Sr. Investigator (Full-time, Remote)

Integrity Management Services•Alexandria, VA

20d•Remote

About The Position

Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business that supports government and commercial clients with compliance and program integrity, including preventing and detecting fraud, waste, and abuse. Its work includes data analytics, technology solutions, audits, investigations, and medical review. IntegrityM describes its workplace as flexible, collaborative, opportunity-focused, and supportive of professional development and corporate-driven sustainability. The Senior Investigator supports healthcare program integrity initiatives by identifying potential fraud, waste, and abuse, analyzing complex information, and developing investigative findings. The role uses investigative techniques and analytical tools to identify subjects, develop cases, document findings, and recommend administrative or enforcement actions. The investigator works independently and collaboratively with investigators, analysts, subject matter experts, and program leadership. This is a full-time remote position.

Requirements

Bachelor's degree in criminal justice, law enforcement, healthcare administration, data analysis, or a related field, or an equivalent combination of education and relevant experience.
Two or more years of experience supporting healthcare program integrity, fraud investigations, Medicare, Medicaid, commercial healthcare, or other government healthcare programs.
Strong investigative, analytical, and problem-solving skills.
Experience reviewing healthcare claims, enrollment records, medical records, or other complex documentation.
Experience analyzing complex data and identifying patterns or anomalies.
Strong written, verbal, and interpersonal communication skills.
Ability to maintain confidentiality and exercise sound judgment.
Ability to work independently and collaboratively within a team environment.
Strong organizational skills and ability to prioritize multiple assignments and meet deadlines.
Proficiency with Microsoft Office applications, including Word and Excel.
Passion for supporting healthcare program integrity and IntegrityM's mission, vision, and values.

Nice To Haves

Experience conducting fraud, waste, and abuse investigations.
Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) certification; certification may be required based on contract requirements.

Responsibilities

Conduct background research to identify relevant information about individuals, organizations, or entities under review.
Investigate potential fraud, waste, and abuse.
Analyze healthcare and operational data to identify trends, anomalies, and potential fraud indicators.
Review applicable laws, regulations, policies, and guidance to support investigations.
Collect, review, and analyze records and documentation relevant to investigations.
Conduct interviews and maintain accountability for evidentiary materials in accordance with established procedures.
Document investigative findings and prepare clear, well-supported reports and recommendations.
Coordinate, as appropriate, with internal staff, legal counsel, government stakeholders, and law enforcement agencies.
Collaborate with investigators, analysts, program managers, and subject matter experts to develop investigative strategies and resolve cases.
Enter and maintain investigative information in case management and tracking systems.
Present investigative findings and recommendations to management and clients.
Help identify emerging fraud schemes and recommend new investigative priorities.
Prepare recurring and ad hoc reports on investigative activities and case status.
Meet established quality standards and project deadlines.