Supervisor - Audit/Investigation

Jobgether SRL; United States; On-site; USD 90,000 - 130,000; Full time

Job summary

Jobgether is seeking a Supervisor - Audit/Investigation in the United States to lead audit and investigation activities addressing Medicare/Medicaid fraud, waste, and abuse. You will oversee case assignments, investigation strategies, workload, quality, and referrals while guiding auditors and investigators.

The role blends hands-on investigative work with team leadership, stakeholder coordination, and regulatory engagement, collaborating with data, medical review, program integrity, regulatory,

Qualifications

• Bachelor’s degree required; relevant professional experience may count.
• 5–7 years of relevant healthcare audits/investigations experience; 8–11 preferred.
• Strong understanding of Medicare/Medicaid processes and program integrity.
• Experience supervising auditors or investigators.
• Certified Fraud Examiner (CFE) or AHFI preferred.

Responsibilities

• Review audits and assign cases based on workload and priorities.
• Oversee provider vetting with government agencies and law enforcement.
• Review plans, documentation, and case-tracking for quality.
• Supervise interviews, on-site audits, and site verifications.
• Lead complex projects with strategy development and stakeholder meetings.
• Collaborate with Data and Medical Review teams.
• Prepare and present audits and investigations at meetings.
• Maintain communications with law enforcement and regulators.
• Manage case closing, QA, and documentation.
• Provide testimony when required.
• Manage team performance and development.
• Work independently with escalation when needed.

Skills

Leadership

Analytical skills

Communication skills

Regulatory collaboration

Education

Bachelor’s degree

Job description

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Supervisor - Audit/Investigation based in United States.

Lead audit and investigation activities focused on identifying and addressing potential Medicare and Medicaid fraud, waste, abuse, and compliance issues.

You will oversee case assignments, investigation strategies, workload, quality, and referral decisions while guiding a team of auditors and investigators.

The role combines hands‑on investigative work with team leadership, stakeholder coordination, and regulatory engagement.

You will collaborate with data, medical review, program integrity, regulatory, and law enforcement partners to advance complex cases.

The position requires strong judgment when evaluating findings, determining appropriate courses of action, and preparing matters for administrative or legal proceedings.

You will also contribute to major case coordination, quality assurance, reporting, and the development of team capabilities.

This is an opportunity to make a meaningful impact on the integrity, efficiency, and accountability of healthcare programs.

Accountabilities

• Review new audits, investigations, and incoming leads to determine appropriateness, assign cases, and establish priorities based on workload and program requirements.
• Oversee provider vetting activities with appropriate government agencies and law enforcement partners.
• Review audit and investigation plans, priorities, documentation, and case‑tracking records to ensure quality, completeness, and alignment with established criteria.
• Conduct regular file reviews and evaluate requests for information, data, reports, and correspondence prepared by auditors and investigators.
• Supervise and participate in investigative activities, including interviews, onsite audits or investigations, and site verification when required.
• Lead complex audit and investigation projects by developing strategies, coordinating stakeholder meetings, reviewing investigative actions, and documenting findings for management.
• Collaborate with Data and Medical Review teams to support efficient and effective audits and investigations.
• Prepare and present audits, investigations, overpayments, and related questions during stakeholder and case coordination meetings.
• Review investigative findings with team members, determine appropriate courses of action, and approve case decisions within established guidelines.
• Prepare and review cases for Major Case Coordination meetings and ensure investigative work meets quality assurance standards.
• Maintain communications with law enforcement and regulatory agencies and present or support the presentation of findings for potential further investigation, prosecution, or administrative action.
• Supervise and review administrative remedies such as payment suspensions, provider revocations, and provider education activities.
• Review and approve audit and investigation closing summaries and ensure cases are properly documented and resolved.
• Collect and submit information and documentation requested by internal and external stakeholders, including CMS, law enforcement, and FOIA requests.
• Collaborate with other program integrity contractors when required and provide testimony at legal or administrative proceedings as necessary.
• Manage team performance through regular feedback, formal performance reviews, coaching, engagement, motivation, and professional development.
• Work independently while escalating significant questions, issues, and cases when appropriate.

Requirements

• Bachelor’s degree required, with relevant professional experience potentially considered as a substitute where applicable.
• 5–7 years of relevant experience required, with 8–11 years preferred.
• Experience in healthcare audits, investigations, program integrity, fraud, waste and abuse, compliance, or related areas.
• Strong understanding of Medicare and/or Medicaid processes, healthcare program integrity, investigative practices, and applicable administrative or regulatory requirements.
• Demonstrated ability to evaluate complex cases, identify potential fraud, waste, abuse, or compliance issues, and determine appropriate next steps based on established criteria.
• Experience supervising auditors, investigators, or similar professional teams and managing workload, priorities, quality, and performance.
• Strong investigative judgment and analytical skills, with the ability to assess documentation, evidence, findings, and case strategies.
• Excellent written and verbal communication skills, including the ability to prepare reports, present findings, communicate with stakeholders, and support legal or administrative proceedings.
• Ability to collaborate effectively with government agencies, law enforcement, healthcare stakeholders, data teams, medical reviewers, and other program integrity partners.
• Strong organizational skills and attention to detail, particularly when managing multiple complex investigations and maintaining accurate case documentation.
• Ability to work independently, exercise sound judgment, and elevate issues appropriately.
• Certified Fraud Examiner (CFE) or Accredited Healthcare Anti-Fraud Investigator (AHFI) certification is preferred.

Benefits

• Competitive compensation based on qualifications and experience.
• Opportunity to contribute to healthcare program integrity and efforts addressing fraud, waste, abuse, and compliance.
• Professional environment focused on quality, accountability, and meaningful public-sector and healthcare outcomes.
• Opportunities to collaborate with regulatory agencies, law enforcement, healthcare organizations, and program integrity professionals.
• Team leadership and professional development opportunities.
• Supportive environment emphasizing engagement, performance, and continuous team development.

How Jobgether Works

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Why Apply Through Jobgether?

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.