Medicaid Investigator (Northeast) NE UPIC - Remote/Field

Purisolve • Spring Hill, PA

21d • $70,000 - $70,000 • Remote

About The Position

Purisolve, Inc. is seeking a qualified Medicaid Investigator to support fraud and compliance investigations under the Northeast Unified Program Integrity Contractor (UPIC) contract. This position focuses exclusively on Medicaid-related investigations in the Northeast area, addressing potential fraud, waste, and abuse in the region’s healthcare delivery system. The ideal candidate has experience conducting investigations in Medicaid environments—particularly for or with CMS contractors—and demonstrates strong interviewing, analytical, and written communication skills. This is a mission-critical role that contributes directly to safeguarding taxpayer-funded healthcare programs.

Requirements

• 3+ years of investigative experience focused on Medicaid, Medicare, or healthcare program integrity.
• Demonstrated proficiency in interviewing, evidence gathering, and report drafting.
• Ability to work in a high-paced environment handling numerous concurrent investigations.
• Strong working knowledge of Medicaid policies, fraud typologies, and regulatory enforcement.
• Excellent written communication and attention to detail.
• Proficiency in Microsoft Office applications (Word, Excel, Outlook).
• Residence in Northeastern US and willingness to travel occasionally for site visits.

Nice To Haves

• Prior experience supporting ZPIC, UPIC, or SIU (Special Investigations Unit) contracts.
• Familiarity with Medicaid rules and provider structures.
• Certified Fraud Examiner (CFE) or other fraud-related credentials.
• Experience using electronic case management and claims analytics tools.

Responsibilities

• Conduct field-based investigations related to Medicaid fraud, abuse, or non-compliance, aligned with UPIC protocols and state-specific Medicaid rules.
• Interview healthcare providers, beneficiaries, and witnesses to gather key case evidence.
• Analyze Medicaid claims, billing patterns, and supporting documentation to identify irregularities or suspicious activity.
• Prepare detailed investigative reports suitable for law enforcement referrals, overpayment recovery, or administrative actions.
• Collaborate with law enforcement entities, state Medicaid agencies, and CMS stakeholders.
• Maintain and manage documentation and case files in compliance with CMS and contractual standards.
• Represent Purisolve with professionalism and discretion during field engagements and stakeholder communications.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED