Medicare & Medicaid Program Integrity Investigator

SoftDev Incorporated; New London (CT); On-site; USD 60,000 - 90,000; Full time

Job summary

SoftDev is seeking a qualified Program Integrity Analyst to join our CMS-related program integrity team in the New London, CT area. The role focuses on high-level investigations of medical providers, developing cases for action, and coordinating with state and federal partners to enforce program rules and safeguard beneficiary interests.

The position requires strong investigative, communication, and organizational skills, background checks, and the ability to work independently or as part of a

Qualifications

• Prerequisites: US citizenship or Green Card
• BS 5-7 years, MS 3-5, PhD 0-2
• Three to five years investigative experience preferred
• Strong investigative skills
• Strong communication and organization skills
• Experience in reviewing claims for technical requirements, medical review, and/or developing fraud cases
• Must pass a drug screening
• Must pass a criminal background check
• Must reside in FL, GA, AL, TN, SC, NC, VA, or WV

Responsibilities

• Conduct high level complex investigations of medical providers
• Develop cases for action including referrals to law enforcement
• Respond to data requests and support investigations
• Prepare investigative reports applying relevant regulations
• Maintain confidentiality of health information in compliance with laws
• Present findings and educate stakeholders on program safeguard matters
• Appear in court to testify about work findings
• Manage multiple caseloads and document all steps thoroughly

Skills

Investigative skills

Communication skills

Organizational skills

Drug screening

Criminal background check

Education

Bachelor's degree

Master's degree

PhD

Job description

SoftDev is seeking a qualified Program Integrity Analyst to join our CMS-related program integrity team in the New London, CT area. The role focuses on high-level investigations of medical providers, developing cases for action, and coordinating with state and federal partners to enforce program rules and safeguard beneficiary interests.

The position requires strong investigative, communication, and organizational skills, background checks, and the ability to work independently or as part of a