Investigator III
About The Position
The Investigator III will support the integrity and effectiveness of federal healthcare programs through rigorous investigations, compliance oversight, and risk assessment. This role will support the review of pharmacies, dispensers, and manufacturers; develop investigative strategies and compliance processes; analyze data and evidence; and produce clear, actionable findings. The ideal candidate combines expertise in Medicare Part D, pharmaceutical pricing, and federal healthcare regulations with strong analytical, investigative, communication, and project management skills. This position will also collaborate with CMS, OIG, legal, audit, and other stakeholders while serving as a subject matter expert and mentor to support consistent, high-quality program integrity efforts.
Requirements
- Bachelor’s degree plus 5 years of relevant professional experience, or Associates degree plus 8 years of relevant professional experience, or High school diploma plus 9 years of relevant professional experience
- Demonstrated knowledge of Medicare Part D, drug pricing, manufacturer rebate structures, or government pricing programs.
- Strong analytical and investigative skills.
- Knowledge of federal healthcare regulations, especially those related to pharmaceutical pricing and compliance with government programs.
- Exceptional communication and writing skills, with ability to present complex findings to technical and non-technical audiences.
- Strong project management skills with the ability to manage multiple investigations simultaneously.
- Experience using case management systems, e-discovery tools, and data analytics platforms.
Responsibilities
- Support the Investigation Lead with functions of the task order, including the review of dispensers, pharmacies, and manufacturers’ practices to ensure adherence to Negotiation Program requirements.
- Assist in the development of all necessary compliance requirements to inform compliance, investigations, reporting, and market surveillance activities.
- Assist in developing necessary investigation processes to ensure implementation of timely, thorough, and unbiased investigations.
- Assist in developing an investigation strategy and approach to ensure investigations are completed in accordance with program timelines and quality standards.
- Identify and assess potential risks or violations through data analysis, stakeholder interviews, audits, and tips received through oversight channels.
- Assist with intake, triage, and prioritization of investigative matters aligned with CMS compliance objectives.
- Collaborate with data analysts, auditors, compliance officers, legal experts, and other stakeholders to collect and assess evidence.
- Draft detailed investigation plans, memoranda, and final reports with actionable findings and recommendations.
- Coordinate with CMS, OIG, and other federal oversight bodies on escalated matters requiring enforcement or corrective action.
- Maintain a secure, documented chain of evidence throughout each case in compliance with federal guidelines.
- Establish and refine investigation protocols, SOPs, and escalation procedures in coordination with the complaint/dispute and auditing teams.
- Mentor junior staff and serve as subject matter expert (SME) related to investigative techniques and healthcare program integrity.
Benefits
- A variety of additional benefits
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
