Part D Senior Investigator

OpenKrill; United States; Remote; USD 90,000 - 110,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

PTO 3.5 weeks + 11 holidays

401(k) retirement plan with 4% match

Life and disability insurance

Tuition reimbursement and professional

Job summary

Attain Talent is seeking a Part D Sr Investigator in the United States to support federal healthcare program integrity through rigorous investigations, compliance oversight, and risk assessment. You will review dispensers, pharmacies, and manufacturers; develop investigation strategies; analyze data; and produce actionable findings.

The ideal candidate has Medicare Part D and pricing experience with strong analysis, communication, and project management skills, collaborating with CMS, OIG, and

Qualifications

• Bachelor’s degree plus 5 years of relevant professional experience.
• Associates degree plus 8 years of relevant professional experience.
• High school diploma plus 9 years of relevant professional experience.
• Demonstrated knowledge of Medicare Part D, drug pricing, manufacturer rebate structures, or government pricing programs.
• Strong analytical and investigative skills.
• Knowledge of federal healthcare regulations, especially those related to pharmaceutical pricing and compliance with government programs.
• Exceptional communication and writing skills, with ability to present complex findings to technical and non-technical audiences.
• Strong project management skills with the ability to manage multiple investigations simultaneously.
• Experience using case management systems, e-discovery tools, and data analytics platforms.

Responsibilities

• Support the Investigation Lead with review of dispensers, pharmacies, and manufacturers’ practices for Negotiation Program compliance.
• Assist in developing compliance requirements for investigations, reporting, and surveillance activities.
• Help implement timely, thorough, and unbiased investigations.
• Develop an investigation strategy ensuring timelines and quality standards are met.
• Identify and assess risks through data analysis, interviews, audits, and tips.
• Assist with intake, triage, and prioritization of investigative matters.
• Collaborate with analysts, auditors, legal, and stakeholders to assess evidence.
• Draft investigation plans, memoranda, and final reports with actionable findings.
• Coordinate with CMS, OIG, and other bodies on escalated matters.
• Maintain a secure chain of evidence in line with guidelines.
• Refine SOPs and escalation procedures with teams.
• Mentor junior staff as SME in investigative techniques.

Skills

Analytical skills

Investigative skills

Project management

Data analysis

Communication skills

Writing skills

Case management

Education

Bachelor's degree + 5 years

Associates degree + 8 years

High school diploma + 9 years

Tools

Case management systems

E-discovery tools

Data analytics platforms

Job description

Attain Talent seeks a Part D Sr Investigator to support the integrity and effectiveness of federal healthcare programs through rigorous investigations, compliance oversight, and risk assessment. This role will support the review of pharmacies, dispensers, and manufacturers; develop investigative strategies and compliance processes; analyze data and evidence; and produce clear, actionable findings. The ideal candidate combines expertise in Medicare Part D, pharmaceutical pricing, and federal healthcare regulations with strong analytical, investigative, communication, and project management skills. This position will also collaborate with CMS, OIG, legal, audit, and other stakeholders while serving as a subject matter expert and mentor to support consistent, high-quality program integrity efforts.

Key Responsibilities

• - Support the Investigation Lead with functions of the task order, including the review of dispensers, pharmacies, and manufacturers’ practices to ensure adherence to Negotiation Program requirements.
• - Assist in the development of all necessary compliance requirements to inform compliance, investigations, reporting, and market surveillance activities.
• - Assist in developing necessary investigation processes to ensure implementation of timely, thorough, and unbiased investigations.
• - Assist in developing an investigation strategy and approach to ensure investigations are completed in accordance with program timelines and quality standards.
• - Identify and assess potential risks or violations through data analysis, stakeholder interviews, audits, and tips received through oversight channels.
• - Assist with intake, triage, and prioritization of investigative matters aligned with CMS compliance objectives.
• - Collaborate with data analysts, auditors, compliance officers, legal experts, and other stakeholders to collect and assess evidence.
• - Draft detailed investigation plans, memoranda, and final reports with actionable findings and recommendations.
• - Coordinate with CMS, OIG, and other federal oversight bodies on escalated matters requiring enforcement or corrective action.
• - Maintain a secure, documented chain of evidence throughout each case in compliance with federal guidelines.
• - Establish and refine investigation protocols, SOPs, and escalation procedures in coordination with the complaint/dispute and auditing teams.
• - Mentor junior staff and serve as subject matter expert (SME) related to investigative techniques and healthcare program integrity.

Qualifications

• - Bachelor’s degree plus 5 years of relevant professional experience, or
• - Associates degree plus 8 years of relevant professional experience, or
• - High school diploma plus 9 years of relevant professional experience
• - Demonstrated knowledge of Medicare Part D, drug pricing, manufacturer rebate structures, or government pricing programs.
• - Strong analytical and investigative skills.
• - Knowledge of federal healthcare regulations, especially those related to pharmaceutical pricing and compliance with government programs.
• - Exceptional communication and writing skills, with ability to present complex findings to technical and non-technical audiences.
• - Strong project management skills with the ability to manage multiple investigations simultaneously.
• - Experience using case management systems, e-discovery tools, and data analytics platforms.

Benefits

• - Comprehensive medical, dental, and vision coverage, plus telehealth services and a confidential Employee Assistance Program.
• - Paid time off starting at 3.5 weeks annually, increasing with tenure, plus 11 paid holidays.
• - 401(k) retirement plan with an employer match of up to 4% of eligible compensation after six months of employment.
• - Company-paid basic life, accidental death and dismemberment, and short- and long-term disability insurance.
• - Professional development and tuition reimbursement programs, each offering up to $1,500 annually for eligible employees after six months of service, subject to approval.

Attain Talent is committed to fair and equitable compensation practices. The individual base salary for this position is unique to each candidate and will be commensurate with experience, education, and skills.

Salary Range$90,000-$110,000 USD

Attain Talent is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.

Applicants have rights under Federal Employment Laws. For more Information visitEEO,EEO Poster Supplement,Family and Medical Leave Act (FMLA), andEmployee Polygraph Protection Act (EPPA).

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.