia
Posted
1 day ago
Salary
$55K - $85K / year
Seniority
Senior
Job Description
Senior Investigator
Integrity Management Services, Inc.
• 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.
Job Requirements
- 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
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