Fraud Investigator - Federal Healthcare
About The Position
The Fraud Investigator will work as a Project Consultant in Deloitte’s Forensics and Investigations practice, helping clients address fraud, waste, and abuse and protect the integrity of public healthcare programs. The role supports investigations and referrals of suspected healthcare fraud, including identifying emerging fraud schemes, suspicious billing patterns, identity theft, and program vulnerabilities. The position works with investigators, government program representatives, law enforcement, case teams, and analytics teams. It uses specialized databases and customized applications, supports AI-enabled workflows, and contributes to investigative procedures, workflow improvement, quality review, and presentation of findings. The role is part of Deloitte’s Government & Public Services practice and its Enterprise Operations & Risk offering. Employment is tied to the project role, with a benefits package described as competitive for project-focused professionals.
Requirements
- Bachelor’s degree.
- At least 2 years of experience with claims analysis.
- Experience with fraud detection.
- Certified Fraud Examiner (CFE) certification.
- Ability to obtain and maintain the required clearance.
- Ability to travel an average of 25%, depending on work and clients served.
- Must be legally authorized to work in the United States without employer sponsorship now or in the future.
- Ability to work independently and collaboratively as part of a team.
- Effective written and verbal communication skills.
- Meticulous attention to detail and quality of work product.
- Ability to build and sustain professional relationships.
- Ability to lead projects or workstreams.
- Ability to manage and prioritize multiple tasks in a fast-paced, dynamic environment.
- Strong interpersonal skills and professional demeanor.
- Ability to meet deadlines.
- Ability to provide clear guidance to others.
Nice To Haves
- Strong grasp of healthcare claims.
- Experience with electronic health records.
- Experience with Microsoft Excel.
Responsibilities
- Work with investigators to develop investigations and referrals of suspected healthcare fraud for potential action.
- Use specialized databases and customized applications, including development and configuration management.
- Collaborate with government program representatives, law enforcement, and case teams to gather, design, and implement investigative and referral procedures that meet quality and evidentiary standards.
- Contribute to vulnerability detection, investigative workflow, quality review, and presentation of findings.
- Support AI-enabled workflows and coordinate with analytics teams on structured and unstructured data.
- Analyze health insurance claims, open-source material, and public information to identify emerging fraud schemes and suspicious billing patterns or other potentially fraudulent activity.
- Analyze open-source and public information to identify sources of identity theft.
- Develop fraud referrals for presentation to the client, law enforcement, and other government agencies.
- Identify public health insurance program vulnerabilities through data analytics and open-source information.
Benefits
- Benefits package competitive for project-focused professionals.
- Potential eligibility to participate in a discretionary annual incentive program; any award depends on applicable program rules and individual and organizational performance.
- Deloitte offers employees a broad range of benefits.
- Opportunities for professional development, including on-the-job learning, formal development programs, leadership opportunities, and mentorship.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
