Sr. Investigator (Full-time, Remote)

Integrity Management Services, Inc.; United States; Remote; USD 45,000 - 65,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

401(k) retirement plan

Paid holidays

Job summary

Integrity Management Services, Inc. is seeking a Senior Investigator to conduct investigations supporting healthcare program integrity initiatives, identifying fraud, waste, and abuse, and developing findings with recommended actions.

Role involves independent and collaborative work with investigators, analysts, SMEs, and leadership. Responsibilities include data analysis, interview processes, documentation of findings, and coordination with legal counsel and government stakeholders.

Qualifications

• Bachelor's degree in criminal justice, law enforcement, healthcare administration, data analysis, or related field, or equivalent experience.
• 2+ years in healthcare program integrity or related government healthcare investigations.
• Fraud, waste, and abuse investigations experience preferred.
• Strong investigative, analytical, and problem-solving skills.
• Experience reviewing healthcare claims and complex documentation.

Responsibilities

• Conduct background research to identify information about individuals, organizations, or entities under review.
• Conduct investigations involving potential fraud, waste, and abuse.
• Analyze healthcare and operational data to identify trends, anomalies, and indicators of fraud.
• Review applicable laws, regulations, policies, and guidance to support investigative activities.
• Collect, review, and analyze records relevant to investigations.
• Conduct interviews and maintain accountability for evidentiary materials.
• Document findings and prepare clear, well-supported reports and recommendations.
• Coordinate with internal staff, legal counsel, government stakeholders, and law enforcement as appropriate.
• Collaborate with investigators and subject matter experts to develop investigative strategies and resolve cases.
• Enter and maintain investigative information in case management systems.
• Present findings and recommendations to management and clients.
• Identify emerging fraud schemes and prioritize investigative work.
• Prepare recurring and ad hoc reports on activities and case status.
• Meet established quality standards and deadlines.

Skills

Investigative skills

Analytical skills

Communication skills

CFE/AHFI preferred

Education

Bachelor's degree

Tools

MS Office

Excel

Job description

About Us

http://www.integritym.com

Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review.

At IntegrityM, we offer a culture of opportunity, recognition, collaboration, and supporting our community. We thrive off of these fundamental elements that make IntegrityM a great place to work. Our small, flexible workplace offers an exceptional quality of life and promotes corporate-driven sustainability. We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees' professional development. Large company perks...Small company feel!

Description

We are seeking a Senior Investigator to join our team. In this role, the Senior Investigator will conduct investigations that support healthcare program integrity initiatives by identifying potential fraud, waste, and abuse (FWA), analyzing complex information, and developing investigative findings. The Senior Investigator will use a variety of investigative techniques and analytical tools to identify subjects, develop cases, document findings, and recommend appropriate administrative or enforcement actions. This position works both independently and collaboratively with investigators, analysts, subject matter experts, and program leadership.

Responsibilities

• Conduct background research to identify relevant information regarding individuals, organizations, or entities under review.


• Conduct investigations involving 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.


• Assist with identifying emerging fraud schemes and recommending new investigative priorities.


• Prepare recurring and ad hoc reports regarding investigative activities and case status.


• Meet established quality standards and project deadlines.

Qualifications

• Bachelor's degree in criminal justice, law enforcement, healthcare administration, data analysis, or a related field, or 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.


• Experience conducting fraud, waste, and abuse investigations preferred.


• 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.


• Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) preferred (or may be required based on contract requirements).


• Ability to maintain confidentiality and exercise sound judgment.


• Ability to work independently and collaboratively within a team environment.


• Strong organizational skills with the 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.

This position is eligible for the benefits applicable to full-time regular employees, such as: vacation, sick leave, paid holidays, health insurance, dental insurance, vision insurance, short- and long-term disability, life insurance, employee assistance plan, 401(K) retirement plan, and educational benefits.

U.S. remote annual salary range: $45,000-$65,000/annual

For candidates in jurisdictions requiring range disclosure, this is the good-faith range for this role; final pay may vary by work location and job-related factors such as skills, experience, location, and internal equity. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.

IntegrityM is an Equal Opportunity Employer and we do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, and gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.