Medicare Fraud Prevention & Education Specialist

Colorado Department of Regulatory Agencies; Denver (CO); Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

RTD EcoPass

Flexible schedules

Wellness programs

Bike-to-work program

PERA retirement benefits

Medical and Dental Insurance

Job summary

The Colorado Department of Regulatory Agencies (DORA) seeks a Senior Medicare Fraud Investigator within the Senior Health unit to investigate consumer reports of Medicare fraud and coordinate with subgrantees and partner agencies. This role focuses on SMP programs, mentors staff, and supports data entry in the online reporting system.

Strong collaboration and attention to detail are essential. The position offers a hybrid work arrangement with some in-office reporting and flexible work options

Qualifications

• Six years of professional experience in healthcare or regulatory settings.
• Experience with fraud prevention and anti-fraud awareness.
• Experience with education and training on healthcare fraud prevention.
• Strong recordkeeping and information gathering skills.

Responsibilities

• Create protocols to manage investigations and ensure proper use of federal funds.
• Conduct partner trainings on entering fraud cases and interagency coordination.
• Design training content for local affiliates on fraud prevention.
• Serve as contact for subgrantees and ensure complete case submission.
• Maintain relationships with federal, state, and local partners on Medicare fraud investigations.

Skills

Health insurance inquiries

Fraud prevention

Training coordination

Recordkeeping

Education

Associate's Degree (related field)

Job description

The Colorado Department of Regulatory Agencies (DORA) seeks a Senior Medicare Fraud Investigator within the Senior Health unit to investigate consumer reports of Medicare fraud and coordinate with subgrantees and partner agencies. This role focuses on SMP programs, mentors staff, and supports data entry in the online reporting system.

Strong collaboration and attention to detail are essential. The position offers a hybrid work arrangement with some in-office reporting and flexible work options