Program Integrity Researcher
About The Position
The Program Integrity Researcher is responsible for reviewing, documenting, and researching incoming allegations, referrals, and requests related to potential fraud, waste, and abuse. This role supports program integrity operations by creating and maintaining accurate database records, gathering relevant information through follow-up outreach, and obtaining supporting documentation such as medical records and claims data. The position requires strong attention to detail, organizational skills, and the ability to handle sensitive information professionally and confidentially. Our Government Contract Requires US Citizenship for this Position.
Requirements
- High School Diploma
- Basic Computer Knowledge
- Experience Conducting Telephone Outreach and Follow-up Conversations
- Strong Data Entry and Documentation Skills with High Attention to Detail
- Ability to Manage Multiple Assignments and Prioritize
- Organizational and Time Management
Nice To Haves
- Basic Medical Claims Experience
- Experience Working with Healthcare Documentation and Databases
- Experience in Program Integrity, Healthcare, Claims Review
Responsibilities
- Review incoming referrals and documentation to ensure all relevant details are captured in the case management system.
- Conduct follow-up calls to members, providers, internal partners, or other involved parties to verify information and gather additional details needed for research or case development.
- Request and track medical records needed to support program integrity reviews and investigations.
- Request, obtain, and organize claims data for analysis and review.
- Support analysts, investigators, and leadership by preparing case information and documentation for further review.
Benefits
- medical, dental and vision benefits
- 401(k) retirement savings plan
- time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
- short-term and long-term disability
- life insurance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
