Part D Sr Investigator

RELI Group, Inc.; United States; On-site; USD 90,000 - 110,000; Full time

Job summary

RELI Group, Inc. is recruiting a Part D Sr Investigator to support integrity and effectiveness of federal healthcare programs through investigations, compliance oversight, and risk assessment.

The role reviews pharmacies, dispensers, and manufacturers; develops investigative strategies and compliance processes; analyzes data and evidence; and produces actionable findings. Collaboration with CMS and OIG is expected.

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 pricing and compliance.
• Excellent written and verbal communication.
• Strong project management skills.
• Experience using case management systems, e-discovery tools, and data analytics platforms.

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.

Skills

Medicare Part D knowledge

Data analysis

Investigative skills

Regulatory compliance

Communication/writing

Project management

E-discovery tools

Data analytics platforms

Education

Bachelor's degree + 5 years experience

Associates degree + 8 years experience

High school diploma + 9 years experience

Tools

Case management systems

Data analytics platforms

Job description

About Us:

At RELI Group, our work is grounded in purpose. We partner with government agencies to solve complex challenges, improve public health, strengthen national security, and make government services more effective and efficient. Our team of over 500 professionals brings deep expertise and a shared commitment to delivering meaningful outcomes. Behind every solution is a group of experts who care deeply about impact-whether we're supporting data-driven decisions, modernizing systems or safeguarding critical programs.

The Part D Sr Investigator will 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.

EEO Employer

RELI Group is an Equal Employment Opportunity / Affimiative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

HUBZone

We encourage all candidates who live in a HUBZone to apply. You can check to see if your address is located in a HUBZone by accessing the SBA HUBZone Map.

The annual salary range for this position is $90,000 to $110,000. Actual compensation will depend on a range of factors, including but not limited to the individual's skills, experience, qualifications, certifications, location, other business and organizational needs, and applicable employment laws. The estimate displayed represents the typical salary range for this position and is just one component of the total compensation package for employees. RELI Group provides a variety of additional benefits to its employees. For additional details on the benefits that RELI Group offers click here