Investigator Jobs

About The 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; 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 indicators of fraud.
• Review applicable laws, regulations, policies, and guidance to support investigative activities.
• 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 with internal staff, legal counsel, government stakeholders, and law enforcement agencies as appropriate.
• 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 about investigative activities and case status.
• Meet established quality standards and project deadlines.

Benefits

• Vacation
• Sick leave
• Paid holidays
• Health insurance
• Dental insurance
• Vision insurance
• Short- and long-term disability insurance
• Life insurance
• Employee assistance plan
• 401(k) retirement plan
• Educational benefits