(763) Senior Healthcare Fraud Investigator

Arlo Solutions LLC•Washington, DC

8d•Hybrid

About The Position

Arlo Solutions is supporting the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Office of Integrity and Compliance (OIC) in standing up and running the VHA Fraud Rapid Response Center ("VA War Room"). The War Room uses data analytics, fraud risk assessment and fast administrative action to protect Veterans and taxpayer dollars, in line with Executive Orders 14395 and 14243. The work gets high-level oversight and reporting to the White House, Congress, the Secretary of Veterans Affairs and the Under Secretary for Health. The Senior Healthcare Fraud Investigator leads healthcare fraud lead and case development from day one, turning analytic leads from VA's Palantir platform into weekly, decision-ready War Room referral packages. The role is advisory and analytical. All final decisions stay with Government personnel.

Requirements

Bachelor's degree in a relevant field
8+ years of federal healthcare program integrity and fraud investigations experience, such as Medicare/Medicaid and VHA healthcare fraud referrals and case development
Working knowledge of healthcare fraud law: the False Claims Act, Anti-Kickback Statute, Stark Law, Civil Monetary Penalties Law and HHS OIG exclusion authorities
Strong written and verbal communication for executive-level audiences
Able to pass or hold a Tier 2 / Moderate Background Investigation (MBI)

Nice To Haves

Certified Fraud Examiner (CFE) certification
Current or prior VA/VHA system access, or current active VA contractor status
Experience working with HHS OIG, VA OIG or other federal law enforcement on healthcare fraud referrals
Experience with VA Community Care claims, CMS program integrity data or provider exclusion screening
Familiarity with Palantir or similar analytics and case-management platforms
Experience with CIRTS or similar compliance case-tracking systems
Knowledge of GAO Green Book, OMB A-123 and Payment Integrity Act fraud risk frameworks

Responsibilities

Review and validate anomalies and prioritized leads from the War Room analytics (including Provider 360, anomaly detection and network analysis).
Develop cases for potential community care provider fraud, waste and abuse (FWA) and coordinated billing schemes.
Build War Room referral packages with documentation that supports potential administrative actions, such as provider removals, referral holds, recoupments and referrals to oversight bodies.
Help produce weekly analytic runs and decision-ready case packages that include facts, analysis, a recommendation and traceability.
Prepare claim review workpapers and determination packages and apply case-file QA checklists and sampling plans.
Help design the end-to-end case workflow from intake to closure, including roles, handoffs, SLAs and escalation paths, aligned with CIRTS triage practices.
Contribute to the intake and triage SOPs, the case lifecycle and status taxonomy, and standard investigation templates.
Keep the overpayment, recovery and referral status tracking register and the oversight and tracking log up to date.
Give investigative subject-matter input on FWA scheme typologies, rule logic, provider risk-scoring and case-prioritization criteria.
Do case documentation and evidence work only under real, active direction from a federal investigator. No opening cases, making findings or making referral decisions.
Work closely with OIC staff, VA OIG and VHA stakeholders.
Support ad hoc white papers, outcome summaries and leadership briefings.
Help with training materials, kaizen sessions, after-action debriefs and knowledge transfer so VA staff can run War Room operations on their own by contract end.